ANNEX - CASE STUDIES ON GOOD PRACTICES different institutions: the Ministry of Justice had 750 people on the waiting list, while the Conference of the Regions and Autonomous Provinces had 568 on the same date, and a further 103 people who could not be placed in REMS because they were in prison or because they could not be found. While this might appear a mere numerical difference, in reality, it is a more general indicator of a communication difficulty (that becomes a management one) between the institutional actors involved. The average time spent on the waiting list is indicated in the Report as 304 days; however, further clarification is needed. The REMS system, belonging exclusively to the National Health Service, is organised on a regional and provincial basis (for the autonomous provinces); it follows as also stated in the Report - that the 304 days of waiting represent a national average, since there are very deep differences from Region to Region. In some regions the phenomenon of waiting lists seems to be marginal, while five regions (Sicily, Apulia, Campania, Calabria and Latium) seem to have the longest waiting times and also the largest numbers (172 people waiting in Sicily alone). It is worth noting the existence of the requirement of territoriality with regard to placement in REMS, which means that it is unlikely that a person will be placed in a REMS in a Region other than their Region of residence (as of 31 July 2021, only 19 out of 596 persons were in this condition). As of 31 July 2021, there were 61 persons in prison on the waiting list for a place in an REMS, none of whom according to the DAP were placed in hospital psychiatric services (ex Art 286 CPP). In the Report, as cited in the Court's judgement, there is also a significant decrease in the number of prisoners waiting for a place in the REMS from 98 on 28 October 2020 to 35 on 25 October 2021. Between 20 June and 25 September 2021, according to the DAP 15 probation orders were issued in favour of people on the waiting list for placement in REMS and previously detained in prison. In the Report, the Ministries identified some of the difficulties encountered by the system up to that time; the Ministry of Justice summarised the limitations of the system 126 in the lack of places in the REMS and the difficulty of communication between the actors involved. For the Ministry of Health, the limitations were to be found in the culture of the operators (health workers, judiciary and prison workers). Following the reception of this report, the Constitutional Court, in Judgment No. 22 of 2022, while recognising the constitutionality of Law No. 81 of 2014 and therefore judging positively the path of abolition of the OPG, nevertheless indicated some friction points with the constitutional principles. It indicated in particular the need to promptly execute the judicial measures andto address the problem of the waiting list, thus referring detailed analyses and solutions to the various institutional actors and not excluding, indeed hoping for a new legislative intervention. Indeed, the Court calls for a comprehensive and urgent reform of the system, which would ensure that the admission to REMS 'has an adequate legal basis', ensuring at the same time 'the development and proper functioning, throughout the national territory, of a sufficient number of REMS to meet the real needs, in the framework of an overall and equally urgent development of facilities on the territory able to ensure alternative interventions adequate to the needs of treatment and to those, equally essential, of protection of the community'. A critical passage of the Court's motivations concerns the nature of the custodial security measure that currently combines deprivation of liberty and coercion of treatment. An interpretation that raises many perplexities because for the offender with an intellectual or psychosocial disability the Laws No. 180 of 1978 and No. 219 of 2017 do not apply, but even more so because on the psychiatric medical level there can be no treatment without consent, participation, responsibility and the prospect of freedom. If such an interpretation of the security measure were to persist, it would open a question mark over the meaning of the Health care management of REMS.