ABSTRACT
As rapid and apparently consensual as the enactment of law 180 had been, any false impressions about a new consensus emerging on mental health policy were quickly shattered. In fact the passage of the law was succeeded by a period of sharp and increasingly bitter conflict between proponents of the law and a newly organized and vocal bloc of critics. What was at issue were not only the real effects of the law, but what were essentially opposing philosophies of care which suggested quite different standards for or judging mental health policy in general. Those who tended to see psychiatry in ‘political’ terms remained relatively favourable avourable to the purposes of the law. Their principal aim had been to reverse the exclusion of the mentally ill, and hence the social reintegration of ex-patients was in that sense a higher priority than medical care per se. Critics of the law, on the other hand, tended to stress the predictable shortfalls of care, which they attributed directly to limitations in the legislation: the law interrupted hospital care, but the new alternative services envisioned by the law were slow to develop and patchy, and the quality of care they delivered uncertain; moreover the predicament of long-stay and chronic patients seemed to be greatly exacerbated by the anti-institutional provisions of the law. The radicals’ response to such criticisms was to argue that the lack of alternative services was a direct consequence of their opponents’ refusal to implement the law, or worse, the result of a deliberate attempt to sabotage
[M]erely changing the law is no magic formula for altering the practice of psychiatrists, the attitudes of the population, or the concerned involvement of politicians and administrators, especially if a comprehensive program is lacking.
