Intellectual Disability, Mild to Moderate, Mental Disorder, Personality Disorders and Disturbances in Behavior, Personality Disorders, Antisocial, Recovery, Schizophrenia and Related Disorders
Conditions
Keywords
Forensic, social dangerousness, therapeutic security
Brief summary
The model of care for forensic psychiatry in Italy was changed by law (Law 81/2014) so that the six legacy secure forensic hospitals (Judicial Psychiatric Hospitals, OPG) were closed and new secure community residences for the execution of security measures (REMS) were opened in each of the 20 regions of Italy. This transition was in place by 2015. This observational study evaluates the health gains for patients both previously in OPGs and those admitted first to REMS. Health gains assessed include recovery measured by symptoms, function, need for therapeutic security and recovery of legal autonomy.
Detailed description
All those detained in REMS in the twelve month period 2019 to 2020 form the reference population. Samples are assessed for symptom severity (BPRS), global function (GAF), cognitive function (MMSE), risk and protective factors for violence (HCR-20, SAPROF), personality factors (PCL-R), measures of need for therapeutic security (DUNDRUM-1), treatment response relevant to violence and mental illness (DUNDRUM-3) and forensic recovery (DUNDRUM-4). Outcome measures include violent and challenging behaviour (MOAS), length of stay, conditional (legal) discharge.
Interventions
OTHERTreatment as usual (TAU)
the components of treatment as usual (TAU) are summarised and assessed by the items of the DUNDRUM-3: physical health, mental health, substance misuse, problem behaviours, self care and activities of daily living, education occupation and creativity, family and intimacy.
Sponsors
University of Dublin, Trinity College
University of Bari
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* admitted to REMS * voluntarily consents to participate
Exclusion criteria
* MMSE less than 19
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| length of stay in REMS | date of admission to REMS through study completion, an average of 18 months | time (days) from admission to move out of REMS |
| Functional recovery | Date of first, second and third assessments in REMS through study completion, an average of 18 months | change in GAF over time |
| violence while in REMS | Date of first, second and third assessments in REMS through study completion, an average of 18 months | MOAS in the intervals between first, second and third assessments in REMS an average of 18 months |
| Readmission to REMS | date of discharge from REMS to date of readmission to REMS, if any. | time (days) until readmission to REMS following discharge from REMS an average of 18 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| conditional discharge | date of assessment to date of conditional discharge an average of 18 months | time (days) from date of assessment to date of conditional discharge |
Other
| Measure | Time frame | Description |
|---|---|---|
| Death | from date of admission to date of death while in REMS, if any up to two years | death while in REMS, if any |
Countries
Italy
Outcome results
None listed