Abstract
The closing of six forensic psychiatric hospitals (OPG-Ospedali Psichiatrici Giudiziari) in Italy completed the long transition to a psychiatric community model of treatment. From 2014 to 2017, 20-bed, secure, community forensic residential facilities (REMS) were built and activated by regional health authorities in Italy, where people with mental disorders who committed a criminal offense, without criminal responsibility but still considered socially dangerous, must be treated. The REMS are health facilities where healthcare workers encourage inpatients to participate in a recovery-oriented rehabilitation project in order to return them to local services as soon as possible. Many difficulties obstruct the road to rehabilitation: interaction between the judicial and the healthcare sectors and among healthcare workers inside and outside the REMS; characteristics of the inmates and their level of collaboration; and lack of a penal code befitting the new situation. In this chapter, the authors describe the risks of violent behavior and the manner in which it must be avoided and managed in the two REMS of the Piedmont region. Following a request by the healthcare workers, an internal, unarmed guard was added to the staff. This guard participates in rehabilitation activities with the patients, reducing risk of injuries in the forensic residential facilities.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Margara A. Il lungo processo di superamento degli ospedali psichiatrici giudiziari. Riv Sper Fren. 2011;1:53–74.
Crepet P, De Plato G. Psychiatry without asylums: origins and prospects in Italy. Int J Health Serv. 1983;13(1):119–29.
Carabellese F, Felthous AR. Closing Italian forensic psychiatry hospitals in favor of treating insanity acquittees in the community. Behav Sci Law. 2016;34(2–3):444–59.
Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman R. The mental health of prisoners: a review of prevalence, adverse outcomes and interventions. Lancent Psychiatry. 2016;3(9):871–81.
Butler T, Indig D, Allnutt S, Mamoon H. Co-occurring mental illness and substance use disorder among Australian prisoners. Drug Alcohol Rev. 2011;30:188–94.
Voulgaris A, Kose N, Konrad N, Opitz-Welke A. Prison suicide in comparison to suicide events in forensic psychiatric hospitals in Germany. Front Psychol. 2018;9:398.
Castelpietra G, Egidi L, Caneva M, Gambino S, Feresin T, Mariotto A, et al. Suicide and suicides attempts in Italian prison epidemiological findings from the “Triveneto” area, 2010–2016. Int J Law Psychiatry. 2018;61:6–12.
Blitz CL, Wolff N, Shi J. Physical victimization in prison: the role of mental illness. Int J Law Psychiatry. 2008;31:385–93.
Teplin LA, McClelland GM, Abram KM, Weiner DA. Crime victimization in adults with severe mental illness—comparison with the national crime victimization survey. Arch Gen Psychiatry. 2005;62:911–21.
Goncalves LC, Goncalves RA, Martins C, Dirkzwager AJE. Predicting infractions and health care utilization in prison: a meta-analysis. Crim Justice Behav. 2014;41:921–42.
Campbell MA, French S, Gendreau P. The prediction of violence in adult offenders: a meta-analytic comparison of instruments and methods of assessment. Crim Justice Behav. 2009;36:567–90.
Schenk AM, Fremouw WJ. Individual characteristics related to prison violence: a critical review of the literature. Aggress Violent Behav. 2012;17:430–42.
Baranyi G, Cassidy M, Fazel S, Priebe S, Mundt AP. Prevalence of posttraumatic stress disorder in prisoners. Epidemiol Rev. 2018;40:134–45.
Håkansson A, Jesionowska V. Associations between substance use and type of crime in prisoners with substance use problems—a focus on violence and fatal violence. Subst Abuse Rehabil. 2018;9:1–9.
Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction. 2017;112:1725–39.
Seppanen A, Törmänen I, Shaw C, Harry Kennedy H. Modern forensic psychiatric hospital design: clinical, legal and structural aspects. Int J Ment Health Syst. 2018;12:58.
Casacchia M, Malavolta M, Bianchini V, Di Michele V, Giosuè P. Closing forensic psychiatric hospitals in Italy: a new deal for mental health care? Riv Psichiatr. 2015;50(5):199–209.
Ferracuti S, Biondi M. The reform of the Penitentiary Order. A cultural revolution that involves the Mental Health Services. Riv Psichiatr. 2018;53(1):1–4.
Yoon I, Fazel S, Slade K. Outcomes of psychological therapies for prisoners with mental health problems: a systematic review and meta-analysis. J Consult Clin Psychol. 2017;85(8):783–802.
Cimino L. Il superamento degli Ospedali Psichiatrici Giudiziari: un’analisi critica. Riv Crim, Vitt e Sicur. 2014;8(2):229–45.
Di Lorito C, Castelletti L, Lega I, Gualco B, Scarpa F, Vӧllm B. The closing of forensic psychiatric hospitals in Italy: determinants, current status and future perspectives. A scoping review. Int J Law Psychiatry. 2017;55:54–63.
Pelissero M. Pericolosità sociale e doppio binario. Vecchi e nuovi modelli di incapacitazione. Torino: Giappichelli; 2008.
France G, Taroni F. The evolution of health-policy making in Italy. J Health Polit Policy Law. 2005;30(1–2):169–88.
Gadon L, Johnstone L, Cooke D. Situational variables and institutional violence: a systematic review of the literature. Clin Psychol Rev. 2006;26:515–34.
Nhiwatiwa FG. The effects of single session education in reducing symptoms of distress following patient assault in nurses working in medium secure settings. J Psychiatr Ment Health Nurs. 2003;10(5):561–8.
Baxter E, Hafner RJ, Holme G. Assaults by patients: the experience and attitudes of psychiatric hospital nurses. Aus N Z J Psychiatry. 1992;4:567–73.
Sacchetti E, Mencacci C. The closing of the Italian forensic hospitals: six months later. What we have learned and we need. Evid Based Psychiatr Care. 2012–2015;1:37–9.
Atkinson JM, Garner HC. Least restrictive alternative–advance statements and the new mental health legislation. Psychiatr Bull. 2002;26(7):246–7.
Tomlin J, Bartlett P, Völlm B. Experiences of restrictiveness in forensic psychiatric care: systematic review and concept analysis. Int J Law Psychiatry. 2018;57:31–41.
Latte G, Avvisati L, Calandro S, Di Filippo C, Di Genio M, Di Iorio G, et al. From OPG to REMS: the role of a territorial health service in the implementation of security and non-custodial measures towards offenders with psychological problems. Riv Psichiatr. 2018;53(1):31–9.
De Girolamo G, Buizza C, Sisti D, Ferrari C, Bulgari V, Iozzino L, et al. Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence. J Psychiatr Res. 2016;80:5–13.
Kay SR, Wolkenfelf F, Murrill LM. Profiles of aggression among psychiatric patients: I. Nature and prevalence. J Nerv Ment Dis. 1988;176:539–48.
Acknowledgments
The authors thank Marina Gentile and Antonella Maffioletti of the Health Regional Authority and Martina Ciminiello for technical editing.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Zanalda, E., De Cori, D., Ala, G., Sodano, A.J., Zuffranieri, M. (2020). Violent Behavior in Forensic Residential Facilities: The Italian Experience After the Closure of Forensic Psychiatric Hospitals. In: Carpiniello, B., Vita, A., Mencacci, C. (eds) Violence and Mental Disorders. Comprehensive Approach to Psychiatry, vol 1. Springer, Cham. https://doi.org/10.1007/978-3-030-33188-7_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-33188-7_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-33187-0
Online ISBN: 978-3-030-33188-7
eBook Packages: MedicineMedicine (R0)