The Italian experience of deinstitutionalization: Achievements, challenges, and future directions

• In Event: The importance of alternatives: Mental health and wellbeing in correctional contexts

Abstract

Italy has led a radical deinstitutionalization process, completing the closure of civil psychiatric hospitals in the last century and shutting down forensic psychiatric hospitals ten years ago. Contrary to widespread concerns, this transition did not lead to a public safety crisis. Mental health care is now almost entirely managed at the community level, though severe resource constraints place a heavy burden on professionals. The discrepancy between an ambitious legislative framework and the limited available resources presents a long-term challenge.
One notable issue arising from the closure of forensic psychiatric hospitals is the increasing number of individuals under mandatory supervised release now being managed by community mental health departments. This shift has effectively integrated mental health services into the broader social security system, requiring complex and resource-intensive interventions. Moreover, the care of psychiatric patients—particularly those with severe mental illness, as is often the case for individuals under supervised release—demands a multidisciplinary approach involving psychiatrists, psychologists, social workers, and rehabilitation specialists. However, most community mental health departments in Italy continue to follow a physician-centered model, with a predominance of medical specialists, making such comprehensive management difficult.
More than 45 years after the reform, the overall impact remains positive, though certain aspects require adaptation to contemporary needs. For instance, the lack of intermediate civil measures between compulsory treatment and full autonomy in refusing care poses a significant challenge. Many individuals deteriorate to a critical clinical state before intervention becomes possible. This contribution aims to explore the emerging challenges in managing forensic psychiatric patients within both the justice and healthcare systems.

Authors

• Stefano Ferracuti, Department of Human Neuroscience, “Sapienza” University of Rome.

• Benedetta Barchielli, Department of Human Neuroscience, “Sapienza” University of Rome.