Basaglia's psychiatric reform: A bridge between Italy and Latin America

More than 40 years after the approval of Law 180, Italy remains the only country to have entirely replaced psychiatric hospitals with a comprehensive, community-based mental health system. Driven by the vision of Franco Basaglia, this transformative reform moved psychiatric care away from institutionalization toward a model rooted in human rights, autonomy, and social inclusion. Although pioneering, the implementation was uneven, constrained by limited financial and human resources, and initially hindered by the absence of systems to evaluate care outcomes. Recent nationwide studies have revealed significant shortcomings in continuity of care, limited access to psychosocial interventions, and variability in treatment quality for conditions including personality, bipolar, depressive, and psychotic disorders. Internationally, the Italian model has significantly influenced mental health reforms in Latin America. In Brazil, the development of the Centros de Atenção Psicossocial reflected Basaglia's principles but is now challenged by service overload and a lack of inpatient alternatives. Paraguay has recently adopted progressive legislation promoting community care and deinstitutionalization, while Peru has implemented legal frameworks to integrate mental health into the general health system, although progress remains gradual. These diverse experiences underscore the Italian reform's global relevance and the complexities of translating its principles into practice.