ANNEX - CASE STUDIES ON GOOD PRACTICES ANNEX 4: ITALY THE REMS SYSTEMS THE CREATION OF THE REMS SYSTEM As previously mentioned, the REMS system, despite representing a step forward in the treatment of people with intellectual or psychosocial disabilities, presents many criticalities that should be addressed by policy makers, but the foundation of its creation goes back to twenty years ago. In Judgement No 253 of 2003, the Constitutional Court defined as “constitutionally illegitimate Art 222 CP (Admission to a Judicial Psychiatric Hospital), in so far as it does not allow the judge, in the cases provided for therein, to adopt, instead of the admission to a psychiatric hospital, a different security measure, provided for by law, suitable to ensure adequate care for the mentally ill person and to cope with his social dangerousness”. The Court specified “that the automatism of a segregating and ‘total’ measure, such as admission to a judicial psychiatric hospital, imposed by the law, even when it appears in practice to be unsuitable, breaches the constitutionally necessary balance and violates essential requirements for the protection of the rights of the person, in this case the right to health referred to in Article 32 of the Constitution”.521 Since then, it took five years and the prison healthcare reform of 2008: in the DPCM of 1 April 2008, annex C, the abolition of the OPGs (Ospedali Psichiatrici Giudiziari - Judicial Psychiatric Hospitals) was scheduled; experts began at that time to highlight the problem of the presence of 6 OPGs in Italy, a country where the choice of deinstitutionalisation of the mentally ill non-offenders had been made since 1978 (Law No. 180 of 1978, the so-called Basaglia Law). This annex produced certain effects that nevertheless remained confined to experts. The main effect it produced, which came from the prison health reform, is that of a migration of competences over OPGs from the Ministry of Justice to the Ministry of Health (therefore to the Regions and to the local health authorities). 124 In 2010, the Parliamentary Commission of Inquiry on OPGs was established, chaired by Senator Ignazio Marino, which represented a turning point in this matter because it made the country see the degradation in which inmates in OPGs were forced to live. From that moment, it was possible to start thinking about the construction of a new legislation that would lead to the abolition and closure of those facilities and the guarantee of the start of a path of care and protection for these persons centred on community mental health services. The new legislation was introduced with law no. 9 of 2012, which, however, failed in its purpose of reform. Law No. 9 of 2012 was thus supplemented by Law No. 81 of 2014, which not only postponed the date of the final abolition of the OPGs, but also went on to better specify the future functioning of an undeniably complex area of the penal and health system. In addition, the law went on to establish an active Coordination Body for the two-year period 2014-2016. It had indeed been noted that not all the Regions were moving at the same pace to set up ad hoc health facilities (REMS) suitable to accommodate a part of the OPG inmates and future inmates. Even at the level of the territorial institutions, there was in those years much resistance in accepting the creation of these facilities on the territory due to an important lack of institutional dialogue. This newly established coordination mechanism was called upon to respond to all these practical difficulties, a task that it failed to accomplish to the extent that an ad hoc Commissioner had to be appointed for the two-year period 2016-2017. Law no. 81 of 2014 has established some fundamental principles on the subject: first of all, it has recognised the priority of healthcare assistance, also by assigning the internal management of the REMS exclusively to healthcare authorities. In addition, the focus must be on the therapeutic project, which must be individualised; REMS must be organised in compliance with the principle of territoriality of admissions on a regional basis with respect to the residence of the person to be admitted; REMS represent measures that should be used as a last resort, a char-