Franco Basaglia was the acknowledged leader of a vast movement of psychiatrists, patients, administrators, students, politicians and others to reform the psychiatric system in Italy in the 1960s and 1970s. This movement transformed individual asylums in Italy and the treatment of patients, and led to the 1978 180 Law (also known as the ‘Basaglia Law’), which eventually closed down the psychiatric hospital system entirely (although this ‘closure’ remains controversial at a number of levels). The impact of the ‘Basaglian movement’ and the 180 law was vast across the world, but very different from country to country and even from city to city. This paper will trace the different forms of acceptance, rejection and non-interest in a number of countries, drawing on research that will (in part) be published in a book co-edited by myself and Professor Tom Burns, to be published by OUP in 2019. This impact or non-impact will also shed light on the varying outcomes of the Italian experience itself, and the debates within Italy over the Basaglian legacy which are ongoing today.

Histories of the German psychiatric reform usually identify the origin of this process with the so-called Psychiatrie-Enquete. The Enquete, published in 1975, consisted of a comprehensive report of the status quo and concrete recommendations for a structural reorganization of the West German psychiatric care system: community orientation; patient-centred care; coordination of all service institutions and providers; equal treatment and opportunities for the mentally and physically ill. The scholarship seems unanimous in highlighting the importance of some contemporaneous international developments as an intellectual and institutional blueprint for the German reform, especially the Italian initiative led by Franco Basaglia. Some points of the 1975 reform program, however, had already been actualised in the 1960s, most notably some elements of community care. For example, the considered fruitful relationship between psychiatry and anthropology was to be tested on the grounds of community care. This paper considers two of these early instances, later taken as models: the Zentralinstitut für seelische Gesundheit (Central Institute for Mental Health) in Mannheim and the community psychiatry set in place in Mönchengladbach (NRW). The focus will be on their epistemological setting and their concrete solutions, such as day- and night-clinics, sheltered housings and patient clubs. Finally, we will discuss how far at the time and at the direct aftermath of the Enquete the international developments were mobilised as models for the national reform, or if the Germans tired of affirming their own tradition. This paper as been written by Chantal Marazia and Heiner Fangeru, Heinrich Heine Universität Düsseldorf

Inspired mainly by the example of Italian ‘Democratic psychiatry’, around the mid-nineteen eighties, the policies of both Dutch government and the field of mental health care turned towards the aim of deinstitutionalization. Official governmental directives included the gradual dismantling of some of the larger mental hospitals, the increase of the number of sheltered homes, and the introduction of e.g. assertive community treatment and rehabilitation. These contributed to a shift towards community psychiatry during the nineties. Nevertheless, at the beginning of the 21st century, the Netherlands figured amongst the European countries with the highest number of institutional beds. The reasons for the ‘lagging behind’ or the different pathway of Dutch mental health care are still a matter of discussion and a subject for historical research. Some possible causes can already be hypothesized. Around 1970 Dutch institutional mental health consisted of medium-sized psychiatric hospitals with comparatively high standards of care. Starting during the 1920s, the Netherlands had a pioneering role in the development of a nationwide system of community psychiatry, which probably resulted in a situation in which the pioneer is lagging behind once all the others followed. Furthermore, parallel and interfering developments in society and government policies during the last decades of the 20th century – e.g. the demise of the welfare state and the liberalization of health insurance – had a negative effect on the reorganization of mental health care. In this paper the development of deinstitutionalization in the Netherlands will be analyzed against the background of the international historiography on this subject, aiming both at the distinction of different (national) models and phases in the history of the transfer of psychiatric care to the community.

After conducting path-breaking experiments on introducing token economies in mental hospitals, Australian psychologist Robin Winkler spent a sabbatical in the United States (1970-1971). There, he became acquainted with anti-psychiatry and initiatives in community mental health. After returning to Australia, he repeated David Rosenhan’s famous experiment On Being Sane in Insane Places. After two (mentally healthy) psychology students were admitted to a mental hospital, they behaved normally and made observations about the care provided (which left much to be desired). He also conducted a pseudo-patient experiment with general practitioners; students visited them and presented symptoms of depression. In general, discussions between physicians and pseudo-patients were short, no referrals were organised, and all received prescriptions. Winkler conducted these experiments for two reasons. First, he thought that they provided unique insights into the nature of mental hospitals and general practice (he recommended that they were repeated every few years). Second, these experiments were part of a broader critique on the place of medicine in modern society. Winkler was part of a small group of radical psychologists that criticized psychiatry and medicine during the 1970s and 1980s to realize change.