From custody to community: outcomes of psychiatric security measures in Southern Italy

Objectives. To provide a real-world snapshot of the entire forensic caseload of a community service in Southern Italy, through two cohorts (under measure and discharged after revocation), testing whether community management is associated with deinstitutionalization, clinical improvement and continuity of care, and characterizing the governance criticalities of the pathway (provisional measures, enforcement times).

Methods. Retrospective observational study of two cohorts (n=112 under measure; n=44 discharged for at least one year). Socio-demographic, clinical, criminological and pathway variables were collected; clinical course was measured with the Clinical Global Impression–Severity (CGI-S) at measure initiation (T0) and at assessment (T1). Descriptive analysis and bivariate tests (Wilcoxon for paired data, chi-square/Fisher).

Results. The under-measure population was predominantly male (88.4%), with a mean age of 42.5 years, single (82.1%) and unemployed (83.0%); psychotic spectrum (34.8%) and dual diagnosis (23.2%) predominated, with substance use in 56.2% and offences against the person in 71.4%. A total of 70.5% were under a provisional measure. A shift toward less restrictive measures was observed (REMS 27→22; probation 49→61) and a significant improvement in CGI-S (4.42→3.93; p<0.001), with active care in 97.3%. In the discharged cohort (median follow-up 3.8 years), 75.0% had no critical events and remained in care, with criminal recidivism in 15.9%.

Conclusions. In a Southern Italian service, the community model is associated with clinical improvement, deinstitutionalization and high continuity of care, despite a marked reliance on provisional measures. These data provide an empirical argument against regressive pressures toward increased containment.