Descriptive analysis of pathways to Care and Rehabilitation among Psychiatric Offenders after the closing of Forensic Psychiatric Hospitals in Italy

Abstract

After the closing of Forensic Psychiatric Hospitals in Italy, promoted by the law 81/2014, pathways to care and rehabilitation of Psychiatric Offenders have been redesigned: the Departments of Mental Health have been assigned the task of developing specific treatment paths for offenders and those patients considered to be socially dangerous. Residential Forensic Psychiatric System (REMS, Residenze per l'Esecuzione della Misure di Sicurezza) has been designed to accomplish a preeminent therapeutic purpose for these patients. Aim: this descriptive study aimed to report on the pathways to care and rehabilitation, after five years from the closing of forensic hospitals, among psychiatric offenders from the Department of Mental Health of Foggia, a large urban area in Puglia, in the south of Italy. Methods: medical records of 100 psychiatric offenders and/or socially dangerous mentally ill patients from Foggia have been collected and reviewed from May 2018 to March 2019 for gathering socio-demographic and clinical information. Results: socio- demographic and clinical characteristics of examined cases were similar to those reported in other Italian studies; 55% of offenders have been diagnosed with a mental disorder before committing their first offense: 62% schizophrenia and other psychoses> 17% bipolar disorders > 7% depressive disorders> 5% anxiety disorders = 5% personality disorders> 3% substances abuse (only) > 1% others. Crimes committed were: 48% against persons or sexual abuse> 19% robbery or theft>10% trafficking of drugs; 12% homicides; 11% others. Diagnosis of psychosis was significantly associated with a high rate of crime against persons. Also, 38% of the sample did not receive any rehabilitation intervention and were detained in prison, even if the rate of rehabilitation increased after the approval of the law. Conclusions: these realworld findings reported on the increase of specific rehabilitation interventions for psychiatric offenders after five years from the closing of forensic hospitals. Emerging characteristics of this study may suggest new tailored interventions to be discussed and adopted in the clinical management of this challenging group of severely mentally ill patients.