A visit to San Patrignano May 2022
I first met Monica Barzanti in 2021 during a collaboration project with the University of Derby, during which Sanpa contributed to a collection of artworks for the ‘Creative Arts in Recovery: personal reflections and artwork’ curated collection.
On May 16th, 2022, I set off from London, to visit the community of San Patrignano, more fondly known as Sanpa. I took the train from St Pancras at 8am via Paris, Torino Porta Susa, and Bologna Centrale to Rimini arriving at 11.50pm which was about an hour later than scheduled. A short walk from the station to my hotel made it easy to find.
The next day I spent exploring Rimini centre with its historic monuments and cobbled streets. The sun was shining with beautiful blue sky, it felt so welcoming.
Monica had kindly prepared a scheduled itinerary for my visit over the next two days.
On the 18th May I took a taxi from my hotel to Sanpa for €35 (including a tip). Sanpa was only 7.5 miles away according to my map app. The views of the countryside were perfectly Italian with farmed fields in neat rows and occasional villages dotted across the landscape.
I arrived at Sanpa about 9.10 am and around 15 people were grouped at the entrance, a small outside terrace with bench seating. The view from the entrance looked over to Rimini and on the horizon was the sea.
It was warm like an English summer’s day, the chatter of the people and occasional laughter felt like we were in a good place.
Monica welcomed me an introduced me to Jennifer, a resident from Vancouver, who had spent the last 3 years in Sanpa and had recently visited her home in Canada for 10 days. She tells me she is not ready to leave Sanpa yet. Jennifer has a quiet and calming disposition, an attentive nature and after spending the whole day with her, a beautiful heart. I was in capable hands as Jennifer showed me the arts sectors; media and print, textiles and leather, woodwork, and Sanpa hair. Everyone was smiling and I was greeted with Ciao wherever I went.
Jean Luc guided us around the media and graphics sector which was a professional operation. Well known customer organisations use Sanpa for their printing needs. Publications included newsletters, books, leaflets and packaging.
Elena showed us the textiles sector and the artisan looms of which there were many. Some of the products were available to see and were of the highest quality. Designers such as Ferragamo commission Sanpa for their handmade textiles. In progress was an order from Bethany Williams for a highly textured fabric woven from recycled materials. I saw two people operating a single loom making blankets, meticulously following a pattern and working as a team. Often the materials are provided by the designers to their own specification.
The next sector is sewing and leather. The standard of productions is remarkable. The most beautiful handbags are being made on behalf of design houses such as Todd’s. Sanpa also has its own shop and items made from donated fabrics and leather are created and sold with San Patrignano labels.
Ross from Scotland shows us around the décor sector, explaining how the hand printed wallpapers are made. Some are stencilled whilst others are screen printed. Giuseppe is working on a stencil wallpaper that has two stencils A and B. The centre of the paper is either stencil A or stencil B and are then trimmed and a third stencil fills the gaps. There are lots of opportunities for this process to go wrong so precision is key. The woodwork sector is next door to décor and the exceptional use of 3rd life wood encourages the sustainability nature of their work.
Rea from Sanpa hair is full of life with smiles and hugs. From Dundee in Scotland, she is approaching her third year at Sanpa and will visit home next month for the first time since joining the community. Rea recounts some of her experiences from when she arrived and how others helped her to change her perspectives on her behaviour. At Sanpa hair the skills of hairdressing are taught, and qualifications achieved
All the sectors provide professional training and certification offering residents valuable skills for future work.
After a lovely lunch I met with Virgilio, head of admissions together with Monica, Jennifer stays too.
The Sanpa community raises 65% of its costs through its production. The remaining 35% is received through donations and government funding. Currently they have around 800 people in the community but in the past, it has been as high as 1300. They have sufficient space for 1500 residents. Sanpa has been badly affected by Covid-19 but is rebuilding its numbers. Admission rate is 98% of applicants enter the community, and the majority are from Italy. A small % are from other countries. Applicants from within the European Union (EU) can apply without any further documentation. From abroad, that is outside of the EU, the applicant must go through the same interview process as an Italian. Once a place is offered then a permit (medical visa) is applied for at the Italian Embassy in their home country. If that is approved, then with appropriate private health insurance in place the applicant can move to Sanpa.
There are around 800 treatment communities all over Italy, recognised by the National Public Health System, which provide a variety of programmes. They can range in price from €43 to €180 per day according to the intensity of the therapeutic programme and are paid for by the National Public Health System for Italian and EU residents.
