In 1978 a revolutionary mental health act was passed in Italy. By
closing large mental hospitals and replacing them with community programs,
it required a radical shift in psychiatric practice. The authors discuss
the background philosophy, principles, and practical implications of this
change. They describe a model program and training design of a 4-year
residency in which psychiatrists learn the skills for community work while
actually working in the community. The residency differs from most U.S.
residencies in having trainees responsible for patients wherever they are
being treated (residents are not rotated between services), its strong team
orientation, and the value placed on community work.Abstract Teaser