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“Il Grande Carro” social cooperative and “Monteverde” Daytime Care Centre

The social cooperative “Il Grande Carro” was born in 1996 as part of a project of the Mental Health Care Centre from a Local Health Authority in Rome, specifically the “Centro Diurno Monteverde”. Since its foundation, the Cooperative has been closely working with the Day Centre, where most of the professional training activities take place, whose aim is the inclusion and the work environment placement of its users. As a matter of fact, besides being a Social Cooperative, Il Grande Carro also works for different market areas.

Il “Grande Carro” Cooperative

Historical data and structure

The cooperative is currently made up of 50 members including a great variety of staff. About 20 of them are able-bodied care workers and educators; about 30 are disadvantaged members with serious mental suffering. The disadvantaged members are part of the Board of Directors.

Over the years we have been promoting work and social inclusion opportunities for hundreds of people (around 500) with mental problems. Most of those involved in the programmes have had a job within the cooperative itself, finding a stable occupation in line with their skills and abilities. According to a recent survey, more than a half of its members has been working for the Cooperative for more than 7 years. In the last few years, due to the increasing numbers of young non chronically ill patients, we have focused on looking for job opportunities ‘outside’, in the job market. For this purpose, a specific training laboratory has been created.

Currently underway activities, growth dynamics, and future plans

In terms of turnover, training/assistance activities account for about 30%. The remaining part comes from work and production and acts in different productive fields. Over the years it has worked in different areas: catering service, takeaway meals for community canteens, meetings and parties, gardening, green maintenance and cleaning, porterage, wood and recycled materials handcraft, handmade bookbinding. A social farming experience is underway, as well as a project on bicycles, which will include repairing, cyclo-tourism, and delivering. The Cooperative has also managed a company café, called “Bar-naut” for many years (“Bar” is the Italian name for “cafè” and the full name sounds like “burnout”)

Each activity sector has its own supervisor, who has a decision-making role for both the specific sector and the overall cooperative organization.

The cooperative revenue accounts for 70% on public procurements, such as contracts for professional training activities, goods and services supply agreements with local health authorities, green maintenance of public areas. The remaining 30% comes from the private sector.

In the past 25 years the cooperative revenue has grown, as well as the number of psychiatric patients (from initial 3 to tens, who have found a job during the years).

Strengths and strategies

The significant achievements of our twenty-year experience (job placement, low turnover, good economic balance, quality service) are based on 4 operational tenets:

Close interaction with all the mental health public services

Despite growing tendency for medicalization, we still aim at keeping a connection with the public health system, so as to offer continuity in the rehabilitation process. We strongly believe in the importance of work as a therapeutic treatment and a psychological wellness tool. This keeps our world away from the usual seducing logic of the market (productivity, competition, loss of mutuality).

We consider social acceptance through work activities and income availability as a primary means for integration. It comes first and allows deep and positive compliance with other tools (psychotherapy, medication/drugs, hospitalization).

Territorial rooting and networking

The “outside world” is not only seen in terms of potential marketplace for our products and services. Being in touch with it is paramount for us. The idea of being able to change it reduces the risk of “Burn-out”. This means trying to raise awareness on mental health issues in the local community, strengthen our presence to develop social economy models, be in touch with other organizations.

Creating original products and inventing new areas of production

The diseconomy that may come from the consistent number of disadvantaged members can only be compensated for by promoting innovative and creative goods and products (ex. “edible wishes”), as well as eco-sustainable business activities. In fact, it is the need to manage “critical situations” that sometimes leads us to adopt new solutions. However, the ordinary market itself acts as an input to change our entire productive system periodically.

Great care for productive process quality

The continuous effort to personalise work (tasks, shifts, number of hours) according to the members’ needs makes our cooperative different from any ordinary business. Because the main problem in working with mentally suffering people is not performance but discontinuity, it is essential to have a global perspective on the overall productive cycle, where teamwork is more important than individual skill. Our cooperative is therefore a meaningful place rather than just an ordinary workplace, a point of reference for new sociality, where team spirit is all you need to learn.

Specific activities of the Day care Centre and the tutoring session

The Day Centre “Monteverde” represents the birthplace and the organizational engine of the cooperative.

It is situated on the ground floor of a residential building in a central area of the city, near an important train station, in a headquarter rich in shops, productive activities, tourism. This complies with a specific choice aimed at facilitating the integration of the people with mental suffering in their own neighbourhood.

The Centre homes equipped rooms for structured activities plus common premises, shared daily by around 50 people for many hours a day. Specifically, we have a food workshop, multimedia communication classes, a wood arts and crafts workshop, a repair shop, a bicycle repairing and sustainable mobility workshop.

The tutoring session

Among our initiatives, some are specifically tailored for younger patients; one is the tutoring session, which has been introduced 2 years ago.

The purpose of the sessions is to support the participants in the job search. We work in conjunction with the mental health centre, hospitals, and other day centres, through individual as well as group weekly based classes. The sessions are held by a psychologist and a social worker, who, beyond their qualification, become “adult mates”. In the sessions the participants are helped to:

  • Define and develop a C.V.
  • Identify the addressee.
  • Enrol in employment agencies.
  • Identify public and private recruitment sites.
  • Identify public call.

Peer empowerment is fundamental when they share problems and look for solutions. What is more, through group activities it is possible to work on motivation and awareness (how do I spend my time, how do I see myself etc…). Analysing past experiences, they attempt to build or simply sketch a plan for their future (work, training etc…). The name of the workshop is “Unemployed Anonimous” because, just like in Alchoolics Anonimous, they experience reality testing1.

