The Closure of Forensic Psychiatric Institutions in Italy

Scarpa, Franco; Castelletti, Luca; Lega, Ilaria

doi:10.1007/978-3-030-12594-3_22

Cited by 5 publications

(26 citation statements)

References 5 publications

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“…The emphasis lies on individualized care pathways, including the patients' individual psychosocial and treatment needs, and consideration of the index offense. Treatment is mainly aimed at improvement of insight, understanding of the disorder and its effects, reduction of symptoms, strengthening familiar and services' networks, and ensuring a therapeutic alliance (5).…”

Section: Introductionmentioning

confidence: 99%

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Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

Vorstenbosch

Castelletti

2020

Front. Psychiatry

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The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities are inspired by psychiatric community services, embracing a recovery-oriented approach. Needs and quality of life are broader concepts that consider the more rehabilitative and humanitarian aspects of treatment. In one of the new Italian forensic psychiatric services, this cross-sectional study aimed to investigate the needs and quality of life of forensic psychiatric patients. A second aim was to validate the Italian version of the Forensic inpatient Quality of Life questionnaire Short Version (FQL-SV). Overall, 42 forensic psychiatric patients were assessed using the Forensic version of the Camberwell Assessment of Need (CANFOR), the Historical-Clinical-Risk-Management-20 (HCR-20), the FQL-SV, and the World Health Organization Quality of Life (WHOQoL-Bref). Patients reported significantly fewer needs, whether met or unmet, than their treating clinicians. The general level of agreement between patients and clinicians on specific needs was low Kappa values were < .40 for 64% of the total needs and 46% of the unmet needs. Risk factors according to the HCR-20 mean scores were 13.1, 4.6, and 6.4 for the historical, clinical and risk management subscale. Quality of life was moderate to high for 74% of the patients. Our results showed that lower numbers of needs, whether reported by patients or clinicians, were associated with a better quality of life. The Italian FQL-SV had a Cronbach's alpha of 0.86 and correlated as expected with the WHOQoL-Bref. The FQL-SV is a valid and reliable tool, justifying its use for routinely assessing QoL in Italian forensic psychiatric services. This study enhances our understanding of needs and quality of life of forensic psychiatric patients and how their assessment could have an additional value for recoveryoriented treatment in forensic psychiatry. Although the detained status of forensic patients imposes real limits on the capacity for autonomy and choice, incorporating the patient's perspective on decision-making processes, in relation to aspects of treatment, care, and daily life, may have benefits such as a better treatment adherence or therapeutic alliance. Future research should clarify how routinely assessing needs and quality of life can contribute to the recovery of these forensic psychiatric patients.

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Section: Introductionmentioning

confidence: 99%

“…Finally, the Italian forensic psychiatric system and its recent reforms have been described extensively (2,43). However, the lack of studies supported by data is considered an eminent gap within the Italian system (5), and several authors stress the importance of systematically collecting data for service evaluation (1,44).…”

Section: Introductionmentioning

confidence: 99%

Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

Vorstenbosch

Castelletti

2020

Front. Psychiatry

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“…In 1930, the parliament passed a new penal code, named after the then Minister of Justice Alfredo Rocco (Law 1398/1930), which for the first time included elements inspired by positivistic ideas (Stocco, Dario, Piazzi, & Fiori Nastro, 2009). The code has substantially remained unaltered throughout the 20 th Century and is currently still in use (Scarpa, Castelletti, & Lega, 2017).…”

Section: Fascism and The Rocco Penal Codementioning

confidence: 99%

“…Another consequence of the financial difficulties was reflected in the cuts that the OPG were subject to toward the end of the 1990s, which resulted in further degrading of service quality (Scarpa, Castelletti, & Lega, 2017). A national study carried out by the Italian National Institute of Health (Istituto Superiore di Sanita') to investigate on the status of OPG, reported that by 2012, 17% of the patients in OPG were not offered any rehabilitation treatment, and that only one patient out of six was granted treatment for at least eight hours a week (Lega et al, 2015;Lega et al, 2014).…”

Section: Republican Years and The De-institutionalisation Movementmentioning

confidence: 99%

“…In the same period, as mandated by Law 81, all six OPG suspended admission, with the sole exception of OPG Castiglione delle Stiviere (Mantua, Lombardy), which received a deadline extension, having been evidenced in the Parliamentary investigation of 2010 to offer more favourable conditions for the patients (Scarpa, Castelletti, & Lega, 2017).…”

Section: Development Of Rems Following Lawmentioning

confidence: 99%

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The closing of forensic psychiatric hospitals in Italy: Determinants, current status and future perspectives. A scoping review

Lorito

Castelletti²,

Lega

et al. 2017

International Journal of Law and Psychiatry

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The closing down of Italian forensic psychiatric hospitals represented a fundamental step for human rights. Further work is required to improve the current service, including potential reforming of the penal code, improved referral/admission processes and consistent monitoring to reduce service inequality across regions. Further research is crucial to test the effectiveness of the Italian model of care against traditional ones.

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Difference between forensic patients with schizophrenia spectrum disorders in Italy and other European countries: Results of the EU‐VIORMED project

Castelletti

Iozzino

Zamparini

et al. 2023

Criminal Behav Ment Health

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Background There has been a substantial change in the law on the provision of secure health services for offender‐patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender‐patient admissions between European countries. Aims In this multicentre case–control study, our aim was to compare the socio‐demographic, clinical and criminological characteristics of a sample of Italian forensic in‐patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in‐patient services elsewhere in Europe. Methods Secure hospital unit in‐patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed. Results Overall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide‐related behaviours was significantly lower among the Italian patients than among the others. Conclusions Notwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide‐related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation.

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The Closure of Forensic Psychiatric Institutions in Italy

Cited by 5 publications

References 5 publications

Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

The closing of forensic psychiatric hospitals in Italy: Determinants, current status and future perspectives. A scoping review

Difference between forensic patients with schizophrenia spectrum disorders in Italy and other European countries: Results of the EU‐VIORMED project

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