The model of care for forensic psychiatry in Italy was changed by law (Law 81/2014) so that the six legacy secure forensic hospitals (Judicial Psychiatric Hospitals, OPG) were closed and new secure community residences for the execution of security measures (REMS) were opened in each of the 20 regions of Italy. This transition was in place by 2015. This observational study evaluates the health gains for patients both previously in OPGs and those admitted first to REMS. Health gains assessed include recovery measured by symptoms, function, need for therapeutic security and recovery of legal autonomy.
All those detained in REMS in the twelve month period 2019 to 2020 form the reference population. Samples are assessed for symptom severity (BPRS), global function (GAF), cognitive function (MMSE), risk and protective factors for violence (HCR-20, SAPROF), personality factors (PCL-R), measures of need for therapeutic security (DUNDRUM-1), treatment response relevant to violence and mental illness (DUNDRUM-3) and forensic recovery (DUNDRUM-4). Outcome measures include violent and challenging behaviour (MOAS), length of stay, conditional (legal) discharge.
Study Type
OBSERVATIONAL
Enrollment
245
the components of treatment as usual (TAU) are summarised and assessed by the items of the DUNDRUM-3: physical health, mental health, substance misuse, problem behaviours, self care and activities of daily living, education occupation and creativity, family and intimacy.
University of Bari
Bari, Italy
length of stay in REMS
time (days) from admission to move out of REMS
Time frame: date of admission to REMS through study completion, an average of 18 months
Functional recovery
change in GAF over time
Time frame: Date of first, second and third assessments in REMS through study completion, an average of 18 months
violence while in REMS
MOAS in the intervals between first, second and third assessments in REMS an average of 18 months
Time frame: Date of first, second and third assessments in REMS through study completion, an average of 18 months
Readmission to REMS
time (days) until readmission to REMS following discharge from REMS an average of 18 months
Time frame: date of discharge from REMS to date of readmission to REMS, if any.
conditional discharge
time (days) from date of assessment to date of conditional discharge
Time frame: date of assessment to date of conditional discharge an average of 18 months
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