[1] Prayer from “Alchoolics Anonimous”
God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.

Statistically speaking, considering the first 6 months, out of 22 initial participants, 3 of them started an internship, 2 of them found a job, 3 dropped out; the remaining 14 participants are still attending the classes. An evaluation form is used in the lab, and it considers different areas[1]. Analysing the report card before and after six months, we can observe that the scores increase especially for young patients who turn to be more flexible and able to learn how to look for a job. Their improvement score is higher in the awareness and social skills, where expectations (personal and by their family) play a decisive role in defining realistic projects. Outcomes are perfectly in line with our expectations.

Mental Health Day Centres in Italy and soft-skills study

The functions of Day Centres are clearly described in the “Mental Health Action Plan”. This represents the normative reference for Mental Health Services in Italy, following the Basaglia Law after which psychiatric hospitals were closed. In the Mental Health Action Plan it is stated that, through rehabilitation treatment projects, patients experience and learn how to take care of themselves in everyday life, in interpersonal e group relationships. They also take training activities for work placement. (National Mental Health Care Action Plan 1998-2000).

Day Centres represent one of the paramount services for the assistance of mentally impaired people. Each Mental Health Department should have one, together with Mental Health Centres, psychiatric services, hospitals, communities, and group homes.

You cannot enter Day Centres without a complex project agreed and defined by the Mental Health Centre, which will organize the care assistance. Day Centres deal with treatment and rehabilitation, prevention of hospitalization, and much more. They can be defined as intermediary places between services and interventions, between inside and outside, before

and after, thoughts and actions, static and dynamic proceduralism. They are intermediate horizons among extreme ones, and can allow convergence and integration, i.e., a Fusion of Horizons (Gadamer) between individuals and contexts. Since they are halfway structures, they should be transitional, and include a variety of goals, organisational arrangements, solutions, and activities.

The experience conducted in Rome (that also “Il Grande Carro” Cooperative belongs to) has its own features because it:

  • Is financially supported by the Local authority that favours inclusion and other health and social aspects.
  • Promotes network and activities in the local community.
  • Focuses on social and work integration through social cooperatives.

Many surveys on Day Centres have witnessed positive outcomes not only in terms of decreasing hospitalizations, drug treatments and family responsibility, but also in terms of increasing self-empowerment and number of patients who have succeeded in getting a rewarding job thanks to social cooperatives.

The study on soft skills

During the years the Day Centres for Mental Health have been subjected to a series of assessments that have provided meaningful contribution in different directions.

Among the various experiences, which the Social Cooperative Il Grande Carro particularly actively participated to, it is worth highlighting a deep research and action work that has involved operators in Daycentres and integrated social cooperatives of Lazio together with ISFO (former Workers’ Educational Institute of the Ministry of Labours), which was carried out through focus group and other analysis techniques.

The study lasted around 3 years, at the end of which a book was published in 2013 with the title: “The soft skills of the Mental Health èquipes”.

A model of soft skills emerged that characterizes the work of all the professionals that deal with people in the Centres. We are talking about social skills whose main feature is the fact that they come from a common work in the field that belongs to all the experts, no matter if they are psychologists, educators, nurses, administrative staff, regardless of their roles or functions they have and the services their Centre provide.

Soft skills are shared skills, which means they are common, and non-specific, because they do not belong to a specific profession, but they are distinctive of the relationship that each staff member establishes with the user in the Centre.

A list of soft skills that has been identified includes:

Teamwork: working well with others as a group rather than individuals, valuing cooperation rather than competition, sharing objectives and working on a common project.

Learning to unlearn: getting rid of “defensive” cage and being open to dialogue and reception.

Communication: learning and using a wide range of communication tools and techniques to inform, to build positive relationships with others, promoting new behaviour to obtain support and alliance.

Self-awareness: managing oneself and handling interactions effectively, especially under pressure, ambiguity, and uncertainty. Providing a perspective based on reasonability to manage difficult or conflicting situations.

Empathy: listening carefully and understand thoughts, reasons, feelings and worries even when they are not openly or completely expressed by the speaker. Understanding, or trying to, the reasons of the other person’s behaviour even when this is complex, twisted, ambiguous.

Adaptability: being flexible and working in different situations with different people; understanding and welcoming different and contrasting perspectives on a problem. Managing time, plans and activities prioritising according to the constantly changing needs of the situations.

Creativity: finding pragmatic, original, creative, astonishing but effective solutions to tackle problems, critical and complex situations.

Letting grow: letting people develop and realize their potentials, realistically evaluated, through guidance and support.

Being result-oriented: being motivated to reach a fixed goal with patience and optimism, without giving up. Trying to dig deep into the root of matters, seizing opportunities and realistically adapting paths and rhythms to the ability of the people involved in a project and to the success achieved.

We believe that this makes the difference between simple professional qualification and competence. It does not refer to educational background but to the “climatic broth” they are immersed in.  

This is in our opinion the most effective way to recognize the primacy of groupwork: the best tool to counter the hyperspecialized and neo corporatist models that are somehow disrespectful towards suffering and probably unsuited to relieve it.

We think that part of the future of the services depends on the real and effective enhancement of workgroup and groupwork. It is necessary to create and improve the opportunities to understand and describe how cooperative learning works, and it is for this reason that we consider this kind of ability as the principal background for training.

This is where we can build new professionalism, starting from the inadequacy of the bio-medical paradigm.