The overall number of acute beds per 10,000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable.

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ObjectiveTo describe: a) a self-report questionnaire of 34 item, developed by a Family Association of Psychiatric Patients in collaboration with two psychiatrists to evaluate by key-relative in a clinical practice the perceived quality of mental health services, the needs and family burden; b) the methodology of validation.MethodsIt has been studied (a) the Face Validity by two focus groups of 10 relatives for each group, (b) the concurrent validity of family burden items comparing the ABC with QPF, a widely used questionnaire, in 6 Italian mental health centres on a sample of key-relatives, (c) the discriminant validity comparing three different samples of key-relatives of patients with psychiatric illness, Alzheimer or cancer. The internal consistency of items for assessing relatives' opinions on the quality of care has been evaluated by Chronbach' s α. The test-retest has been evaluated on a sample of 20 key-relatives.ResultsThe results indicate a fairly good performance of the questionnaire in this preliminary but almost complete phase of validation. The time to fill in it has been estimated in a 7 minutes average.ConclusionIt is possible by this self-report questionnaire to evaluate in a clinical routine setting and in a very short time three important problems for relatives and professionals: opinions and needs of relatives, and objective and subjective family burden of severe mental illness.

This paper describes the closing of the mental hospital in Trieste and the establishing of a comprehensive community mental health service, over a period of 13 years from 1971. In 1971 the hospital had 1058 patients. By 1975 there were 656 patients, 403 of whom were guests, in effect ordinary citizens who had nowhere else to live. The paper describes this dramatic and innovative transformation, the rearrangement of wards, the abolition of shock therapies, the establishment of many flats and group homes, the starting of a cleaning cooperative employing ex-patients to do the work they previously did as "ergotherapy", the first mass exodus of the patients into the city.The paper goes on to describe the opening of 7 mental health centres between 1975 and 1977 and the present existing network of services. At this time the hospital buildings were converted into a variety of uses for the benefit of the local people. It describes in greater detail the philosophy and practice of one of these centres at Barcola and how the dialectical relationship between staff and client works to create a flexible and responsive service.It ends by repeating the assertion that the closure of the mental hospital is a first necessary step towards an improved mental health service for everyone.

RÉSUMÉ Les auteurs décrivent l'évolution des services de santé mentale mis en place à Trieste en Italie au cours des 25 dernières années. Ils identifient les principes qui ont conduit à la transformation institutionnelle et au remplacement de l'hôpital psychiatrique traditionnel par une organisation complète de services répartis sur le territoire de Trieste. En cernant l'esprit qui a présidé à ces transformations, ils brossent un tableau complet de la gamme de services offerts de nos jours. Enfin, bien que l'expérience réalisée à Trieste soit liée aux conditions sociales et historiques qui ont favorisé son émergence, les auteurs dégagent des principes généraux pour orienter et transformer la pratique de la psychiatrie communautaire.