The reform of Italian forensic psychiatric hospitals and its impact on risk assessment and management

Italy has a strong history of deinstitutionalization. It was the first country to completely dis-mantle psychiatric hospitals in order to create small psychiatric wards closer to the community (i.e., in general hospitals). Nevertheless, it took the nation nearly 40 years to complete the process of closing all forensic psychiatry hospitals. Deinstitutionalization, however, was not fully addressed by the first wave of Italian psychiatric reform. This paper describes the establishment of new facilities replacing old forensic hospitals, formally known as Residences for the Execution of Security Measures (REMS). REMS are a paradigm shift in terms of community-based residential homes, and are mainly focused on treatment and risk assessment, rather than custodial practices. The use of modern assessment tools, such as the Aggressive Incident Scale (AIS) and the Hamilton Anatomy of Risk Management (HARM), is crucial in order to objectively assess the clinical cases and are consistent instruments that form part of the treatment plan. A preliminary analysis of data from the first 2 years of activity, focusing on severely ill patients who have been treated for more than 12 months, is de-scribed for two REMSs in the Lazio region, close to Rome. Encouraging results suggest that further research is needed in order to assess clinical elements responsible for better outcomes, and to detect follow-up measures of violence or criminal relapse post discharge.

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