Forensic criteria, clinical and theoretical issues of the indication of court-ordered treatment: A comparative survey among experts in forensic psychiatry and sentencing judges in France.

Following the French law n° 98-468 of 17 June 1998 relative to the prevention of sexual offenses and the protection of minors, social and judicial follow-up and court-ordered treatment were introduced with the aim of reinforcing the prevention of recidivism. Court-ordered treatment is one of the possible obligatory measures provided for by social and judicial follow-up. However, there is no consensus between the different professionals concerning the criteria of indication and the final purpose of this measure. Most of the few available studies are retrospective. Only rare studies have assessed the influence of criminological factors on the indication of court-ordered treatment. We carried out a nation-wide qualitative comparative study in two populations, psychiatric experts and sentencing judges, by means of e-mail questionnaires. The aim was to determine the criteria for court-ordered treatment according to psychiatric experts and to sentencing judges, to identify the criteria that gave rise to differences in appreciation between these professionals, and to attempt to explain these differences. The secondary aim of the study was to determine the methods and tools used in expert practice to evaluate dangerousness and risk of recidivism. We obtained 20 responses in each of the two populations. The great majority of psychiatric experts and sentencing judges considered that court-ordered treatment was appropriate when the offender presented with psychiatric dangerousness, and so with an underlying mental disorder. When a subject had no identified mental disorder, the psychiatrists were divided in their opinion, whereas the majority of sentencing judges were in favor of court-ordered treatment. Opinions differed particularly significantly between the two populations in four circumstances: a subject with an antisocial/psychopathic personality disorder, a subject who denied the alleged acts, the influence of precarious social circumstances and the influence of instability in intimate relationships. The majority of experts used international classifications (DSM-5 and ICD-10) as a basis for their psychiatric diagnosis. Just under half of those surveyed used structured or semi-structured interview guides and only a few stated that they used standardized actuarial tools to assess risk of recidivism. The concepts of care, dangerousness and mental disorder are associated with multiple representations that certainly play a part in the disagreements between the different professionals. It is of prime importance to define these concepts more clearly in order to encourage the use of a common language and to clarify the indications and purpose of court-ordered treatment. We also hypothesize that disagreements between professionals regarding the criteria for court-ordered treatment may be related to certain difficulties raised by the management of the convicted person. The development of guidelines that could be used by all professionals would help to reduce some of these difficulties. Psychiatric experts remain attached to clinical evaluation. Their limited use of assessment tools may relate to the material constraints and time constraints involved. The issue at stake in court-ordered treatment and social and judicial follow-up is to promote cooperation between the various professionals by creating a space for exchange of ideas where the fundamental questions raised by these measures can be discussed, fears shared and knowledge pooled.

Impact of statutory revisions to family-petitioned civil commitment in South Korea.

INTRODUCTION: This study examined the impact of statutory revisions in 2016 which aimed to enhance procedural justice within the process of civil commitment for persons diagnosed with mental illnesses (PDMI) in South Korea. These changes included requiring that PDMI pose a threat of danger to self or others and the need for treatment simultaneously as criteria for petitioning civil commitment. Additionally, the revision established a public entity to oversee the legitimacy of petitions to involuntarily commit PDMI to inpatient treatment. Despite these statutory changes, families providing care for PDMI still appear to depend on civil commitment as a way to seek respite from care burden, not necessarily to respond to psychiatric emergencies involving dangerousness. This practice seems to be aided by processes within the public entity providing oversight. Due to such barriers we hypothesized that, even after the statutory revision in 2016, PDMI who had been civilly committed following petitions from families will not exhibit elevated dangerousness compared to PDMI who had never been hospitalized during the same period. METHODS: Trained interviewers recruited 331 participants self-identified as PDMI from psychiatric rehabilitation agencies in the community and aided them in completing a survey including measures of self-reported hospitalization history, suicidality, and aggression toward others. Participants were classified into four groups: Family-petition committed (FPC) group (n = 30, 9.1%), voluntarily hospitalized (VH) group (n = 34, 10.3%), public-petition committed (PPC) group (n = 31, 9.4%), and never hospitalized (NH) group (n = 236, 71.3%). We conducted logistic regression analyses to compare self-reported dangerousness between groups with the NH group as the reference group. RESULTS: In the past 12 months, 43.5% of PDMI participants had self-reported behaviors that may have met the dangerousness criteria for civil commitment. Controlling for confounding factors, the PPC group was 2.96 times and 3.02 times as likely to report suicidal ideation and physical aggression, respectively, compared to the NH group. However, as hypothesized, the FPC group did not differ from the NH group on any indicator of self-reported dangerousness. CONCLUSION: The findings were based on cross-sectional correlational data and should not be viewed as conclusive evidence that the 2016 statutory revision is ineffective in preventing family-petitioned civil commitment in cases where dangerousness is not apparent. Nevertheless, these findings encourage further empirical studies that illuminate the etiology of procedural justice in civil commitments petitioned by family members and that assess factors and contexts that promote the consideration of least coercive treatments, rather than resorting to involuntary hospitalization when psychiatric emergencies arise.

