RESEARCH ARTICLE


An Innovative Approach to the Dismantlement of a Forensic Psychiatric Hospital in Italy: A Ten-year Impact Evaluation



Liliana Leone1, *, Gaetano Giunta2, 3, Gaspare Motta4, Giancarlo Cavallaro5, Lucia Martinez1, 6, Angelo Righetti7
1 CEVAS Centre of Research and Evaluation, Roma, Italy
2 Community Foundation of Messina o.n.l.u.s., Messina, Italy
3 Department of Secretary General, Fondazione di Comunità di Messina O.n.l.u.s., Italy
4 Mental Health Department, ASP 5, Messina, Italy
5 Consortium SO.LE. Solidarity and Energy, Messina, Italy
6 Istat Italian National Institute of Statistics, Roma, Italy
7 Scientific Committee- Community Foundation of Messina o.n.l.u.s., Messina, Italy


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Creative Commons License
© 2023 Leone et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the CEVAS Centre of Research and Evaluation, Roma, Italy; Tel: +39 3494210845; Email: leone@cevas.it


Abstract

Aims:

This study aimed to evaluate the impacts of a pilot project concerning the closure of a Forensic Psychiatric Hospital (FPH) inspired by Human Development Theory and the Capability Approach.

Background:

The dismantlement of the FPH of Barcellona Pozzo di Gotto (Sicily Region in Italy) began in 2010 with the pilot project Luce é Libertà and ended in 2017. With the closure of six FPHs, Italy officially became the first country worldwide to close such institutions. After the closure of FPHs, some critical issues emerged, and the debate shifted to developing small-scale facilities and residences for the execution of security measures (RESM). However, few studies have provided results on the cohort of patients discharged from FPHs.

Objective:

Following are the objectives of this study: a) Assessing the effectiveness of the pilot project in terms of better functioning accordingly to the Classification of Functioning of Disability and Health (ICF) framework, social and labour insertion, health conditions, level of dangerousness to other, rate of readmission in forensic services, b) cost analysis, and c) describing how the CA has been applied and translated into methodological and administrative devices and concrete intervention strategies.

Methods:

A pre-post evaluation design was performed with a comparison between the intervention and the control group for the healthcare cost analysis. Data were collected from 2010 to 2019 at three points: T0) as a baseline, T1 and T2) for the follow-up. The instruments are a structured questionnaire, the Scale HoNOS Secure, 4 sub-scales of ICF (Activity and participation dimensions: sociality, culture, and knowledge, daily life, income, and work) (Cronbach’s Alpha from 0.76 to 0.94), and n.20 interviews with key stakeholders and beneficiaries.

Results:

Main results include a) the discharge of 55 patients through the use of a person-centered approach and the Personal Capability Budget (PCB), b) the expansion of substantial freedom of choice and the improvement of ICF score (t-test Sig. <, 02), c) the reduction of the risk for others and themselves (Mean Diff. -2,15 Sig. .000), d) at T2 42% of beneficiaries achieved a job placement and 36% were living in one's own home, e) at T2 the need of security measures has reduced from the initial 70% to 6.8%, and f) reduction of the healthcare costs from the fourth year onwards.

Conclusion:

Indications emerge to support processes of deinstitutionalisation and capabilities expansion through innovative models, a person-centered approach supported by PCBs, social finance, and social impact investments.

Keywords: Job placement, International classification of functioning, Forensic hospital, Capability approach, Cost analysis, Deinstitutionalization.