[Closing forensic psychiatric hospitals in Italy: a new deal for mental health care?].
The date of March 31, 2015, following the Law 81/2014, has marked a historical transition with the final closure of the six forensic psychiatric hospitals in Italy. This law identifies a new pathway of care that involves small-scale high therapeutic profile facilities (Residenze per la Esecuzione della Misura di Sicurezza, REMS) instead of the old forensic psychiatric hospitals. The Law promotes a new recovery-oriented rehabilitation approach for the persons with mental disorders who committed a criminal offence, but lack criminal responsibility and deemed as socially dangerous. After a brief description of what happens abroad, this article highlights the positive aspects of the law that, as a whole, has to be considered innovative and unavoidable. The main debated problems are also reviewed, including the lack of changes to the Criminal Code; the improper equation between insanity and mental illness and social dangerousness; the evaluation of "socially dangerousness", based solely on "subjective qualities" of the person, assessed out of his/her context, without paying attention to family and social conditions suitable for discharge; the expensive implementation of the REMS, mainly based on security policies and less on care and rehabilitation, the delay in their construction, and the search for residential alternatives structures; the uncertain boundaries of professional responsibility. Finally, several actions are suggested that can support the implementation of the law: information programs addressed to the general population; training activities for mental health professionals; systematic monitoring and evaluation of the outcomes of the care provided to the forensic psychiatric population; implementation of Agreement Protocols and a better cooperation with the judiciary. Scientific societies dealing with psychosocial rehabilitation need to be involved in such issues relating to the identification of the best care and rehabilitation pathways, which should be implemented following closure of forensic psychiatric hospitals.
Presidente della Sezione Italiana della Word Association for Psychosocial Rehabilitation (WAPR) - Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università dell'Aquila.
Massimo
M
Casacchia
Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università dell'Aquila.
Maurizio
M
Malavolta
Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università dell'Aquila.
Valeria
V
Bianchini
Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università dell'Aquila.
Laura
L
Giusti
Dipartimento di Salute Mentale, Pescara; Centro di Salute Mentale, Penne (PE).
Vittorio
V
Di Michele
Dipartimento di Salute Mentale, Teramo; Centro di Salute mentale, Atri (TE).
Patricia
P
Giosuè
Dipartimento di Sanità Pubblica e Medicina di Comunità, Sezione di Psichiatria, Azienda Ospedaliera Universitaria Integrata Verona, Università di Verona.
Mirella
M
Ruggeri
Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma.
Massimo
M
Biondi
Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università dell'Aquila.
Rita
R
Roncone
D003416:Criminal Law / Q000331:legislation & jurisprudence; D057237:Criminals; D003617:Dangerous Behavior; D005555:Forensic Psychiatry / Q000331:legislation & jurisprudence*; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006271:Health Facility Closure / Q000331:legislation & jurisprudence*; D006291:Health Policy; D006778:Hospitals, Psychiatric / Q000331:legislation & jurisprudence*; D006801:Humans; D007558:Italy; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health / Q000331:legislation & jurisprudence