The influence of the convention on the rights of persons with disabilities on the European court of human rights in the area of mental health law: Divergence and unexplored potential.

This article explores how the European Court of Human Rights has applied the norms of the UN Convention on the Rights of Persons with Disabilities (CRPD) in the area of mental health law. The European Court was initially receptive to the CRPD, including the UN Committee on the Rights of Persons with Disabilities' call for a repeal of legislation permitting involuntary psychiatric hospitalisation, but later distanced itself from it. The CRPD has nevertheless influenced how the European Court approached (a) involuntary hospitalisation, (b) separating detention from treatment, (c) restraints and other forms of ill-treatment in institutions, and (d) disability-neutral detention based on disability. Despite the two treaty bodies' different jurisprudential methodology and their different assumptions about the role of medical and legal professionals, the CRPD can continue to influence the European Court in areas such as less restrictive alternatives to coercive treatment, the relevance of capacity, and the importance of personal integrity for mental health treatment.

Una plaga citadina peligrosa: los murciélagos / A dangerous urban pest: bats

Los murciélagos son mamíferos vertebrados presentes en la Ciudad de Buenos Aires, estimándose una población de 4 animales por habitante. Son portadores de varias enfermedades importantes y además empeoran las condiciones respiratorias de enfermos crónicos. En el campo cumplen una interesante función, ya que se alimentan de insectos perjudiciales para las siembras. El guano puede ser útil en el abono de la tierra debido al aporte de carbono y nitrógeno. En las ciudades su presencia tiene consecuencias diferentes. Se encuentran en los taparrollos de las habitaciones, así como también en todas las oquedades de muros, árboles, grietas, etc. Se exponen aquí los peligros y los cuidados que deben tenerse en la Ciudad de Buenos Aires ante la invasión de estos quirópteros. (AU)

Bats are vertebrate mammals present in the City of Buenos Aires, with an estimated population of 4 animals per inhabitant. They are carriers of several important diseases and also worsen the respiratory conditions of the chronically ill. In rural areas they fulfill an interesting function, since they feed on insects harmful to crops. Guano can be useful in soil fertilization due to its contribution of carbon and nitrogen. In cities their presence has different consequences. They are found in the roll covers of the rooms as well as in all the hollows of walls, trees, cracks, etc. The dangers and precautions to be taken in the city of Buenos Aires in the face of the invasion of these chiroptera are described here. (AU)

Investigating the cognitive processing of tools: Effects of dangerousness and directionality on attentional biases.

Research has found a tool-based head-superiority effect (responses are faster to target stimuli that appear at the head than at the handle position). However, these studies did not consider the effects of directionality and dangerousness. This study investigated how directionality and dangerousness influence the head-superiority effect. Subjects were required to respond to the target location in all experiments. Experiment 1 manipulated the directionality, dangerousness and target location. Experiment 2 matched the sharpness of the tool tip in the directed conditions. Experiment 3 shortened the presentation time of the cue stimuli from 800 ms to 200 ms. Experiment 4 selected four tools with different functions to rule out an alternative explanation caused by functional repetition. The results indicate that a head-superiority effect emerges in the directed condition, and that dangerousness modulates the magnitude of this effect during the 800 ms condition. However, the modulation effect of dangerousness diminishes during the 200 ms condition.

