Dall'OPG alle REMS: studio di risk assessment in una popolazione psichiatrico forense

The legislative innovation introduced by Law 81/2014 ratified that the implementation of the custodial Security Measures and the consequent admission in REMS (Residences for the Execution of Security Measures) of psychiatric patients offenders constituted a condition of extrema ratio to be activated only where "every other measure has proved to be not appropriate to ensure adequate care and to cope with the patient's social dangerousness". Given that the law has intervened on a legal structure unchanged and rigidly focused on the concept, now obsolete, of social dangerousness, it was expected that the new legislative orientation determined a clear reduction of the custodial Security Measures in view of a more objective and clear assessment of category of danger best described as a risk of recidivism. In fact it was expected that the forensic psychiatry could finally participate in the "scientific" construction of the social dangerousness’ concept, based on the survey and evaluation of the presence and extent of potential risk factors and protection in the case, with the prospect of contribute to a sort of "risk assessment" of violent behavior of the psychic suffering. OBJECTIVES: The aim of the study is to assess how the intervention of the law 81 has changed number and social dangerousness profile of patients undergone a custodial security measure. METHODS: We recruited all patients interned in the Judicial Psychiatric Hospital of Castiglione delle Stiviere in the previous year of the REMS’ opening and compared, about social dangerousness and clinical and legal variables, to all the subjects interned within the following year of the Judicial Psychiatric Hospital closure. The assessment of the risk of recidivism (risk assessment) was carried out by the administering of actuarial scales (VRAG; HCR-20, PCL-R) capable of identifying a risk class. RESULTS: Analysis of the data would seem to indicate that the legislative innovation nothing has changed in terms of the number of designations and hazard profiles, glimpsing a wide level of criticality regarding the ways and possibilities of application of the law itself.