Mental health services in Ireland, like many parts of the world, are often criticised for beingoverly medicalised, underfunded, and detached from the communities they aim to serve. Despite significant investments and policy developments, many individuals experiencing mental health difficulties continue to face systemic barriers to holistic, person-centred care. Against this backdrop, the Trieste model—a pioneering approach to mental health care originating from Italy—offers a compelling alternative. But one must ask: if it works so effectively in Trieste, why has Ireland not adopted a similar framework?
Understanding the Trieste Model
The Trieste model, developed in the 1970s under the leadership of psychiatrist Franco Basaglia, revolutionised mental health care by rejecting the traditional asylum-based system in favour of community-centred support. Basaglia’s philosophy was rooted in human rights, dignity, and the belief that people experiencing mental distress should not be institutionalised or stigmatised but instead supported to live full, autonomous lives within their communities.
Key features of the Trieste model include:
● No Closed Psychiatric Hospitals: Traditional psychiatric hospitals were dismantled, replaced with open-door community mental health centres (CMHCs) operating 24/7.
● Community Integration: Care is delivered in non-clinical environments, such as community centres, workplaces, and homes, reducing stigma and fostering inclusion.
● Holistic Support: The model focuses not just on medical treatment but also on housing, employment, nutrition, social connections, and personal aspirations. Importantly, the role of nutrition in mental health—an often overlooked aspect—is integral to this holistic approach. Emerging research highlights how diet affects mood, cognitive function, and overall mental well-being, yet this remains an area many individuals are uninformed about.
● Collaborative Care: Service users are active participants in their care plans, with a strong emphasis on dialogue and co-production. Trieste’s approach has been globally lauded, influencing mental health reforms in several countries. Its success is evident in low rates of compulsory treatment, reduced hospital admissions, and high levels of user satisfaction and community integration.
The Irish Context: Where Do We Stand?
Ireland’s mental health policy landscape has evolved over the decades, with A Vision for Change (2006) and the more recent Sharing the Vision (2020) outlining ambitions for a recovery- oriented, community-based system. Yet, a substantial gap persists between policy and practice. Despite commitments to deinstitutionalisation, Ireland still relies heavily on inpatient care, with many individuals experiencing lengthy hospital stays, often in under-resourced and outdated facilities.
Additionally, significant regional disparities exist. Access to community mental health services varies depending on location, with rural areas, including Donegal, facing pronounced service shortages. Waiting lists for psychological therapies are often months long, and crisis services can be inconsistent or inaccessible, particularly outside of urban centres.
Critically, while recovery-oriented language has permeated Irish policy documents, the lived experience of service users frequently suggests a continued emphasis on biomedical interventions over holistic, person-centred care. The result? Individuals in distress often encounter fragmented services that address symptoms but neglect broader determinants of mental well-being, such as housing, meaningful occupation, nutrition, and social connection.
Why Not Trieste? Barriers and Misconceptions
Given the proven success of the Trieste model, the question arises: why hasn’t Ireland embraced a similar approach? Several factors may contribute to this resistance:
1. Institutional Inertia
Healthcare systems are complex, and large-scale reforms often encounter bureaucratic resistance. Established institutions and professional hierarchies can be slow to adopt radically different models, particularly when they challenge entrenched power dynamics.
2. Medicalisation and Risk Aversion
Irish mental health services remain heavily influenced by a medical model that prioritises diagnosis and medication. A Trieste-style approach, which emphasises social determinants of mental health, requires a paradigm shift that some clinicians and policymakers may find uncomfortable or risky.
3. Resource Allocation and Funding Priorities
While the Trieste model is cost-effective in the long run, it requires upfront investment in community infrastructure, staff training, and ongoing support services. In Ireland, funding is often directed towards crisis intervention and acute care, leaving preventative and community- based services underfunded.
4. Public Perception and Stigma
Despite progress in mental health awareness, stigma persists. Public and political support for community-based care can be undermined by misconceptions about safety and efficacy, particularly regarding non-coercive approaches to crisis management.
5. Legislative and Policy Frameworks
Trieste’s success is underpinned by Italy’s strong legal commitment to human rights in mental health care, exemplified by Law 180, which abolished psychiatric hospitals. While Ireland’s Mental Health Act (2001) has undergone review, it still falls short in fully safeguarding rights.
Reimagining Possibilities: How Ireland Could Adapt the Trieste Model
Adopting a Trieste-style approach in Ireland would require systemic reform, but it is far from impossible. Here are practical steps Ireland could consider:
1. Community Mental Health Hubs
Establish 24/7 community-based centres that provide integrated support for mental health, housing, employment, nutrition, and social connections. These centres should be non-clinical, welcoming spaces where individuals feel respected and valued.
2. Co-Produced Services
Service users and peer support workers should be at the heart of service design and delivery. Their lived experience provides invaluable insights into what works—and what doesn’t.
3. Investment in Holistic Supports
Mental health is not just about medication or therapy; it’s about having a place to live, a purpose, and people to connect with. Nutrition plays a pivotal role in mental well-being, yet it is often neglected in service provision. Funding must prioritise supported housing, vocational programmes, nutritional education, and community engagement initiatives.
4. Legislative Reform and Human Rights Frameworks
Modernising Ireland’s mental health laws to align with international human rights standards, particularly the UN Convention on the Rights of Persons with Disabilities (CRPD), is crucial. Rights-based legislation can drive cultural change and accountability.
5. Training and Cultural Change
Healthcare professionals need training in non-coercive crisis management, trauma-informed care, and community-oriented practices. Equally, education on the link between nutrition and mental health should be integrated into mental health services. Shifting the culture of mental health services requires leadership at all levels, from government to frontline staff.
A Call to Action
Mental health is not just a medical issue; it is a societal concern that demands collective responsibility. Ireland has an opportunity to reimagine its mental health services, moving beyond crisis-driven, medicalised care towards a compassionate, community-based model that truly supports recovery and inclusion. The Trieste model provides a roadmap—one rooted in dignity, respect, and humanity.
So why not Ireland? The question is not just rhetorical. It is a challenge to policymakers, service providers, and communities to confront the systemic barriers that prevent meaningful change. Mental health care should not be about managing symptoms in isolation; it should be about supporting people to live meaningful lives, connected to their communities and free from stigma and discrimination. This means acknowledging and addressing all facets of well- being—including the often-overlooked role of nutrition. The time for incremental change has passed. Ireland must be bold enough to embrace a new paradigm—one that places people, not just diagnoses, at the centre of care.
Hi Mark,
Do you know of any psychiatrists in Ireland who could help my daughter taper off Abilify…it has ruined her life.
Many thanks
Sandra Brady