From assistance to citizenship. The challenge of the Disability Reform

From a medical and care-based approach to a biopsychosocial model: legislation places the person, their skillsand aspirations at the centre

By Mario Barbuto

President of the Italian Union of Blind and Partially Sighted Persons

Among the most significant reforms of recent years concerning the rights of persons with disabilities, the process launched by Enabling Act No. 227 of 2021 and implemented, at least in part, through Legislative Decree No. 62 of 2024 undoubtedly represents one of the most profound and ambitious changes ever undertaken in Italy.

This is not merely an administrative revision of disability assessment procedures. The reform's true innovative scope lies in the cultural change it proposes: moving from a predominantly medical and care-based approach to a perspective founded on rights, social participation and the recognition and development of each person's remaining functional capacity.

For a long time, disability was viewed almost exclusively through the prism of pathology: assessments focused on impairment, deficit and percentage of invalidity. In short, the tendency was to measure only the degree and impact of the 'impairment', without seeking to identify and value the person's remaining functional capacity.

This reform, by contrast, finally proposes a paradigm shift inspired by the principles of the United Nations Convention on the Rights of Persons with Disabilities. Disability is no longer understood solely as the effect of a medical condition, but as the result of the interaction between a person's characteristics and the environment in which they live.

It therefore introduces the biopsychosocial approach, which considers at the same time the health, psychological, relational, educational, employment and environmental aspects of a person's life.

Within this new perspective, functional classification takes on particular importance. A clinical diagnosis alone is no longer sufficient. It is necessary to understand how that condition concretely affects the person's daily life: mobility, communication, personal autonomy, education, employment, social relationships and access to culture.

For a blind or partially sighted person, for example, simply stating the visual condition cannot be considered sufficient to describe needs, potential and opportunities. It becomes essential instead to assess the level of autonomy, the accessibility of the environment, the availability of assistive technologies, educational and employment support, and all those factors that can facilitate or limit full participation in social life.

Even more innovative is the objective of pursuing an independent, personalised and participatory Life Project. For the first time, the legislation places the person, their aspirations, wishes and choices at the centre. The system will no longer exclusively determine which interventions are to be provided. Instead, a shared pathway will be developed, taking into account the person's own life goals.

The Life Project must therefore become a single, integrated tool capable of coordinating health, social, educational, training, employment and housing interventions. Not a collection of fragmented services, but an overall strategy aimed at autonomy, inclusion and quality of life.

For the organisations representing persons with disabilities, and for the Italian Union of Blind and Partially Sighted People in particular, this shift marks a historic step. For years we have argued that genuine inclusion cannot be achieved by addressing health-related aspects alone, but by creating the conditions for every person to fully express their potential.

At the same time, there must be a mature awareness of the critical issues and questions that a reform of this depth will inevitably bring with it until it is fully implemented in the day-to-day work of institutions, professionals and service users.

The most significant issue to date concerns the introductory medical certificate, which acts as a gateway to the new assessment system. Many professionals and organisations have highlighted the risk that this stage may prove complex, uneven across the country, subject to resistance and, in any event, not always adequate to represent the person's actual functional situation.

A second critical issue concerns the classification of medical conditions and disability situations. Defining new assessment criteria requires continuous updating, specialist expertise and constant attention to developments in scientific knowledge. For some disability groups, there is a legitimate concern that the new tools may not adequately capture the many specific features of different conditions. Yet effective interventions must be based precisely on the use of specific methods and resources tailored to the distinctive characteristics of different disabilities. Otherwise, there is a risk of adopting overly generic measures that are entirely unsuitable and ineffective in addressing those specific needs.

There is also the question of the pilot phase. The new system is currently being introduced gradually in a number of areas identified by the legislature. This approach appears reasonable as a way of testing procedures and tools in practice, but it inevitably results, albeit temporarily, in differences between citizens living in different parts of the same country.

Finally, uncertainty remains regarding implementation timelines. The reform is expected to become fully operational on 1 January 2027. Until then, the outcomes of the pilot phase will need to be monitored carefully, any shortcomings corrected and adequate training ensured for the professionals involved. It is therefore worth insisting on the importance of a comprehensive discussion among all stakeholders, to be held as soon as possible, openly and without hesitation.

The challenge is great, but so is the opportunity.

The reform introduced by Act No. 227 of 2021 and Legislative Decree No. 62 of 2024 does not merely establish a new disability assessment system. It affects the very idea of citizenship, in which a person with a disability should no longer be a passive recipient of services, but the leading actor in their own life pathway.

The success of the reform will depend not so much on rules or administrative procedures, important though they are, but above all on the ability of institutions, professionals, the Third Sector and representative organisations to turn the new cultural model into a concrete reality capable of genuinely improving people's daily lives.

And this is precisely where the true strength of a reform will be measured: in its ability to transform rights written on paper into real opportunities for freedom, autonomy, citizenship and participation.