[Isolation and restraint in units for difficult patients and in psychiatric intensive care units]. / Isolement et contention en unités pour malades difficiles et en unités de soins intensifs psychiatriques.

The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures.

[Soothing in units for difficult patients and in psychiatric intensive care units]. / Apaisement en unités pour malades difficiles et en unités de soins intensifs psychiatriques.

In the units for difficult patients (UMD) and the intensive psychiatric care units (Usip), patients whose mental pathologies have or could generate violent acts which can go as far as committing homicide are taken care of. If, during the psychiatric care of these patients, isolation and restraint measures can be put in place as a last resort, in general it is the symptomatological and behavioral appeasement of these persons that is sought in an alternative way.

Front-line health professionals' recognition and responses to nonfatal strangulation events: An integrative review.

AIM: The aim of this study was to determine how front-line health professionals identify and manage nonfatal strangulation events. DESIGN: Integrative review with narrative synthesis was conducted. DATA SOURCES: A comprehensive database search was conducted in six electronic databases (CINAHL, Wed of Science, DISCOVER, SCOPUS, PubMed and Scholar) resulting in 49 potentially eligible full texts, reduced to 10 articles for inclusion after exclusion criteria were applied. REVIEW METHODS: An integrative review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Data were extracted, and a narrative synthesis using Whittemore and Knafl (2005) framework was undertaken to determine how front-line health professionals identify and manage nonfatal strangulation events. RESULTS: The findings identified three main themes: an overall failure by health professionals to recognize nonfatal strangulation, a failure to report the event and a failure to follow up on victims after the event. Stigma and predetermined beliefs around nonfatal strangulation, along with a lack of knowledge about signs and symptoms, were the salient features in the literature. CONCLUSION: Lack of training and fear of not knowing what to do next are barriers to providing care to victims of strangulation. Failure to detect, manage and support victims will continue the cycle of harm through the long-term health effects of strangulation. Early detection and management of strangulation are essential to prevent health complications, particularly when the victims are exposed to such behaviours repeatedly. IMPACT: This review appears to be the first to explore how health professionals identify and manage nonfatal strangulation. It identified the significant need for education and robust and consistent screening and discharge policies to assist health providers of services where victims of nonfatal strangulation attend. NO PATIENT OR PUBLIC CONTRIBUTION: This review contains no patient or public contribution since it was examining health professionals' knowledge of identifying nonfatal strangulation and the screening and assessment tools used in clinical practice.

General and Case-Specific Approval of Coercion in Psychiatry in the Public Opinion.

BACKGROUND: Psychiatric patients are subjected to considerable stigmatization, in particular, because they are considered aggressive, uncontrollable, and dangerous. This stigmatization might influence the approval of coercive measures in psychiatry by the public and healthcare professionals and might have an influence on the clinical practice of coercive measures. We examined whether the general approval of coercive measures for psychiatric patients with dangerous behaviors differs from case-specific approval. METHOD: We conducted a representative survey of the general population (n = 2207) in the canton of Basel-Stadt, Switzerland. In total, 1107 participants assessed a case vignette depicting a fictitious character with a mental illness and indicated whether they would accept coercive measures (involuntary hospitalization, involuntary medication, and seclusion) for the person in the vignette. It was explicitly stated that within the last month, the fictitious character displayed no dangerous behavior (Vignette ND) or dangerous behavior (Vignette D). Another 1100 participants were asked whether they would approve coercive measures (involuntary hospitalization, involuntary medication, and seclusion) for psychiatric patients with dangerous behavior in general (General D), i.e., without having received or referring to a specific case vignette. FINDINGS: The logistic regression model containing all variables explained 45% of the variance in approval of any type of coercive measures. Assessment of case vignettes without dangerous behavior (Vignette ND) was associated with significantly reduced approval of coercive measures compared to assessment of a case vignette with dangerousness (Vignette D), while approval for coercive measures in a person with mental health disorder with dangerous behavior in general (General D) was significantly higher than for the case vignette with dangerousness. CONCLUSIONS: The general approval of coercive measures for people with mental disorders seems to differ depending on if the respondents are asked to give a general assessment or to examine a specific and detailed clinical case vignette, indicating an increased role of stigmatization when asking about generalized assessments. This may contribute to diverging findings on the acceptance of coercive measures in the literature and should be considered when designing future studies.

