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In Italy, the treatment of dangerous patients found not guilty by reason of insanity (NGRI) underwent a radical reform in 2014 with the Law 81, that promulgated the closure of secure hospitals, Ospedali Psichiatrici Giudiziari (OPG), that provided psychiatric care within a secure setting. OPG were replaced by new psychiatric facilities called Residence for the Execution of a Security Measure (REMS) which currently host NGRI patients who cannot be sent to prison. Eight years after the creation of the REMS, many questions still need to be addressed in relation to their functions, limitations, and cooperation with the other services.
This article describes the process of deinstitutionalisation of psychiatric care in Italy over the past forty years, which culminated in the creation of the REMS. The functioning of the REMS and some of the issues that have emerged since their creation are explored, and possible solutions are proposed. Finally, the impact of the 2014 reform on psychiatric care in Italian prisons is highlighted.