Allen Frances, MD: Save Trieste’s Mental Health System


From The Lancet: “For people who have never seen the Trieste model in action, it might sound too good to be true. How can any mental health system help patients with severe and chronic conditions with so few hospitalisations and so little involuntary treatment? I was once among the profound sceptics. But immersion during five visits convinced me that Trieste is the best place in the world to be a patient with a mental disorder‚ÄĒwhereas visits to patients in prisons and on the streets of the USA convinced me that the USA is among the worst. It is startling how well patients do when they are treated well in Trieste; how much sicker they become when neglected in the USA.

Trieste’s approach is based on four principles: patients are citizens deserving dignity and respect; there is great therapeutic value in including them in the city’s daily activities; work with the community creates an inclusive social fabric that welcomes patients; and patients function best when we preserve their freedom and play to their strengths.

Trieste promotes mental health with its strong emphasis on interpersonal relations, family involvement, improved living conditions, and opportunities to work and play. Involuntary treatment, seclusion, and closed doors are eliminated in a system that is markedly caring and inviting. Neglect in the USA allows acute symptoms to become chronic, allows worse symptoms to emerge, and promotes demoralisation.”

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  1. For sure Trieste is a more rational and humane manner of approach, but it is not something Francis could operate, not with his mindset.

    You have to be healed from cult based thinking, practice, in order to make change. You cannot copy what worked for the guy that made the change.
    That change came about from a profound belief, from the very being of that person. You can train others in the way you train a dog, but the passion, compassion, the sincere beliefs are just not there. They can be understood, but understanding is not enough to make those vital connections to other humans.

    I find ALL of medicine has gone to complete authority in doctors hands. There is absolutely not “shared decision making”.

    It is absurd that two professionals discuss you without you being part of that conversation. It is your body, it is alive. And as long as it is alive, others have zero business in excluding you from what affects you.

    We pay people to talk about us to others.

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    • I know exactly the “feeling”—these two alleged professionals speaking about you as if your were not there, but making decisions about you, based mainly that to them, you are are no longer an individual person; a human being; but, an object, an experiment, something material like a car or a piece of furniture. Yes, this has happened and by not just psychiatrists, psychologists, etc. And here is something worse, but related. They write a “report” about you. They base it on evidence from some sort of testing or something else. It is derogatory and defamatory. They treat as fact and that it can not be questioned. They read it to you. I am not sure what they expect. But, after the end of this reading, you feel like a nobody, a nothing. I have had this done to me by psychologists, psychiatrists, and M.D.s in several specialties. It is dehumanizing. Thank you.

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