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What They Don't Say About REMS

What are they?

REMS, an acronym of four words unknown to most people. The residences for the execution of safety measures were first established in 2014 with the law n.81, to close once and for all the judicial psychiatric hospitals (OPG in Italian).

These structures were thought as places where authors of crime affected by mental diseases and considered socially dangerous could be hosted. The staff is entirely made up of healthcare workers, with the purpose of accompanying these people through a treatment path, to better re-integrate into society once their period of detention is finished.

Safety measures are taken in two circumstances, specifically when the existence of a crime or the dangerousness of the culprit is confirmed. These disciplinary actions can be renewed within an interval of six months, following an evaluation on the patient’s mental health status.

Why are they important?

Two important passages were made in Italy for the birth of REMS. The first achievement goes back to law n.180 in 1978, known as Basaglia law. The name of the law derives from the Italian psychiatrist, neurologist, and Professor Franco Basaglia. As a result, criminal madhouses were finally closed, and the OPG hospitals were instituted. 

The institution of OPG entered the Italian penal system in 1975. However, this new method had not been able to sort out a big problem within judicial psychiatric hospitals: the white life sentence. An expression signifying the abandonment of patients in mental hospitals, due to the absence of proper places and staff able to provide for their needs. To end this phenomenon, the existing law was changed: the presence of a person in a facility could not be longer than the penalty prescribed for his/her crime.

The residences for the execution of safety measures were then born as a solution to permanently delete the problem of white life sentences.

How are they distributed?

REMS are entirely administrated by regions, to allow residents to receive appropriate mental health services in their place of residence. In fact, the method established with law n.81 of 2014 has the aim to prevent the patient’s eradication from their birthplace. If it happens, this could greatly aggravate the patient’s condition. In order to have as many residences as possible at nation level, the Italian State has decided to allocate 170 million euros. The previous idea of the project was to equip regions with these structures within the 31st of March 2015.    

From the map updated to the 31st of November 2020 we are able to see some anomalies and special cases that are apparently in contrast with the law instituting the REMS. The first emerging element from the graphic is the lack of structures in Valle d’Aosta, Umbria and Molise. This underlines the failure of the project’s aim of 2015. As a result, the residences that are currently open are 32. The second aspect concerns the single situation of Lombardia, where only one structure counts 151 patients. Castiglione delle Stiviere is in fact a polyclinic system, within which there are 8 REMS.

Graphic with the Italian map and structures.

What are the waiting lists and why are they a problem?

The absence of facilities in some Italian regions and the limited number of places available per facility has created a problem that calls into question their validity: waiting lists.

Among the reasons that forced the Italian State to adopt the system of REMS there was the urgency to resolve the overcrowding within OPG. With the agreement of the 26th of February 2015, the maximum of sleeping accommodations per structure was limited to 20. However, to respect the imposed parameters, access to these structures became nearly impossible for criminal offenders affected by mental health problems and socially dangerous. The preliminary investigation of June 24 2021 (Report 2) conducted by the Italian Constitutional Court showed that between 670 and 750 people are currently on the waiting list for allocation into a REMS, with an average waiting time of 10 months.

These data, however, may not be accurate at all, given the lack of updated information in some Regions. In fact, the SMOP (Informative system for the monitoring of the psychiatric hospitals’ overcoming) shows only 175 patients currently on the waiting list (Report 1). To conclude, although the results of the two studies are not identical, both show that waiting lists are getting longer.

Graphic of the waiting lists.

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