Effects of Mass Shootings on Mental Illness Stigma in the United States.

Although the vast majority of people with mental illness (PWMI) are not violent, Americans tend to think they are more dangerous than the general population. Because negative media portrayals may contribute to stigma, we used time-series analyses to examine changes in the public's perceived dangerousness of PWMI around six mass shootings whose perpetrators were reported to have a mental illness. From 2011 to 2019, 38,094 U.S. participants completed an online study assessing implicit and explicit perceived dangerousness of PWMI. There were large, upward spikes in perceived dangerousness the week of the Sandy Hook mass shooting that were relatively short-lived. However, there was not a consistent pattern of effects for other events analyzed, and any other spikes observed were smaller. Effects tended to be larger for explicit versus implicit perceived dangerousness. Sandy Hook seemed to temporarily worsen perceived dangerousness of PWMI, but this pattern was not observed for other mass shootings.

Emerging Adult Perceptions of Cannabis Consumption Post-Legalization: Considering Age and Sex Differences.

PURPOSE: Increased access to legalized non-medical cannabis has led to growing concern over the potential adverse health impacts of cannabis consumption among youth and emerging adults. This study explored emerging adult perceptions of cannabis consumption and if perceptions changed based on the age and sex of the cannabis consumer. METHODS: Canadian emerging adults between the ages of 18 and 25 years (N = 1,424, Mean = 21.23) were randomly assigned to one of six vignettes that varied by age (14 years, 21 years, and 28 years) or sex (male, female) of the cannabis consumer. Participants were asked to rate seven single-item measures on perceived dangerousness, problematic consumption, negative impacts, and level of disapproval related to the vignette character's almost daily cannabis consumption. RESULTS: The results of seven 2 × 3 factorial analyses of variance revealed a main effect of age on six of seven items, no main effects of sex, and no interactions. Except for social life, participants noted significant differences in harms of cannabis consumption by 14-year-olds, compared to 21-year-olds and 28-year-olds. There were no significant differences in overall perceived dangerousness, problematic consumption, or impact on mental or cognitive health between 21-year-olds and 28-year-olds. Participants perceived cannabis consumption by a 21-year-old to be more harmful to brain development and reported greater disapproval than consumption by a 28-year-old. DISCUSSION: Emerging adults may appreciate the impacts of cannabis consumption within their age cohort on brain development and perceive greater risks for youth. Further education should focus on the potential cognitive and mental health impacts of cannabis in emerging adults.

A critical ethnographic perspective on risk and dangerousness in forensic psychiatry.

In the Canadian forensic psychiatric context, the concepts of risk and dangerousness interact, intersect, and morph into the notion of significant threat to the safety of the public. Stemming from the results of a critical ethnography of the Ontario Review Board, this article unpacks the central role of forensic psychiatric nursing, as an example of a 'psych' discipline (e.g., psychiatry and psychology), in a system that is built to produce risky persons and to legitimize their detention and supervision. By using excerpt of interviews conducted with nurses, ethnographic observations of Review Board hearings, and other documentary artifacts, the findings illustrate how rationalizations of risk and dangerousness are contingent on space, time, and observer. Depending on the time of the assessment or on the health-care professional who performs it, different elements including, but not limited to, mental illness, interpersonal relationships, financial instability, and sexual vulnerability, are relied upon in very fluid, interchangeable, and discretionary ways to justify findings of dangerousness. Such a dynamic expands the reach of psychiatry's legitimacy at identifying risky conduct and controlling risky persons to domains very loosely associated with the notion of dangerousness. The work of Foucault and Castel provides the theoretical backdrop on which rests the discussion and the implications for nursing.

[Management of patients with addictions in units for difficult patients]. / Prise en charge de patients présentant des addictions en unité pour malades difficiles.

