Solutions Lab


Path-Breaking Program at a Crossroads

Trieste’s World-Famous Community Mental Health Program Under Attack

When Pierfranco Trincas took up his job as the director of the Barcola mental health center in Trieste, Italy, he took center stage in a battle over the future of a mental health system praised by the World Health Organization and admired around the globe. The appointment of Trincas on August 1 set alarm bells ringing among supporters of Trieste’s unique system of community mental health, developed in the 1970s by psychiatrist Franco Basaglia, who led a revolution from within against the city’s brutal mental asylum and created a new model to replace it. Suddenly, it seemed, a program that…

A View from Two Years Ago

The Old Asylum Is Gone: Today A Mental Health System Serves All (For Now)

This story was originally published in the February 2020 issue of Health Affairs. In Trieste, Italy, local leaders have transformed how mental health care is provided. Other cities have taken note. Spend a week in Trieste, Italy, and the first thing you may notice is what’s missing. There are no tents on the sides of roads or under bridges—a common sight in the cities of California, where I live. There are no cardboard boxes serving as mattresses for distressed, disheveled people. No one sleeps on the sidewalk or publicly confronts the voices in their heads as passersby avert their gaze.…


The Kids Are Not Alright

A group of masked fourth graders at Fall-Hamilton elementary school in Nashville, Tennessee sits in a circle on colorful yoga mats. Hands stretched across bellies, eyes closed, they are breathing deeply in quiet calm when teacher Kara Kennard breaks the silence. “Time for Mountain Pose!” she says. The children leap to life in their socked feet, stretching their hands down by their sides.   “I am confident. I am proud!” they chant together.   After yoga, students pass around the “breathing ball.” When the students catch it, they take a breath, exhale and give a name to how they’re feeling.  When she…

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Can Income Reduce Mental Illness?

In 2019, Stockton, California Mayor Michael Tubbs started a guaranteed income experiment, giving $500 a month to randomly selected residents. The stipend improved participants’ job prospects and financial stability — and reduced their depression and anxiety. For 18 months, from February 2019 through most of the pandemic’s first year, Tomás Vargas was part of an economic experiment in Stockton, California. A pilot program called SEED offered a guaranteed monthly income to its participants, and the 36-year-old father of two was among those receiving a $500 monthly stipend. The program aimed to provide an economic boost, but what Vargas noticed most…

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Plagued in her youth by anxiety and panic attacks, a California educator now works to curb student suicide

“I keep picturing these little kids playing some game in this big field of rye and all…And I’m standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff – I mean if they’re running and they don’t look where they’re going I have to come from somewhere and catch them. That’s all I’d do all day. I’d just be the catcher in the rye and all.”— Holden Caulfield, 16, from J.D. Salinger’s novel Catcher in the Rye  Monica Nepomuceno has something in common with the…

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