An Innovative Approach to Overcoming a Forensic Psychiatric Hospital in Italy: A Ten-Year Impact Evaluation


 
 To evaluate the impacts of a pilot project concerning the closure of a Forensic Psychiatric Hospital (FPH) inspired by Human Development Theory and the Capability Approach
 
 
 
 The dismantlement of the FPH of Barcellona Pozzo di Gotto (Sicily Region in Italy) began in 2010 with the pilot project Luce é Libertà and ended in 2017. With the closure of six FPH, Italy officially became the first country worldwide to close such institutions. After the closure of FPHs some critical issues emerged, and the debate shifted to the development of small-scale facilities and the residences for the execution of security measures (RESM). Few studies, however, have provided results on cohort of patients discharged from FPHs.
 
 
 
 a) Assessing the effectiveness of the pilot project in terms of better functioning accordingly the Classification of Functioning of Disability and Health (ICF) framework, social and labour insertion, health conditions, level of dangerousness to other, rate of readmission in forensic services; 
 b) cost analysis; 
 c) describing how the CA has been applied and translated into methodological and administrative devices and concrete intervention strategies.
 
 
 
 A pre-post evaluation design was performed with a comparison between the intervention and the control group for the healthcare cost analysis. Data were collected from 2010 to 2019 at three points: T0) as a baseline, T1 and T2) for the follow-up. The instruments are a structured questionnaire, the Scale HoNOS Secure, 4 sub-scales of ICF (Activity and participation dimensions: Sociality, Culture and knowledge, Daily life, Income and work) (Cronbach’s Alpha from 0.76 to 0.94), and n.20 interviews with key stakeholders and beneficiaries.
 
 
 
 Main results are: a) the discharge of 55 patients through the use of a person-centred approach and the Personal Capability Budget (PCB); b) the expansion of substantial freedom of choice and the improvement of ICF score (t-test Sig. <, 02).; c) the reduction of the risk for others and for themselves (Mean Diff. -2,15 Sig. .000); d) at T2 42% of beneficiaries achieved a job placement and 36% are living in one's own home; e) at T2 the need of Security Measures has fallen from the initial 70% to 6.8%; f) reduction of the healthcare costs from the fourth year onwards.
 
 
 
 Indications emerge to support processes of de-institutionalisation and capabilities expansion through innovative models, a person-centred approach supported by PCBs, social finance and social impact investments.
