Gender, Profession, and Psychiatry: Italian and American Social Workers' Role in Democratising Mental Health Care

Although significant scholarship compares deinstitutionalisation in Italy and the United States (Ramon, 1989; Scheper-Hughes & Lovell, 1986), few examine it from the perspective of the social work profession. The shift from asylums, originally conceived as therapeutic retreats, to carceral institutions by the mid-20th century triggered global movements demanding reform. In the USA, the National Mental Health Act of 1946 catalysed a demand for more mental health services, prompting service investment in social workers to address this growing need. However, it was not until the passage of The Community Mental Health Act of 1963, which incentivised community-based services, that dehospitalisation evolved into full-scale deinstitutionalisation. In contrast, Italy’s approach was more abrupt and legally enforced through Law No. 180, passed in 1978 and known as the “Basaglia Law” after the influential psychiatrist Franco Basaglia’s Psichiatria Democratica (Basaglia & Tranchina,1979). This law mandated the closure of psychiatric hospitals, transferring the provision of mental health services to communities, managed by local governments. In both Italy and the USA, social workers emerged as critical agents in the integration of social and psychiatric interventions at the community level.

These legislative acts, deeply embedded within broader civil rights movements, provided social workers with opportunities to redefine the profession as emancipatory agents of democratic practices. But, did they succeed? Exploring archival evidence, we show how, despite distinct sociopolitical differences, the responses of social workers to deinstitutionalisation in both countries shared several notable similarities. There was a rapid and substantial increase in the female workforce within the profession, an expansion of university education for social workers, and the legal protection of the social work title -- all of which contributed to the professional legitimisation of social work. During this period, psychiatry experienced a resurgence of biomedical models of mental illness, which were formally incorporated into social work training programs. This expanded social work’s autonomy and bolstered its credibility. However, oral testimonies from Italian and American social workers who practiced in psychiatric settings during the 20th century, alongside institutional records, revealed the hidden costs of this progress.

Social workers in both countries found themselves battling for representation in the development of services, as they advocated for their patients. Although political responses to deinstitutionalisation movements materially addressed feminist critiques by offering more women wages for historically unpaid caregiving, the increased participation of women in the privatisation of social reproduction legitimised neoliberalism. Furthermore, many social workers found themselves in subordinate roles within male-dominated psychiatric models, rather than as leaders in the movement toward democratic, community-based care.

By adopting a comparative approach, we unpack the factors associated with achieving independence and authority as women and as social workers in the field of psychiatry following deinstitutionalisation. These lessons will mobilise social work to internalise Basaglia’s vision and turn social work itself into a “critical practice of freedom ... that would help resituate the marginal, the excluded, the scapegoated and help them reclaim their buried history” (Scheper-Hughes & Lovell, 1986). Italian and American social workers translated Mary Richmond’s spiritual convictions of their hearts into practice.