EPV1427 - Risk management strategies in community-based psychiatry: a narrative review focusing on Italy

EPV1427

Risk management strategies in community-based psychiatry: a narrative review focusing on Italy

G. Listanti ^{1 2,*}, S. De Persis ², D. Tripi ¹, S. Ferracuti ¹

¹Department of Human Neuroscience, Sapienza, University of Rome, Roma, ²Dipartimento Tutela e Promozione Salute Mentale, Azienda Sanitaria Locale, Rieti, Italy

 

Introduction: In psychiatry, Risk Management (RM) has mainly focused on hospital settings, while incidents of violence and burnout are increasingly affecting community-based services. In Italy, after the reform of forensic psychiatry, local mental health departments are fully responsible for the treatment of psychiatric offenders. The Italian National Action Plan for Mental Health 2025–2030 now formally recognizes RM as a strategic priority.

Objectives: This study provides an overview of key domains, critical issues, objectives and intervention strategies for RM in Italian community-based mental health services.

Methods: We conducted a non-systematic review of international and Italian literature.

Results: Our results identify 5 key domains of clinical risk:

        -  Staff well-being and safety

        -  Hospital-community continuity

        -  Forensic patients management

        -  Informed consent

        -  Training and guidelines

Specific critical issues, objectives and intervention strategies for each risk domain are summarized in Table 1.

Risk domain	Critical Issues	Objectives	Intervention Strategies
Staff well-being & safety	High emotional load; staff shortages; unsafe home visits; risk of aggressive behaviours	Burnout & violence prevention; implementing reporting systems	Person-centred culture; pre-visit risk assessment & team visits; de-escalation/crisis training
Hospital-community continuity	Limited service access; geographic & organizational barriers; chronic disorders	Strengthen transition pathways; reduce access barriers	Family engagement; proactive post-discharge follow-up; strengthening inter-service links
Forensic patients management	High clinical complexity & aggression; difficult care/containment balance; poly-drug treatments	Structured recidivism risk assessment; develop specialized teams & pathways	Use of standardized tools; joint DSM-REMS project development; specialized staff training
Informed consent	Fluctuating decisional capacity; clinical judgment-only assessment; poor SDM adoption	Regular capacity assessment; promote SDM & recovery	Use of standardized tools; recovery-oriented practices; promote SDM in rehab projects; family engagement
Training & Guidelines	Evidence-practice gap; heterogeneous training; difficulty implementing procedures & monitoring safety outcomes	Continuous EBP training & safety indicators	Continuous staff education on EBP implementation & safety outcome monitoring

Table 1. Critical issues, objectives and intervention strategies for each clinical risk domain in community-based psychiatry

Conclusions: RM in community-based psychiatry in Italy requires a systemic approach. It is essential that Italian mental health departments invest their resources in trained personnel, standardized tools, evidence-based practices, and a culture of shared decision-making. As a non-systematic review, this study is not exhaustive and further research is needed to fully map RM practices in Italian community-based psychiatric services.

 

Disclosure of Interest: None Declared