From a Custodial Model to a TherapeuticRehabilitative Model: A Critical Analysis of the Italian Forensic Psychiatric System, the Contribution of Dedicated CRAPs in Puglia, and the New Guidelines of the PANSM

Abstract

The Italian psychiatricforensic system has undergone a radical transformation with the definitive closure of the Forensic Psychiatric Hospitals (OPGs), established by Law No. 81/2014, which introduced Residences for the Execution of Security Measures (REMS) and a network of facilities integrated with territorial services. Despite these advances, significant critical issues persist: a shortage of beds in REMS, marked regional disparities in service provision, and difficulties in the social reintegration of discharged patients. This article critically analyzes the current system and proposes concrete operational solutions to improve the quality of forensic treatment in Italy, focusing on territorial equity, public safety and human rights, in light of the National Action Plan for Mental Health (PANSM). Furthermore, the article presents the case study of the dedicated Psychiatric Assisted Rehabilitation Communities (CRAPs) in the Apulia region – a denomination specific to the Apulian Regional Health Service (SSR) – which systematically applies Structured Professional Judgment (SPJ) tools. Empirical data on 92 patients suggest preliminary evidence of the effectiveness of individualized rehabilitation pathways (reductions in symptom severity, risk of violent recidivism, and increases in protective factors), offering insights for less restrictive, more rehabilitationoriented
models as a valid alternative to REMS for mediumtolowrisk patients.