This cross-border investigation uncovers the growing influence of transnational companies specialising in elderly care as they expand into the more lucrative psychiatric care sector in France and Italy.
In Italy, the journalists revealed how the ongoing privatisation of mental health care threatens the legacy of pioneering legislation from the late 1970s — known as the Basaglia Law — which revolutionised psychiatric treatment by shutting down public mental hospitals and prioritising community-based care.
That groundbreaking reform, a global first, sought to treat mental illness with the same seriousness as physical illness and provide support within the community rather than through institutional confinement.
Today, however, half of Italy’s national mental health budget is spent on housing people in private psychiatric residential facilities, while care quality in public psychiatric wards and territorial mental health centres continues to deteriorate.
The investigation also revealed the increasing use of so-called mechanical restraint — physically tying patients’ arms, legs and torso to hospital beds — in both adult psychiatric wards and child neuropsychiatry departments.
This rise is attributed largely to staff shortages and a lack of specialised training. In a striking case, the Lazio region near Rome allocated funds originally earmarked to eliminate the use of restraints to instead purchase an electroconvulsive therapy (ECT) machine and organise training sessions that included instruction on how to properly apply mechanical restraints. Notably, the head of the psychiatric department behind these decisions, Orazio Schillaci, is a consultant to the Ministry of Health.
This data-driven investigation, the first of its kind in Italy, relied on freedom-of-information requests submitted to all 20 Italian regions to build a nationwide picture of restraint use.
It revealed that at least 12,000 people are subjected to physical restraints in psychiatric wards each year — typically for around 20 hours, but in some cases, patients are tied down for up to six consecutive days. Evidence also confirmed that children are among those being restrained, despite a €60 million government allocation in 2022 aimed at eliminating the practice altogether.
For the first time, national media reported testimonies of sexual abuse linked to the use of mechanical restraints.
The investigation sparked national debate, prompting the Human Rights Committee of the Italian Senate to hold hearings on the issue. During the second hearing, project coordinator Ludovica Jona was invited to testify. A legislative proposal is now in development to monitor and regulate the use of restraints in psychiatric care.
In response to the findings, members of the Italian Parliament and the Lazio Regional Council submitted formal questions to the Ministry of Health and the president of the Lazio Region, seeking to understand why funds intended to promote no-restraint practices were diverted to purchase an ECT machine and train staff in restraint techniques.
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