Sanpa is free to those who join the community. Only recently, in 2020, Sanpa allocated 100 places to government funded scheme which will pay for the first 12 to 18 months stay. This restricts the number of people to a room which can only be 6, in line with the government guidelines. The accommodation I visited with Jennifer shared 6 or 8 people to a room. I understand some of the accommodation can have up to 12 people in a room in the male dormitories, however, these are configured differently as a type of loft, with two floors and multiple bathrooms.
Sanpa uses an association system for Italian referrals. There are 43 associations across Italy that can initiate and process applications, gathering personal history, medical conditions etc. through a centralised digital system. This makes applications more streamlined. Sanpa has on average 35 new residents per month. There are also two associations abroad, one in London and one in Split, Croatia, managed by parents of residents and/or former residents of the Community who support people seeking to join Sanpa.
On arrival residents are allocated to a sector which is chosen for them by the admissions team. It is selected based on the initial assessment interviews and the personal history of the applicant. Also considered are the interests of the community as a whole. Of vital importance is knowing that the sector can receive the new entrant and cope with their individual characteristics. The system is forever evolving, some sectors fade whilst new ones are established. Supply and demand are factored into the decision making.
The Sanpa model of recovery is shared willingly with others both Nationally and Internationally. Sanpa also recognises their programme is not for everyone and some people are better suited to other programmes. One model cannot fit all and so they will refer people to other programmes when appropriate. Other countries with Sanpa style communities exist in Norway, Sweden, Australia, Scotland, Canada etc. Other governments are showing interest and Monica who has been working at Sanpa since 1979 provides study visits and workshops to people wanting to set up a similar community.
Each sector has someone as head of the sector who is not only very knowledgeable of the recovery programme but is an expert in the sector field. There is a system of support, led by a team of ‘responsibles’ in each sector who have built up expertise usually through their own personal journey at Sanpa, and often they have completed these personal competencies with appropriate qualifications as educator, social worker etc. In each sector there is, in addition to the person(s) in charge of the sector, an extended staff group, which also includes residents nearing the end of their pathway, people benefiting from paid internship periods before final reintegration, and people who are hired after the completion of their pathways.
Regular meetings are organised involving the heads of sectors (often professional educators and experts by experience) and the entire team in charge of the residents’ pathways to assess progress or difficulties. Each resident’s next steps are carefully planned: for example add psychotherapy, schedule a change of sector as requested by the resident, start a training course or start school, etc
Sectors are selected based on several factors including safety, self-esteem, and employability. Whilst sectors are allocated on admission, changing sector is an option although only usually considered after about 1.5 years, on a case-by-case basis. Some sectors are gender specific such as laundry and textiles are women only. The winery is men only. Some are mixed such as the kitchen, medical services, dog kennel, décor and Sanpa hair.
Relationships inevitably form between men and women which although it is not encouraged it does happen. When this occurs, a process is initiated and controlled to protect both parties.
Recent enhancements of the rules include the reintroduction of a smoking policy which took place in early 2022, allowing residents to smoke, although they need to pay for their own cigarettes. Residents who have no income and cannot pay are subsidised and given 5 cigarettes a day which is the maximum allowance.
The founder of San Patrignano, Vincenzo Muccioli, gave over his country home and land in the 1970’s which consisted of a small property and 40 hectares of land, mainly used for breeding dogs at the time. Today San Patrignano has 300 hectares and housing for 1500 potential residents.
Given the war in Ukraine Sanpa has recently hosted a delegation of Ukrainian sports people entering the silent Olympics (Deaflympics 2022). They were able to use Sanpa’s gym and facilities to continue their training in advance of the games. Their medal success is a tribute to their hard work. This delegation will return and stay again at Sanpa en route home to Ukraine when possible.
My second day at San Patrignano was equally as illuminating as the first. Today my guide is Thomas from the winery sector. He greeted me at the entrance and Monica drove us to the winery. Thomas took me around the wine production area explaining each part of the process and told me of his own personal story as we walked. He showed a sincerity of gratefulness I have rarely seen.
The winery is an extremely professional operation and makes some of the finest wines of the region. The winery conducts all the stages of the process from growing the grapes to bottling. It is one of the highest contributors to the Sanpa finances and its wines are shipped far and wide. People who work in the winery are not allowed to taste the wine. Thomas told me once a month they have dinner with a glass of wine per person and they celebrate all the birthdays of residents during that month.
There are about 60 people working in this sector of which about 35 are assigned to the fields. The vines cover an area of about 120 hectares. This sector also looks after the landscaping throughout the community. It is hard work that Thomas enjoys. He grew up in Italy and speaks very good English having been taught by his mother who is from Yorkshire and now living in Parma, only 2.5 hours from Sanpa. She visited him yesterday and he will go home for one week only, in a few months’ time. Thomas’ father is Italian and currently lives in Liverpool, in the UK. Once Thomas leaves Sanpa he wants to live in the UK and has earmarked Bristol or London as potential places.
