Community-based mental health care in Britain and Italy : geographical perspectives.

This thesis examines the implementation of mental health reforms in Britain and Italy since the 1950s from a geographical perspective. Both countries have experienced the policies of deinstitutionalisation and community care, yet the timing, methods and outcomes of implementation have varied considerably, both between the countries and within them. This situation suggests that underlying social, political, economic and cultural differences have been important influences on the implementation of the respective mental health reforms, and this is a theme that is considered throughout the thesis. The research was conducted at three levels of enquiry: firstly by comparing the implementation of mental health reforms at the national scale in Britain and Italy, looking in particular at the influence of politics and place; secondly by focusing upon the implementation of the reforms in two cities, for which Sheffield and Verona were selected; thirdly a case study approach was adopted in order to study in greater detail one community-based mental health service in each city. It was at this level of enquiry that the more intensive research was carried out, in the form of two local resident questionnaire surveys, one in each city, and semi-structured interviews with mental health professionals from the two case study services. This research illustrates that the implementation of mental health reforms in Britain and Italy has led to a geographical unevenness in the distribution of community-based services at all spatial scales. However, the social, cultural and political contexts in which the reforms have occurred in the two countries have been quite different and therefore when contemplating direct comparisons between mental health reforms in Britain and Italy, the argument that 'place matters' is highly pertinent.