Roberto Mezzina

Roberto Mezzina, Open Doors, Open Dialogues

In the ever-changing world of mental health, service providers are often working in an old system that does not honor the person receiving support. In turn, we providers take matters into our own hands and create programs to improve recovery for those we are serving. Roberto Mezzina of Trieste Mental Health is doing just that.

Since the 1980s the city of Trieste, Italy has closed its psychiatric hospitals and created an incredible network of community mental health centers open 24/7 and designed around the whole person. They have proven it is possible to eliminate traditional mental health hospitals with warm, community-based, voluntary care, creating open doors and open dialogues.

“These centers support persons with mental illness in their daily life with the goal of community reintegration and recovery,” says Roberto.

In addition to receiving support for a person’s life challenges, Roberto’s team provides the opportunity to further move their journey into a life of recovery through supervised living systems, e.g. supported accommodations, small group homes, and day centers managed by real people with real recovery through associations and social coops.

Currently the services in Trieste are supporting a population of 240,000. The program continues to be a role model for what the Italian Mental Health Act of 1978 sought to do more than 40 years ago. Transform psychiatric and mental health care for the better and allowing people receiving services to maintain their civil and human rights, despite having challenges in their journey.

Even with Trieste changing the way it approaches and provides mental health services, Roberto and his team have continued to elevate the conversation of involving the community it serves. Their system has recently created the figure of a paid peer support worker, which before would have been a volunteer position or unheard of altogether.

“We provide people with lived experience a chance to attend a several month course and then use these services to employ our own graduates.”

This training includes “extensive practical training” within the cooperative’s community dwellings, recovery houses, the public community mental health centers as well as instruction by others with lived experience. In their first graduating class of 14 people, 10 have moved to become workers in the community-based mental health system. A second course has been completed this year.

“[Peer workers] are the protagonist of contributing change to our system,” Roberto says. Peers keep the person seeking services as the central focus while they are learning and seeking recovery, instead of merely their diagnosis. The programs believe keeping persons with lived experience in the forefront promotes being open minded about recovery and how it presents in the community.

Roberto has looked at other countries with an employed peer workforce, including the United States, and recognizes that it is possible. Trieste cooperatives are working toward consolidation of the gained knowledge and developing an even bigger name for the peer workforce and community-based mental health.

“We are seen as an example of public service rooted and based in the community. People are noticing this when they visit and learning that the word ‘recovery’ is important and supportive to a person’s healing.”

Roberto has been the director in Trieste for six years and is looking to retire this year. He says he intends on continuing the collaboration with the community. “I want to make sure the mission of creating community services stays person-centered, recovery-oriented and open-minded.”

Author Kristen Ellis, LMFT
Kristen has worked in the mental health field for more than 5 years, with a focus on crisis work, substance use services, and bringing a voice to lived experience. Her ambition is to change the way mental health care and recovery is seen and achieved, so to redefine what it means to defeat adversity.