Involuntary psychiatric hospitalization in Italy: critical issues in the application of the provisions of law

Abstract

Involuntary psychiatric hospitalisation in Italy raises some critical forensic issues. We analysed the sociodemographic, psychopathological, and behavioural characteristics of involuntarily hospitalised psychiatric patients, and the effectiveness of the juridical procedure of guarantee. Case files (n ¼ 2796) related to involuntary psychiatric hospitalisation (IPH) at the Office of the Tutelary Judge of the Ordinary Court of Rome (Italy) between January 2013 and May 2016 were analysed. For each case file sociodemographic, clinical and procedural information were collected. The sample included 53.7% men, patients had a mean age of 41.8 ± 13.9. Most of the IPH proposal certificates reported more than one reason, among which the most frequent were symptoms referring to a psychotic dimension (54.8%), agitation (38.0%), and symptoms of bipolar and related disorders (26.3%) Female patients showed a higher prevalence of symptoms of the bipolar spectrum (F ¼ 29.7%, M ¼ 23.3%; p < 0.05), while male patients showed a higher prevalence of aggressive behaviour (F ¼ 7.7%, M ¼ 12.6%; p < 0.01). Over 85% of the IPH proposal certificates did not explicitly mention issues related to adherence to care, which is the second criterium requested for IH (treatment refusal) and up to 7.3% of the proposals were not properly motivated. However, only 0.8% cases were not validated by the Tutelary Judge. Possible issues in the IPH procedures emerged since a significant number of certifications showed poor concordance with law-criteria for involuntary psychiatric hospitalisation. Despite this evidence, the low rate of unvalidated procedures by the Tutelary Judge, suggests a possible limitation of this form of guarantee.

Reporting Incidents in the Psychiatric Intensive Care Unit

“…There is evidence of the association between aggression and involuntary hospitalization (Abderhalden et al, 2007;Biancosino et al, 2009;Canova Mosele et al, 2018); nevertheless, dangerousness to self or others is not a legal criterion for involuntary psychiatric hospitalization in Italy. Our result of a large proportion of involuntarily hospitalized patients among those included is not unexpected, because a large study has already shown that approximately 10% of patients undergoing involuntary psychiatric hospitalization in Italy present reasons of aggression and danger (Ferracuti et al, 2021).…”

Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study

“…According to the Italian jurisdiction, involuntary treatment requires that in the opinion of two different physicians the patient suffers from psychic alterations requiring immediate intervention, refuses treatment, and cannot be adequately treated in other non-hospital-based settings. Involuntary psychiatric treatment must be confirmed by the city mayor and by a judge; danger to oneself or to others is not a legal criterion in Italy (Ferracuti et al, 2020). In the study ward, a number of definite communication strategies (Biondi et al, 2021) for dealing with patients with acute mental disorders are routinely used by specifically trained staff members in order to obtain patients’ consent to treatment, when possible.…”

“Caring for a Crisis”: Care and Control in Community Mental Health

“…The absence of a dangerousness criterion relates to the vision of Basaglia, and it is seen as a fundamental step to break the often-made connection between mental disorders and dangerousness ( 31 ). In Italy the dangerousness criterion is not listed as a requirement for forced treatment ( 32 ). The need for treatment criterion prevails.…”