BackgroundItaly’s community-based mental health model, grounded in Law 180, has long been regarded as a global example of rights-oriented psychiatric reform. However, recent years have witnessed a crisis in the national health system, marked by chronic and progressively accumulating underfunding, workforce shortages, and organizational strain, rather than a single acute disruption. This s/tudy compares two samples of informal caregivers of individuals receiving mental health care in Sardinia (2024 vs. 2025) to explore differences in their perceptions of service quality, organizational well-being, and respect for human rights.MethodsA cross-sectional design was used to compare independent caregiver samples (2024: n = 100; 2025: n = 74). Participants completed the Well-Being at Work and Respect for Human Rights Questionnaire (WWRR), which assesses satisfaction with care, perceptions of organizational quality, and respect for users’ and staff’s rights. Data were analyzed with ANOVA and chi-square tests.ResultsCaregivers in 2025 reported significantly higher satisfaction than those in 2024 regarding the quality of services (p = 0.007), organizational aspects (p = 0.007), and respect for the human rights of both users (p < 0.001) and staff (p = 0.037). No differences emerged in perceived user satisfaction or resource adequacy, with both cohorts expressing persistent concern about staffing and infrastructure. The perceived need for additional nurses, doctors, and support staff increased in 2025, which may indicate growing awareness of workforce fragility.ConclusionsThese differences in satisfaction should be interpreted within a context of prolonged systemic strain, which may foster adaptive or resilience-based perceptions among informal caregivers. Despite ongoing structural difficulties, informal caregivers maintain high confidence in Italy’s community mental health services and perceive them as respectful of human rights. However, their increasing concern about resource shortages highlights the urgent need for investment to preserve the ethical and organizational strengths of the Italian model.
Radically different