Social enterprises, vocational rehabilitation, supported employment: working on work in Italy

Since Basaglia's pioneering work in the 1960s, programs geared to employment have been considered hallmarks of good practice in Italian community psychiatry. These programs mostly include "train and place" schemes: sheltered workshops, training placements and temporary grants with public/private employers, and social enterprises (cooperatives). Law 68/1982 on disability and work demanded a "quota of workplaces" to be reserved for citizens with disability by public and private employers, but application to the psychiatric field proved problematic. Despite large investments, outcomes in terms of competitive employment have decreased over the decades, and now, less than 10% of all attenders of these programs attain the open labor market. More recently, some "place and support" programs have been tried with promising results. Individual Placement and Support is practiced in one third of mental health centers in the Emilia-Romagna Region and in pilot programs in three more regions. It is difficult to forecast how the rapid changes brought by the current financial crisis will impact on Italy, but very likely, supported employment programs will find more space in Italian mental health services.