The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Addictive co-morbidities, which are increasingly frequent, are an additional risk factor for some of these patients to commit dangerous acts. Psychiatric and psychological care for pathological perpetrators of such violence can be provided under certain conditions in units for difficult patients, with addiction treatment if necessary.

[Social care for patients hospitalised in units for difficult patients]. / Prise en charge sociale des patients hospitalisés en unité pour malades difficiles.

The units for difficult patients are secure psychiatric wards that receive mentally ill people who could have committed or have committed dangerous acts. As part of the overall care of these patients, the treatment of their social problems by social workers plays an essential role. These interventions provide the psychosocial benefits necessary for the stabilisation and evolution of these subjects.

Periculosidade e características da personalidade em autores de violência sexual / DANGEROUSNESS AND PERSONALITY CHARACTERISTICS IN SEXUAL OFFENDERS / PELIGROSIDAD Y CARACTERÍSTICAS DE LA PERSONALIDAD EN AUTORES DE LA VIOLENCIA SEXUAL

The aim of the article was to analyze the dangerousness and personality characteristics of perpetrators of sexual violence (SVA). 69 inmates who participated in this study were serving time for sexual crimes in a closed regime and were divided into two groups: SVA convicted of victimizing children (G1) (n = 41) and SVA convicted of victimizing adolescents and adults (G2) (N = 28 ). The collected data derived from the reading of the criminal case and the application of the Rorschach test in the Performance Assessment System (R-PAS). For data analysis, a variable called dangerousness was created, through the principal component factor analysis, using criminal profile variables, to verify the correlation between the R-PAS variables and the participants' riskiness. Comparisons were also made between the groups. The results showed that the greater the danger, the greater the use of intellectualization as a defense mechanism, in order not to deal directly and realistically with aspects that generate emotional or social anguish. In addition, G2 showed a higher degree of danger.

O objetivo do artigo foi analisar a periculosidade e as características de personalidade de autores de vio-lência sexual (AVS). Participaram deste estudo 69 reeducandos que cumpriam pena por crimes sexuais em regime fechado, divididos em dois grupos: AVS condenados por vitimizar crianças (G1) (n = 41) e AVS con-denados por vitimizar adolescentes e adultos (G2) (N = 28). Os dados coletados derivaram da leitura do processo criminal e da aplicação do teste de Rorschach no Sistema de Avaliação por Desempenho (R-PAS). Para a análise dos dados, criou-se uma variável denominada periculosidade, por meio da análise fatorial de componente principal, mediante variáveis do perfil criminal, para verificar a correlação entre as variá-veis do R-PAS e a periculosidade dos participantes. Também foram realizadas comparações entre os gru-pos. Os resultados apontaram que quanto maior é a periculosidade, maior é o uso da intelectualização como mecanismo de defesa, para não lidar de modo direto e realista com aspectos que geram angústia emocional ou social. Além disso, o G2 revelou maior grau de periculosidade.

El objetivo del artículo fue analizar la peligrosidad y las características de personalidad de autores de vio-lencia sexual (AVS). Participaron de este estudio 69 reeducandos que cumplían condena por crímenes sexuales en régimen cerrado, divididos en dos grupos: AVS que victimizaron niños (G1) (n = 41) y AVS por adolescentes y adultos (G2) (n = 28). Los datos recogidos derivaron de la lectura del proceso criminal y de la aplicación del test de Rorschach en el sistema de evaluación por performance (R-PAS). Para el análisis de los datos, se creó una variable denominada peligrosidad por medio del análisis factorial de componente principal, mediante variables del perfil criminal, para verificar la correlación entre las variables del R-PAS y la peligrosidad de los participantes. También fueron realizadas comparaciones entre los grupos. Los re-sultados apuntaron que, cuanto mayor es la peligrosidad, mayor es el uso de la intelectualización como mecanismo de defensa, para no lidiar de modo directo y realista con aspectos que generan angustia emo-cional o social. Además de eso, el G2 reveló mayor grado de peligrosidad.

Reform of Forensic Mental Health Services in Italy: Stigma and Blaming the Messenger: Hermenoia.

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness-we have called this social sensitivity against psychiatrists "hermanoia," blaming the messenger. The authors do not provide certain solutions but propose good practices.

