Psychiatric Risk Governance Across Jurisdictions: A Comparative Analysis of Involuntary Treatment, Community Treatment Orders, and Forensic Mental Health Services
Rattachement africain : it, ca, nl, tr, gb, fr, de, es, us. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Psychiatric Risk Governance Across Jurisdictions: A Comparative Analysis of Involuntary Treatment, Community Treatment Orders, and Forensic Mental Health Services
- Date Crossref
- 20/09/2025
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Sapienza University of Rome Department of Anatomical pays non établi dans la noticeUniversité ou école supérieure
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Università Campus Bio-Medico pays non établi dans la noticeUniversité ou école supérieure
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McGill University Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Nijmegen Donders Institute for Brain pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Medical Center Department of Human Genetics pays non établi dans la noticeOrganisme public
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Donders Institute for Brain pays non établi dans la noticeStructure de recherche
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University of Bologna Department of Biomedical and Neuromotor Sciences pays non établi dans la noticeUniversité ou école supérieure
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Bakırköy Psychiatric Hospital pays non établi dans la noticeÉtablissement de santé
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Oxford Health NHS Foundation Trust pays non établi dans la noticeÉtablissement de santé
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University of Oxford Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
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Université de Lille pays non établi dans la noticeUniversité ou école supérieure
Department of Anatomical — Sapienza University of Rome, Università Campus Bio-Medico et Department of Psychiatry — McGill University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.