The genoa paradigm: Transitioning from OPGS to REMS and the struggles of law 180

Abstract

The purpose of this dissertation is to analyze the transition sanctioned by italian Law 180, known as the Basaglia Law; the closure of the Psychiatric Judicial Hospitals (OPGs) and the establishment of the Residences for the Execution of Security Measures (REMS), with particular attention to the lack of clear, effective and standardized operating procedures. This work stems from my interest in the prison system, the treatment of psychiatric disorders and the rights of offenders. The in-depth study of these issues was accomplished not only through the acquisition of theoretical/regulatory knowledge, but through the internship experience in collaboration with a specialized micro-team. The experimental research was conducted at the REMS in Genoa Prà Villa Caterina, one of the most remarkable facilities nationwide in terms of number of discharges. Particularly was investigated the case of M.A, a patient transferred from the OPG who has been residing in the REMS for seven years. This study seeks to understand the extent to which legislation has shaped the current system, questioning whether the reasons for the patient's delayed transfer to a community are due to the severity of the illness or an overly complex system. This regime seems to undermine confidence in real progress toward community reintegration by stabilizing patients in a facility that, although comfortable, was not designed as a permanent residential solution but as a therapeutic step toward the community. The legal and policy implications arising from this lack of uniformity will also be analyzed, paying particular attention to operational practices and the effectiveness of patient treatment. This research aims to highlight how, despite the reforming intent of Law 180, significant discrepancies in the application of security measures persist, influenced by regional variability and available resources. The thesis offers a critical reading of the current system, calling for greater standardization and uniformity in REMS practices to ensure more equitable and effective treatment of forensic psychiatric patients. My direct experience in the REMS has provided me with in-depth insight, prompting me to examine an area that still requires much attention, both human and legal. Through the analysis of M.A's clinical case, an attempt was made to highlight the complications arising from regional enforcement discretion and lack of operational standardization. The goal is to propose improvements for a more consistent and efficient management of forensic psychiatric patients in Italy, reducing unnecessary and potentially harmful transfers.