Clinical risk management in High-Security Forensic Psychiatry Residences. Protecting patients and health professionals: perspectives and critical issues of the Law 81/2014
V. 171 N. 2 (2020), Commentary
V. 171 N. 2 (2020)

Clinical risk management in High-Security Forensic Psychiatry Residences. Protecting patients and health professionals: perspectives and critical issues of the Law 81/2014: doi: 10.7417/CT.2020.2196

Commentary
Pubblicato 2020-03-10
G. Gualtieri
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena
S. Traverso
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena
A. Pozza
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena
F. Ferretti
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena
F. Carabellese
Aldo Moro” University of Bari, Bari
R. Gusinu
Health Service Management Board, Santa Maria alle Scotte University Hospital of Siena, Siena
A. Coluccia
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena
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Parole chiave

Violence risk assessment
Clinical risk management
Psychiatric patients
Violent behaviour
Mental health services
REMS

Abstract

The Italian Law n. 9/2012 provided the Italian Regions with a new decisional role by demanding the management/rehabilitation of prisoners judged as partially/fully mentally ill to care and protection delivered by the psychiatric services of the Regional Health Service. Healthcare has to be guaranteed by the so-called High-Security Forensic Psychiatry Residences (Italian: Residenze per l’Esecuzione delle Misure di Sicurezza: REMS) and by community mental health centres. Ensuring patients’ and professionals’ health and safety is a complex issue which requires effective strategies to cope with several structural, technological, and organisational problems.

The present paper summarises the historical evolution of the Italian laws towards the development of the High-Security Forensic Psychiatry Residences in Italy, focusing specifically on the Tuscany Region situation. The paper also presents the key issues emerging after the implementation of the Law 81/2014 which complemented the Law 9/2012. Since these reforms included the need for assessing to what extent the patient may be considered as a danger to society and for ensuring the safety of National Health Service (NHS) professionals, they underscored the importance of a preventive use of specific clinical governance tools aimed to reduce risk of adverse events.

The present work has the strength of proposing a new, evidencebased scientific approach to the implementation of assessment and care pathways in High-Security Forensic Psychiatry Residences

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