Lessons from Italy - 48 years of mental health care through housing rather than institutions

For people living with chronic mental illness, the solution is often framed around treatment. But just as important is where that care happens, and what surrounds it.

For nearly fifty years, mental health care in Italy has been delivered through a system centred on community, housing and local services, rather than long-term institutional settings. This shift was set in motion in 1978 through the introduction of Law 180, a reform that encouraged support in environments that reflect everyday life, with care integrated into those settings rather than separated from them. 

Over time, this has led to a network of supported residential options, outpatient services and small psychiatric units within general hospitals. Law 180 also prevented new admissions to traditional mental hospitals and led to their gradual closure, meaning Italy now operates without institutional psychiatric facilities. Instead, care is delivered through community-based settings, with residential facilities providing around 46 beds per 100,000 people, higher than many comparable countries. 

The outcomes from this approach are strong. Compulsory admissions have reduced significantly, falling from more than 20,000 per year in 1978 to fewer than 9,000 in 2015, and now account for less than 5% of all psychiatric admissions. Over the same period, suicide rates have remained broadly stable, moving from 7.1 per 100,000 people in 1978 to 6.3 in 2012, despite the near elimination of long-stay psychiatric hospital beds. While no system is without its challenges, these results suggest that care grounded in community and supported living can provide a strong and sustainable foundation.

The role of housing stands out. A stable home creates the conditions for care to be consistent, relationships to form, and recovery to be supported over the long term. It allows people to remain connected to their surroundings, rather than stepping away from them.

Italy’s experience shows that when care is built around people and place rather than institutions, it can deliver consistent outcomes while supporting dignity and independence. This is closely aligned with the work of Habilis here in Australia, where we’re creating permanent, supported housing for people living with chronic mental health conditions.

There are lessons in the challenges as well. Variability in services, workforce constraints and the way some residential settings are used over time all point to the need for continued investment and thoughtful design.

When people have a home, and care that meets them there, the foundation for better outcomes is stronger. Italy has shown what that can look like at scale, and Habilis is proving what it can become here.

Reference:

Barbui, C., Papola, D., & Saraceno, B. (2018). Forty years without mental hospitals in Italy. International Journal of Mental Health Systems, 12:43. https://doi.org/10.1186/s13033-018-0223-1