RESIDENCES FOR PATIENTS IN DETENTION MEASURE SECURITY (REMS) OF THE ASL OF CASERTA: A FIRST STATEMENT

Abstract

Background and Purpose: The recent laws related to the overcoming the Forensic Hospitals (or Ospedali Psichiatrici Giudiziari, OPGs)
have led to the closure of the 6 Italian OPGs and the opening of new Residential Services for the Execution of Security Measures
(RSESM), which today welcome mental patients which have been committed a crime. The purpose of this work is to describe the experience
of the RSESM of the ASL of Caserta from 30thApril 2015 to date, showing the achievements but also the difficulties and problems
related to their management.
Method: An analysis of the recent laws related to the OPGs overcoming, together with their application in care pathways was made.
Results: The health management of the mentally ill offenders has profoundly changed in the RSESM compared with the OPGs. In fact,
a custodial approach is no longer present in these structures but only a health/welfare approach. This change has led to a high number of
discharged people (n. 119 of n.152, i.e. 79%) who has been assigned to the territorially competent mental health departments. However,
the application of the new laws still today presents critical issues related to an excessive number of mentally ill patients with minor crimes
which the magistrates send in the REMS; local services that rarely take charge of difficult patients; poor communication between health
professionals and magistrates.
Conclusion: The new healthcare approach has shown positive aspects related to patient care and recovery. However, the poor communication
between health professionals and magistrates, regarding the application of alternative measures to RSESM, are totally or partially
unaddressed problematic features.