Responsibility and Bureaucracy in Italian Psychiatry: Navigating the Tensions of Re-institutionalization, Medicalization and Care

Abstract (English)

Over the last three decades, the Italian healthcare system has experienced significant transformations, including medicalization and managerialization (Vicarelli, Pavolini 2017), which have profoundly impacted both professionals and patients. In this context, Italian mental health care suffers from a steady decline in public attention and investment (Starace 2023) and is witnessing a return to custodial practices - a phenomenon also known as 're-istitutionalization' (Fakhoury, Priebe 2007). Additionally, increasing bureaucratization is imposing a progressive standardization and formalization of care practices that contradicts the empathy and care required to respond to mental health issues appropriately, leaving professionals conflicted.

In this scenario, the ethics of medical practice—particularly significant in psychiatry, where it was addressed and shaped throughout the long process that led to the closure of mental asylums in the 20th century (Foot 2023)— is being narrowed down to the legal aspect of responsibility. Fostering a culture of indifference (Herzfeld 2021), bureaucracy has weakened the alignment among professionals, patients, families and other stakeholders in the mental health field, leaving many feeling isolated and anxious about managing the subject of responsibility.

Drawing on ongoing PhD research at an Italian public Mental Health Center, this paper reflects on the role of responsibility in psychiatry: what are healthcare workers responsible for? What are patients responsible for? Is there a connection between practitioners' representations of responsibility and the ongoing processes of bureaucratization and re-institutionalization?

The first findings of the research will be shared and analyzed through the lenses of the anthropology of responsability (Faubion 2011; Laidlaw 2013; Fassin 2015; Lambek 2015) and the anthropology of organizations (Wright
1994; Caulkins & Jordan 2013; Herzfeld 2021).