From the closure of the old judicial psychiatric hospitals to the complicated start-up of the Residences for the implementation of security measures. A small “revolution”, still underway, for the structures and operators involved in the custody and care of offenders suffering from psychiatric pathologies. A long journey but also full of perspectives around which the Bari Local Health Authority, in the Putignano theatre, organized the event “Dangerous relationships – Psychiatry between care and custody”, an entire day dedicated to the training of 200 healthcare workers and , at the same time, to initiate a profound reflection between magistrates and psychiatrists with the aim of building together shared paths capable of improving the common vision between legal provisions and concrete implementation, especially at the level of territorial psychiatric structures.
Also in light of a phenomenon which, in the ASL Bari alone, consists (in 2023) of 267 offenders with psychiatric pathologies (mainly personality disorders, alcohol and substance abuse) belonging to mental health centres, of which 56 percent placed in a psychiatric rehabilitation community (Crap) and the rest managed within structured pathways, including waiting for inclusion in the two Rems structures active in Puglia: in Spinazzola and Carovigno.
A dialogue with many voices, strongly desired by Luigi Fruscio, acting general director of the Bari ASL, in which mental health professionals such as Anna Maria Camposeodirector of Area 7 Mental Health Center, Roberto Catanesifull professor of Forensic Psychopathology (University of Bari) e Guido Di Sciasciodirector of the Mental Health department Ask Bari, and representatives of Justice, such as Silvia Maria Dominionipresident of the Supervisory Court of Bari, Eugenia Pontassugliapublic prosecutor at the Court of Taranto and Angela Tomasicchio, general advocate of the Court of Appeal of Bari.
The starting point of the broad reflection on psychiatric pathology and crimes was the legislative passage marked by law 81 of 2014, whose laborious application brought to light important issues, both management and in reference to the principles of treatment themselves. Hence the hope, which emerged during the day, for a revision of the law that brings the prerogatives relating to care back into the right places, distinct from those relating to safety. Law 81 of 2014, moreover, sanctioned the closure of the Opg and the establishment of the Rems, a turning point intimately linked to the dismantling of the mental hospital in all its forms and the definitive overcoming of the custodial culture, started at the time with the Basaglia law.
However, the initial needs assessment was found to be insufficient compared to the incremental demand for places. This is the scenario in which psychiatric rehabilitation facilities and hospital psychiatric diagnosis and treatment services are called upon to overcome existing critical issues with an enormous effort by healthcare workers and magistrates.
“At the basis of this, as has been underlined, there is the total delegation to the National Health System of the management of patient offenders, the overlap between the obligation to safeguard and protect the community and requests for care for the sick person – they recall from the ASL – With the effect of placing the centrality of the patient and his needs and having repercussions on common feeling, risking re-proposing in public opinion the dangerous relationship between crime and madness, deviance and illness, fueling prejudices and new pressures towards the exclusion of psychiatric patients and distrust and suspicion towards operators”.
