From the closure of the O.P.G. to the functions of the R.E.M.S.: analysis of an experience

Objective. This study analyzes the practical effects of Law 81/2014 by comparing the profiles of two patient cohorts hospitalized in Castiglione delle Stiviere (MN): one in the Judicial Psychiatric Hospital (O.P.G.) in 2013 and the other in the polymodular Residence for the Execution of Security Measures (R.E.M.S.) in 2023.

Methods. Data from 200 patients were collected from medical records and entered into a dedicated database, including socio-demographic, clinical, and legal variables.

Results. The comparison showed a decrease in the proportion of female patients, in admissions from outside the catchment area, and in mean age at admission. Transfers from other O.P.G.s declined, as did admissions for crimes against the person, whereas admissions related to minor offenses such as resisting a public official increased. Substance use disorders became more prevalent. Diagnostic distribution shifted, with schizophrenia and psychotic/delusional disorders still dominant, but a larger share of personality disorders.

Conclusions. The polymodular R.E.M.S. of Castiglione delle Stiviere appears representative of the national R.E.M.S. system. The principles of territoriality and transitoriness introduced by Law 81/2014 are largely respected, but the residual nature of custodial security measures is only partially achieved. This gap is mainly due to limited collaboration between judicial and healthcare authorities and between R.E.M.S. and community psychiatric services.