Across the walls. Treatment pathways of mentally ill offenders in Italy, from prisons to community care

Federico Boaron 1, Beatrice Gerocarni 1, Maria Grazia Fontanesi 1, Velia Zulli 2, Angelo Fioritti 3

1 Forensic Psychiatric Unit, Department of Mental Health and Substance Abuse, AUSL Bologna, Italy; 2 Coordinator of REMS at Department of Mental Health and Substance Abuse, AUSL Bologna, Italy; 3 Director of Department of Mental Health and Substance Abuse, AUSL Bologna, Italy

The process of deinstitutionalization of psychiatric care in Italy has recently included also the care of psychiatric patients who committed offences. This happened following a set of laws enacted since 2008. The Departments of Mental Health (DMH) belonging to the public National Health System (NHS) are now providing care along the whole psychiatric system, from the treatment of inmates in prisons to care plans in the community. This change requires new cultural paradigms and organizational models. Some DMHs have set up Forensic Psychiatry Units (FPU), dedicated to providing care of such patients with specific treatment pathways both inside and outside the places of detention. The DMH of Bologna set up a FPU dedicated to offer mental health care in prison, juvenile prison and secure residential unit for “not guilty by reason of insanity and socially dangerous” offenders (Residenza per l’Esecuzione della Misura di Sicurezza, REMS). 

According to this model, mental health in penitentiary settings is warranted by a multidisciplinary team comprising psychiatrists, psychologists, nurses and psychiatric rehabilitation professionals. Addiction treatment staff closely cooperate with the FPU in the treatment of dual diagnosis inmate patients. FPU aims to ensure continuity of care for inmates with mental health issues, from their access (or from the onset of the psychiatric disorder) up to community care under any form of release. 

FPU has further expertise areas, supporting Community Mental Health Services in developing and monitoring therapeutic pathways for psychiatric patients under judicial order. This include assessing violence risk at the request of the supervisory courts, and working closely with courts and expert witnesses in developing tailor-made prescriptions for offenders sentenced to the safety measure of probation.

In view of the complexity of these cases, in which the needs of care, control and reintegration into the social fabric are intertwined, we consider mandatory to widespread specific skills regarding offenders assessment and treatment, relying whenever possible on evidence-based tools.

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