Alongside the winery is the farm with cows, pigs and a few goats. This sector provides all the milk for the community and the excess is sent to the sector that makes cheese.
The next sector we visited was the dog kennels and we were shown around by Sarah and Elisa, both have been in Sanpa for over a year. The kennels have 70 rescue dogs which they look after. These dogs are rehabilitated and retrained in agility and obedience before being selected for the Sanpa adoption programme. In addition, boarding kennels are available for local people to bring their family dogs for care and attention whilst they are on holiday. The kennels have both summertime and wintertime (with heating) kennels to choose from. The people in this sector, about 20, take the dogs in their care for walks each day around the community. They also have grassed compounds with trees for the dogs to run around. The services of the kennel sector are paid for by customers boarding their dogs, and by those paying adoption fees. Also, a grooming parlour is available on site which also contributes to the income of the sector. People working in the dog kennels, who want to, receive an education as dog trainer and educator, which provides a promising career for the future. The training also includes how to groom dogs, nutrition and basic elements of dog health care, under the supervision of a veterinary team.
As we continue the tour with Thomas we stop at a corner, and he explains there is a school available for those who want it. Maybe they didn’t finish high school and want to complete to the high school standard. Italian language classes are available for those in the community that arrive without any knowledge of Italian.
Two girls appear nearby both smoking cigarettes. Thomas explains the new recent policy on smoking and when it was introduced, personally he decided not to return to smoking. The change in policy was made to encourage newcomers to join the community as admissions have found it is a barrier to choosing Sanpa.
Also, research has shown around 90% of people leaving Sanpa return to smoking. As we amble along the tree lined pathways our next stop is the bakery where all bread is made. Also, they make different bakery products such as panettone and sweet products for sale. Below the bakery is the cheesery.
To the right opposite the bakery is the building maintenance sector for electricians and plumbers both these sectors look after the building services throughout Sanpa. People in this sector gain valuable skills for future employment something all the sectors are focussed on as this is essential to successful reintegration when people are ready to leave Sanpa.
After a lovely lunch in the prominent dining room, I met with Antonio Boschini. Thomas joins the meeting together with Monica.
Antonio qualified with a medical degree and an advanced degree as a doctor of infectious diseases. Add to that more than 40 years’ experience in the area of addiction, having joined the Sanpa community as a resident in the programme in 1980. Antonio now works closely with the psychiatrist and psychologists of the Community, to identify those with mental health issues which require specific additional treatment. These could be illnesses pre-existing to substance use dependence (SUD’s). On occasions the needs of the people may be too disturbing for the Sanpa programme to be accomplished and they are then carefully referred to the right medical treatment pathway.
Antonio explains he is not the head nor the lead but the follower of any health problems and the research activities of the community. He has no expertise in the finance or commercial side of the community nevertheless he is key to enabling residents to have their mental health needs met. Antonio explains the programme continues to evolve. Originally Sanpa was set up on the premise that addiction was a social disease some 44 plus years ago, and it was believed that education was the key. As time went by it was acknowledged this was not enough. Now Sanpa is based on the premise that addiction is not a brain disease – at least, this is not the main focus of the problem – and they promote a belief in recovery is possible by addressing the biological, psychological and social aspects of addiction.
Most people entering the community are free from substances on arrival, however a few might be given substitute medication for a short time if withdrawal symptoms are recognised. Antonio also explains that not everyone becomes addicted when using drugs, it is the transition from use to addiction that relates to an individual’s vulnerability which can be attributed to traumatic experiences, often in childhood. During the early stages of recovery, the first year at Sanpa is a time that most residents find difficult and some more than others. Sometimes a push from the peer group is necessary for the resident to understand better their own problems and how to process the issues.
Antonio meets with residents when the peer group programme is not fully working. The sector identifies there is a potential problem, and the head of the sector discusses the issues with the resident and with the clinical team. A clinical assessment is made using a Rorschach psychiatric test, a cognition test and an attention deficit hyperactivity disorder (ADHD) test. The results of these three tests help to further identify psychological issues. It may be that some residents need psychotherapy to address the past trauma or medication to help them through a period of low mood. Some residents need ongoing medication to address their needs. About 20 to 25% of the community requires additional clinical help for problems such as high anxiety, depression, instability, or paranoia. Increasingly issues around gender identity and diversity are more prominent in the community. Sanpa tends not to accept people with premorbid severe mental health diagnoses such as a history of violence and/or severe eating disorders, if the applicant is not willing to accept, they need to work on this as well as their addiction. However, if psychotic symptoms are drug induced then they are eligible to join the community.
