The closure of high-security psychiatric hospitals in Italy. Processes of neo-institutionalisation between coercion and rehabilitation

The article illustrates the results of an empirical study that analysed the impact of the law 81/2014, overcoming the high security psychiatric hospital (OPG), in favour of a system based on several territorial mental health services, therapeutic communities and the new Residences for the Execution of Security Measures (REMS). The research was carried out using both quantitative and qualitative tools. In quantitative terms, it analysed the statistical data provided by the SMOP IT system, specifically designed by Campania region in order to evaluate the reform implementation. The qualitative analysis was carried out in Piemonte and Campania, where the Authors directly observed REMS practices and realised interviews and focus groups with REMS and communities’ staff. The results show how the reform impact seems to be quite ambiguous. On the one hand, the new system has probably favoured a partial process of deinstitutionalisation, with a decrease in the inmates’ number, if compared with the previous OPGs’ population. At the same time, the research showed a varied landscape where several actors are resisting against the reform application, sometimes looking for a real throwback. Moreover, at the local level, the dialogue between different legal and professional cultures is producing very different ways to implement the law principles, with a great uncertainty for operators and inmates.