Abstract

MEZZINA, Roberto. Penal conviction and treatment. Mental health services in Italy after the closure of forensic hospitals. Rev. Asoc. Esp. Neuropsiq. [online]. 2022, vol.42, n.141, pp.227-249.  Epub July 18, 2022. ISSN 2340-2733.  https://dx.doi.org/10.4321/s0211-57352022000100015.

The paper describes the process of reform that took place in Italy with the closing of all of the forensic psychiatric hospitals in the country and their replacement with a network of small forensic units. The use of forensic hospitals was ruled by the exclusion from trials of persons with a severe mental illness that hampered their capacity, but, if declared ‘socially dangerous', were submitted to a system of ‘security measures'. This significant change in Italy occurred between 2011 and 2017, and it was meant as the final step of the reform process in mental heathcare that started in 1978, with the complete closure of all psychiatric hospitals in 1999.

The new small forensic units, with an overall limited number of beds for the whole country, are called REMS (Residences for the Execution of Security Measures). They are managed by Regions and are based on the principles of therapeutic and recovery orientation, transitory and territorial response, and responsibility of community mental health services for facilitating discharge. The ways of implementing the law regarding REMS' features were diverse, e.g., public or private management, number of beds, open door policy, or inclusion in mental health departments aiming at the prevention and provision of alternatives on part of community mental health services. Some significant experiences were those of Trieste and the region of Friuli Venezia Giulia, which set up personalized pathways of care, supporting their patients within prison and in the judicial system.

There is still a difficult balance with the judicial and prison system, which often emphasizes confinement and the ‘custodial' function in REMS as a novel substitute of old forensic hospitals, and makes ongoing pressure for a wider use and availability of their beds, including the diversion of people from prisons to REMS. The Constitutional Court has recently stopped the risk of a reaction against the reform, but there is still a harsh debate about the future of REMS. More radical and coherent changes, according to the CRPD and other international instruments for protection of human rights, can be carried out only with a further legislative change, abandoning the concepts of incapacity and dangerousness, which are still the pillars of the penal code. The article provides recent general data, exemplary practices, and critical observations, and concludes with a series of indications for change in policies and practices.

Keywords : forensic hospitals; human rights; mental health services; prison; legislation; incapacity; dangerousness; mental health reform.

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