THE NEW ITALIAN RESIDENTIAL FORENSIC PSYCHIATRIC SYSTEM (REMS). A ONE-YEAR POPULATION STUDY

Abstract

The process of deinstitutionalization of the Italian forensic psychiatric system consisted mainly of the replacement of forensic psychiatric
hospitals with the Residences for the Execution of Security Measures (REMS), and with community treatment of forensic psychiatric
patients. The 30 existing REMS are regional-based community residential facilities with no more than 20 patients each, designed to accomplish
a preeminent therapeutic/rehabilitative purpose, with limited duration of treatment and the absence of police officers. The
present study aims to describe the clinical, criminological, and treatment characteristics of the REMS patient population between June
2017 and June 2018. The health managers of the 28 participating REMS provided data through an ad-hoc form relating to N = 730
patients (80 females), with average age of 41.7 (SD 11.8) years with a mean long history of disease. The patients were mostly already in
psychiatric care at crime time (82.2%), and 48.4% had previous criminal convictions. Most patients suffered from schizophrenia (33.0%),
personality disorder (32.0%) and substance-related and addictive disorders (21.4%). Significant psychiatric comorbidity emerged. The
crimes underlying the measure were homicide/attempted homicide (26%), personal injury/threats/harassment (24%), domestic violence
(29%), property crime (12%), violence against a public official (7%), stalking (7%), sexual crimes (4%), and misdemeanors (1%). Most of
the victims were family members (45%), followed by previously unknown persons (31%). The most frequently used therapeutic approach
was pharmacotherapy (98%), followed by psychiatric rehabilitation (81%) and psychotherapy (57%). We found a significant degree of variability
of aggressive behavior in the REMS as measured by the Modified Overt Aggression Scale, with a predominance of verbal and
physical aggression, but no gender differences emerged. Among recorded critical events we found absconding (5.3%), involuntary admission
to civil hospital (5.9%) and physical restraint (4.1%). The REMS-based Italian forensic psychiatric system has some criticalities that should
be deepened and addressed in order to preserve aspects of the protection of patients and the community.