About this course

Learning Objectives

• Compare and contrast the World Health Organization (WHO) recognized Trieste model of care with the traditional U.S. mental health system by identifying three systemic differences regarding patient autonomy, the use of physical restraints, and the integration of social supports.
• Demonstrate how the practice of "Accoglienza" (Hospitality) impacts therapeutic outcomes.
• Define the "Three Pillars" of recovery (purpose, housing, and social connection) and their role in long-term community reintegration.
• Assess the impact of crisis entry points by comparing the clinical outcomes of traditional U.S. Emergency Department reliance with the Trieste 'open-door' model, focusing on patient agency.
• Explain the role of social cooperatives with traditional vocational rehabilitation to determine which best supports a patient's long-term social inclusion and community belonging.

Learning Levels

• Beginner

Course Instructor(s)

• 

  Morgan Shields, PhD

  Morgan Shields’ researches the quality and accountability of behavioral healthcare. Her work seeks to identify implementation strategies to improve the use of evidence-based practices, with a focus on patient-centered care and equity. She is particularly focused on identifying policies (e.g., payment, regulations) to motivate and support quality improvement. Shields is one of few people studying the quality of inpatient psychiatry. Her research identifying disparities in quality performance at the Veterans Health Administration led to internal investigations by the Deputy Under Secretary for Health and Organizational Excellence.

  In 2019, the Massachusetts Department of Mental Health revamped its critical incident monitoring system in response to Shields’ research. Her analyses highlighting the systematic exclusion of psychiatric patients from national measurement of patient experience has prompted action from national entities to address this discrimination. Shields serves as an expert in related legal cases.

  Shields received training in implementation science and community-academic research through an NIMH T32 postdoctoral fellowship at the University of Pennsylvania. She has a Ph.D. from Brandeis University’s Heller School for Social Policy and Management, where she was an NIAAA T32 fellow and a Harvard Kennedy School Rappaport Public Policy fellow, and an M.Sc. from the Harvard T.H. Chan School of Public Health. Shields publishes in outlets such as Health Affairs, Medical Care, and the JAMA Network. Shields directs the IDEAL (Inclusive, Dignified, Equitable and Effective, Accountable, and Loving) Lab, which identifies strategies for providing patient-centered care.

• 

  Travis Atkinson, MS, LPC

  Travis Atkinson, MS, LPC, has worked in behavioral health services for the past 20 years as a clinician, trainer, supervisor, advocate, and consultant. He has presented on SAMHSA panels around crisis systems and crisis bed registries, researched best practices in emergency behavioral health care, and spoken at national behavioral health conferences on functional crisis systems and behavioral health workforce challenges. Since 2015 he has worked at TBD Solutions, and he was instrumental in authoring the Crisis Residential Best Practices Handbook in 2018. He is the past president of the Crisis Residential Association. He received his BA from the University of Michigan and his Master’s degree in Community Counseling from National-Louis University. Travis lives in Grand Rapids, MI, with his wife and three daughters. He is also a performing songwriter with six albums to his name. Travis is also the host of The Crisis Podcast.

• 

  Tommaso Bonavigo, MD

  Tommaso Bonavigo, has been working in the Trieste system since 2011 (as a resident until 2016, then as a psychiatrist). He works in a Community Mental Health Centre, has conducted some research on the field and coordinates the international cooperation projects of the Mental Health Department.

• 

  Kerry Morrison, MA

  Kerry Morrison, Founder and Executive Director of Heart Forward LA, entered this field not through a clinical door, but through the community door. She spent 22 years managing the business improvement district in Hollywood, which helped to spark an economic renaissance to lure back business, tourism and entertainment. Troubled by the inability to help people with untreated serious mental illness living on the streets of Hollywood, she applied for a Stanton Fellowship which afforded her an opportunity to explore better approaches to mental health care to bring ideas back to Los Angeles. Her two-year study fellowship led her to Trieste, Italy, where she discovered the world-recognized system that focuses upon robust community support, an authentic belief in recovery and a focus upon the whole person. She brought others back to see it and worked with Los Angeles leaders to begin work to adapt the model to address mental health system change in L.A. The collaboration led to a state-funded mental health pilot in Hollywood, inspired by Trieste.
  Morrison has visited Trieste seven times and lived there for a month in 2019, embedded in their system. She most recently (October 2024) escorted a group of 20 leaders from throughout the US to study the system, as a result of a grant awarded by The Hilton Foundation. Heart Forward LA models the guiding principles inspired by Trieste by partnering with Hollywood-based residential communities, community volunteers, the LA County jail and other locations to practice a culture of Radical Hospitality which contributes to social inclusion, personal flourishing and reduced isolation. Morrison also hosts a podcast which seeks to juxtapose the dysfunction of the American mental health system against the North Star which is Trieste. It is called Heart Forward: Conversations from the Heart.

References

• World Health Organization. (2021). Guidance on community mental health services: Promoting person-centred and rights-based approaches. World Health Organization. https://www.who.int/publications/i/item/9789240025707
• Mezzina, R., Saraceno, B., & Sashidharan, S. (2025). Franco Basaglia (1924-1980): the reformer of the Italian psychiatric system: commentary, Mezzina et al. The British journal of psychiatry : the journal of mental science, 227(2), 582–583. https://doi.org/10.1192/bjp.2025.74
• Sashidharan, S. P. (2022). Why Trieste matters. The British Journal of Psychiatry,220(2), 52–53. https://doi.org/10.1192/bjp.2021.149
• Pollice, G., Bodini, C. F., Menchetti, M., Da Mosto, D., Negrogno, L., Betti, L., Furlan, M., & Quaranta, I. (2026). "Is the Service Ready?": Integrating Peer Support Workers Within Community Mental Health: An Ethnographic Study from Trieste and its Region. Community mental health journal, 62(1), 177–189. https://doi.org/10.1007/s10597-025-01513-5
• Muusse, C. G. R., Mulder, C. L., Kroon, H., & Pols, J. (2024). Uncertainty Work: Dealing with a Psychiatric Crisis in Two European Community Mental Health Teams. Medical anthropology, 43(3), 247–261. https://doi.org/10.1080/01459740.2024.2310857
• Basaglia, F. (Ed.). (1968). L'istituzione negata: Rapporto da un ospedale psichiatrico [The negated institution: Report from a psychiatric hospital]. Einaudi.
• Lora, A., Starace, F., Di Munzio, W., & Fioritti, A. (2014). Italian community psychiatry in practice: description and comparison of three regional systems. The Journal of nervous and mental disease, 202(6), 446–450. https://doi.org/10.1097/NMD.0000000000000143