[Units for difficult patients in the mental health care system]. / Les unités pour malades difficiles dans le dispositif de soins en santé mentale.

The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Psychiatric and psychological care of pathological perpetrators of such violence can be carried out under certain conditions in units for difficult patients.

Corrigendum: Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization.

[This corrects the article DOI: 10.3389/fpsyt.2021.819573.].

[Therapeutic education for patients with schizophrenia]. / L'éducation thérapeutique du patient schizophrène.

Schizophrenia is a chronic and complex mental illness with a multifactorial aetiology, resulting from the interaction between neurobiological and environmental factors. Affecting approximately 1% of the world's population, it generally appears slowly and progressively in subjects aged 15 to 25 years. The polymorphic symptomatology is a source of disability and often of social maladjustment, which implies the implementation, if possible at an early stage, of multi-axis support in order to meet the specific needs of these patients and their families. Therapeutic patient education is one of the targeted interventions that have proven to be effective in improving the quality of life and functional prognosis of the subjects with schizophrenic disorders.

La pena y la cura. Servicios de salud mental en Italia después del cierre de los hospitales psiquiátricos judiciales / Penal conviction and treatment. Mental health services in Italy after the closure of forensic hospitals

El artículo describe el proceso de reforma que tuvo lugar en Italia con el cierre de los seis hospitales psiquiátricos judiciales del país y su sustitución por pequeñas unidades forenses. El uso de los hospitales judiciales se regía por la exclusión de los juicios de las personas con enfermedades mentales graves que dificultaban el ejercicio de su capacidad, las cuales, si eran declaradas "socialmente peligrosas", eran sometidas a un sistema de "medidas de seguridad". Este cambio significativo, que se llevó a cabo a través de los Ministerios de Salud y de Justicia, y de las Regiones, ocurrió en Italia entre 2011 y 2017, y se entiende como el paso final del proceso de reforma en la atención de la salud mental que comenzó en 1978 y culminó con el cierre completo de todos los hospitales psiquiátricos en 1999.Las nuevas pequeñas unidades forenses/judiciales, con un número limitado de camas para todo el país, se denominan REMS (Residencias para la Ejecución de Medidas de Seguridad). Están gestionadas por las Regiones y se basan en los principios de orientación terapéutica y de recuperación, respuesta transitoria y territorial, y responsabilidad de los servicios de salud mental de la comunidad para facilitar el alta. Las formas de aplicación de la ley en lo que respecta a las características de las REMS fueron diversas, por ejemplo, gestión pública o privada, número de camas, política de puertas abiertas, inclusión en los departamentos de salud mental con fines de prevención y provisión de alternativas por parte de los servicios comunitarios de salud mental. Experiencias significativas, como la de Trieste y la región de Friuli Venezia Giulia, interpretan esta reforma en función del papel que desempeñan los servicios públicos de salud mental en la prevención de delitos mediante una respuesta rápida y eficaz a las crisis, estableciendo vías de atención personalizadas y apoyando a sus pacientes dentro de la prisión y en el sistema judicial. (AU)

The paper describes the process of reform that took place in Italy with the closing of all of the forensic psychiatric hospitals in the country and their replacement with a network of small forensic units. The use of forensic hospitals was ruled by the exclusion from trials of persons with a severe mental illness that hampered their capacity, but, if declared ‘socially dangerous', were submitted to a system of ‘security measures'. This significant change in Italy occurred between 2011 and 2017, and it was meant as the final step of the reform process in mental heathcare that started in 1978, with the complete closure of all psychiatric hospitals in 1999.The new small forensic units, with an overall limited number of beds for the whole country, are called REMS (Residences for the Execution of Security Measures). They are managed by Regions and are based on the principles of therapeutic and recovery orientation, transitory and territorial response, and responsibility of community mental health services for facilitating discharge. The ways of implementing the law regarding REMS' features were diverse, e.g., public or private management, number of beds, open door policy, or inclusion in mental health departments aiming at the prevention and provision of alternatives on part of community mental health services. Some significant experiences were those of Trieste and the region of Friuli Venezia Giulia, which set up personalized pathways of care, supporting their patients within prison and in the judicial system. (AU)