The forensic patient in psychiatric residential facilities: a research in a Therapeutic Community

Abstract

Italian Government has decided that in 2013 italian forensic mental hospitals (Ospedali psichiatrici giudiziari”) shall close: offenders sentenced to a “misura di sicurezza” (detention in psychiatric care) will be restrained in facilities appointed by the National Health System, either public or accredited private ones. Since the 90s, some private psychiatric residential facilities are already treating such patients, on appointment with NHS mental health departments: the main aim of this study is to understand if and how forensic psychiatric patients hosted in one of such institutions differ from non-forensic ones. For this purpose, an analysis of the characteristics of 147 patients of a private facility, including 66 forensic patients and 81 non-forensic patients (hosted between 2005 and 2010), has been performed. Such facility (Pra’ Ellera) founded in Cairo Montenotte (Savona) over twenty year ago, currently hosts about 60 patients (now mainly forensic) and treats them via an integrated approach (both pharmacological and psychodynamic).

Our findings show that, in general, forensic patients did not generally differ significantly from non-forensic ones. Their presence in the community isn’t making their problem worse, despite serious problems such as the long-stay and risk of re-internment to forensic mental hospital. In particular, forensic patients share with others the same failure rate (a quarter of them ‘can’t cope’); the average length of stay is only slightly higher than non-forensic patients; moreover, they are minor players of self-destructive acts (self-harm, attempted suicides). Unlike other guests, forensic patients significantly show a decrease in psychosis, which remains, however, the most common diagnosis in the facility. One could then say, considering the trend, that increasingly small differences may be observed in future between the categories.