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The introduction to the debate on the current crisis of psychiatric care in Italy is an opportunity to summarize how this crisis, its causes and perspectives are described by those who indicate only delays and incompleteness in the implementation of the reform of Law no. 180 of 1978 and those, instead, who identify structural deficits in the reform itself. The various criticalities are reviewed: from the risk of new asylums to the fragile integration of psychiatric wards in general hospitals; from the limits of involuntary hospital commitment to a renewed idea of dangerousness connected to it; from the rigidity of the Community Mental Health Centers to the unchanged aspect of stigma; from the ambiguity of the concept of evidence-based medicine (EBM) to the changes derived by legislative changes. All this occurs while the lack of resources and innovative proposals are intertwined. It is proposed a change that gives back to mental health its specificity far from the trivializations of popular psychiatry, defines the framework of reference for mental health, draws a new project and a clear model strongly anchored to scientific models, clarifying the necessary resources and limiting local administrative autonomies. [ABSTRACT FROM AUTHOR]