Jelly Kuiters, Groningen, The Netherlands
As a trainee in psychiatry I knew about the EFPT Exchange Programme and decided to apply for the position in Italy because I was already quite familiar with the country, its culture and language. The experience in Trieste proved to be very rewarding to broaden my perspectives on psychiatry and to get to know the city and region.
Trieste has a unique identity due to its history and the geographical location on what is now the border between Italy and Slovenia. It is a pleasant place to stay for its location at the sea (although in winter it can be cold), its size of around 200.000 inhabitants and its compact city centre with restaurants, bars and gelaterie. Although it was possible to find housing through the university, I preferred to stay in the city centre and on the internet I found a room in a house with 3 wonderful flat mates.
In the field of psychiatry Trieste is known as the place from which psychiatrist Franco Basaglia and his team initiated the deinstitutionalisation. This can be understood as a process that took place from the 1970s on, from the radical closure of the asylum to the gradual development of a different mental health care system. From a philosophical point of view this was a paradigm change, where the asylum now stands for abuse of power and social exclusion, leading to a vision on mental ilness and health care that is the point of reference in the current work.
From the moment I applied for the exchange I was in touch with the local coordinator, who was very helpful in practical issues and answering any questions I might have. Together we decided that my ‘base’ would be one of the four Community Mental Health Centres of Trieste, “La Maddalena”. As the other centres, it serves a catchment area of roughly a quarter of the territory of Trieste. It is open 24 hours every day and offers all modalities of care, such as out-patient care (medication, brief psychotherapy, group therapy), consultations in the home, nursing home or hospital, and 24-hour hospitality, for which 8 beds are available. On most days I followed a resident or psychiatrist in a morning or afternoon shift, which always started with a meeting of the multidisciplinary team, consisting of residents and psychiatrists, nurses, psychologists, social workers and work rehabilitators.
The centre of La Maddalena looks welcoming and more like a crisp and modern community centre than a mental health centre as I know it: the architecture shows the values of being community based, accessible, open-door and without restraint. The main aim is to create therapeutic bonds with people with mental disorders. Throughout the work there is a strong sense of the need to progressively getting to know this particular person in his social context and needs. There are no waiting lists, so there is a quick response to resolve the (initial) crisis. While in the Netherlands a team is usually working in a certain modality (like in- or out-patient care) and programme following a national guideline (e.g. mood disorders or psychotic disorders), there is no such division in Trieste: rather, a team member will follow the patients they know. The patients are called ‘users’ of the centre and in team meetings their diagnosis’ or medication are hardly mentioned, while the language focuses on social factors like family, housing or work. These are also the target of active interventions, such as occupational rehabilitation and social activities to improve the integration in society.
I would certainly recommend this exchange to other colleagues. You will profit more, the better your Italian is (mine was B2 on the CEFR scale and to me this seemed a minimum level to feel comfortable, considering the strong influence of the local dialect). The duration of one month was good, although this was still a brief time to comprehend the Trieste system. Due to the summer break I could not attend any educational activities for trainees, but fortunately I met with local colleagues several times after work for a drink or dinner. I felt very welcome and it was interesting to discover some differences in our residency programmes and ways of working. The exchange with colleagues from a different background created a new understanding of the psychiatry in my home country and the differences made me reflect about the aspects I value in my work.