Antonio believes shame is somehow useful to motivate people to start the programme, that realising where their behaviour has had a negative impact on one’s life has not been helpful and provides a prospect for change. I asked about why the programme was three years and Antonio replied that it evolved from the experience of the community which when it started did not have a specific time period and was usually around 18 months, this was extended gradually as they notice the longer people stayed, the recovery success increased. About 20 years ago it was a four-year programme, more recently it has been around three years. However, the current thinking is one of meritocracy where people can succeed in stages, recognising people achieve at different rates, and so this is what the community is now working towards. In fact, they recognise that people who complete their time in the community continue their journey outside of Sanpa, and the process never ends. At some point on the pathway, they are ready to leave Sanpa and are enabled with employment skills, self-esteem and new opportunities ahead. It is a practical programme centred on the individual’s ability to take on new challenges and succeed. Those that leave having completed the programme are welcome back to visit anytime.
Leaving Sanpa is designed within the programme, to include a verification of readiness. This includes a trip home for one week and on return a discussion on how the trip went from a practical and emotional responsiveness perspective. If appropriate a second visit is planned and specifically aimed at gaining meaningful employment as a platform for a healthier and productive lifestyle. The decision of when to leave is a multidisciplinary assessment and invites not only the resident but their educator and the community team. Difficult moments may lead people to abandon the programme. If the person, despite support and encouragement by the staff to return to the initial determination that prompted the start of a recovery process, still decides to stop the process prematurely, any future requests to return are carefully assessed by the admissions office.
Each applicant, once offered a place, signs a contract agreeing to follow the rules not to hurt anyone and to contribute to the community. Changes in the community happen when needed. The recent move allowing smoking was not very popular with the decision makers. In 2007 smoking was banned and a three-month transition period was advised to all residents. This was based on the addictive and physically harmful nature of tobacco. This decision at the time was not popular, especially with staff. However recently it has been reintroduced and Antonio voted for it, because tobacco whilst physically harmful does not have any mind-altering features. Add to that 90% of the people who leave Sanpa return to smoking has led to a recognition that the smoking ban prevents people applying. So they are hoping more people will be able to join the community knowing they can smoke during their stay. Nevertheless, it’s a maximum of five cigarettes per day per person and they must pay for them themselves.
Antonio says, ‘it’s important that Sanpa feels like a home, belonging’ and so ‘a place where you can choose to smoke or not’. Antonio raised the topic of wine and said at first Sanpa residents were given a glass of wine every day with lunch and dinner, as it’s part of the culture of life here in Italy. This is no longer the practice.
There is an online group ‘Sanpa – I was there’ that people can belong to after leaving the community; it was created voluntarily by some former residents, and it is not an official profile managed by the Community. In addition, leavers are asked if they consent to being contacted for research studies. The last study completed in 2005. A study was started in 2014 and included 340 people but was not completed due to Covid. Generally, the studies include a questionnaire, psychological interviews and toxicology tests. The first study took place in 1995 with 711 people who had completed at least 1.5 years at Sanpa. It was found that women have a higher success rate at 85% than men. The average success rate for all genders is 72%. Of course, this includes research bias because only those who respond are included in the analysis.
For countries wanting to know more about the Sanpa programme Monica runs an immersive residential workshop for €1350 per person where topics such as recovery method, sustainability, therapeutic programme, gender aspects, and children in the community are included. An alternative programme for about four days is €800 per person and is not residential, so hotel accommodation is needed.
The leisure activities in the community do not have a specific sector. All departments are able to participate and include people coming from different sectors within the community. Activities are offered and take place outside of the sector work schedule. COVID-19 severely restricted the leisure activities, but they are now re-available and include several sports as well as music and a theatre group of about 25 people who produce shows for the residents to watch. Prior to Covid, the theatre Company of San Patrignano also performed in theatres all over Italy – such as Il Piccolo in Milan. Hopefully the new group of participants to the group led by Pietro Conversano, actor, director, trainer, and expert in theatre pedagogy, will reach a similar goal in the future. There is also a choir of about 25 people who have a director and singing teacher taking care of the group’s education and training.
As I leave Sanpa I am thankful particularly to Monica for her invitation and organising my itinerary. Also, for my host guides Jennifer and Thomas who gave great hugs and to all the wonderful people I’ve met during my visit. I can truly say I’m amazed at the love and kindness people showed not only to me but to each other. I wish I could stay but my time has come to an end, and I hope it will not be the last time I see those who have shared with me their stories, insights and hope for the opportunities ahead. Sanpa, I love you!
By Karen Megranahan