Clinical Practice & Epidemiology in

Mental Health
An open access journal publishing under CC-BY 4.0

ISSN: 1745-0179

An innovative approach to overcoming a forensic

psychiatric hospital in Italy: a ten-year impact evaluation
Authors:
Liliana Leone2*,Gaetano Giunta5,Gaspare Motta1,Lucia Martinez6,Giancarlo
Cavallaro3,Angelo Righetti4

Affiliation:
1
Mental Health Department, DSM, ASP 5, Messina, ITA
2
Research and Evaluation, CEVAS Center for Research and Evaluation, Rome, ITA
3
Health and social services, Consortium SO.LE. Soc.Coop., Messina, ITA
4
Scientific Committee, Fondazione di Comunità di Messina O.n.l.u.s., Messina, ITA
5
Secretary General, Fondazione di Comunità di Messina O.n.l.u.s., Messina, ITA
6
Dipartimento Ricerca Disabilità, ISTAT Istituto nazionale di statistica, Rome, ITA

Abstract:
Aims:
To evaluate the impacts of a pilot project concerning the dismantlement and the
closure of the Forensic Hospital Barcellona Pozzo di Gotto in Italy through a model
based on the Capability Approach and on building opportunity of choice at community
level.
Background:
With the closure of Forensic Psychiatric Hospitals (FP) in 2015 Italy officially became
the first country worldwide to close such institutions. After the closure of Italian FHs
some critical issues arose relating to the development of small-scale facilities and
mental health services such as the residences for the execution of security measures
(REMS). Few studies, however, provided outcome results for cohort of patients
discharged from FPs.
Objective:
Identifing the outcomes of the pilot project Luce é Libertà in terms of social and
labour insertion, health conditions, level of dangerousness to other, rate of
readmission in forensic services, costs for the national health system.
Method:
A pre-post evaluation design was performed with a comparison between the
intervention and control group for the healthcare cost analysis. Data were collected
from 2010 to 2019 at three points: T0) as baseline, T1 and T2) for the follow-up. The
tools used for the assessment are: a structured questionnaire which includes the
Scale HoNOS Secure , 4 sub-scales of ICF- Classification of Functioning of Disability
and Health (Sociality, Culture and knowledge, Daily life, Income and work) with and
high internal consistency (Cronbach’s Alpha from 0.76 to 0.94), and n.20 interviews
with key stakeholders and beneficiaries.
Result:
Main results are: a) the discharge of 55 patients through the use of a person-centred
approach and the Personal Capability Budget (PCB); b) the expansion of capabilities
and a significant improvement of ICF functioning (t-test Sig. <, 02).; c) the reduction
of the risk for others and for themselves (Mean Diff. -2,15 Sig. .000); d) at T2 42% of
beneficiaries achieved a job placement and 36% are living in one's own home; e) at
T2 the need of Residence for the Execution of Security Measures (REMS) or prison has
fallen from the initial 70% to 6.8%; f) reduction of the healthcare costs from the
fourth year onwards.
Conclusion:
Indications emerge to support processes of de-institutionalisation and capabilities
expansion through innovative models, a person-centred approach supported by PCBs,
social finance and social impact investments.
Other:
None

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