Suicide and Psychiatrist's Liability in Italian Law Cases

Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective

Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/2017 'Gelli-Bianco'. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation.Methods: The Italian hospitals' public procedures on suicide prevention issued between 2008 and 2019 (n = 33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations.Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk.Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk.KEY POINTSProcedures for suicide prevention are of uttermost importance for psychiatrist working in hospital.Standards in suicide risk evaluations are needed.Comparison between procedures can improve risk assessment and evaluation.

Lying on the Road Before Being Run Over: Vehicular Manslaughter, Suicide, or Accident? Two Case Reports and Literature Review

We present two apparent hit-and-run cases where two women were run over. The vehicles involved were subsequently traced and their owners charged with manslaughter. Autopsy evidence, scientific investigation of the scene and circumstances of the deaths, technical inspection of the vehicles, and DNA analysis strongly suggested that both victims were lying on the road before the accident. Case 1 was a suicide. In Case 2, the victim had fallen to the ground following acute alcohol intoxication. Victimological analysis was pivotal in reconstructing the dynamics of the events. We suggest that a hit-and-run fatality should not be regarded as a manslaughter case until each piece of evidence has been carefully considered. We also propose an interdisciplinary method of reconstructing run over occurrences based on the following three steps: (i) identify whether there was a primary impact when the victim was in an upright position; (ii) identify victim drug/alcohol intoxication and/or presence of acute or chronic disease or injury, which may have contributed to the impact; and (iii) consider suicide intent.

Italian Investigation on Mental Health Workers' Attitudes Regarding Personal Recovery From Mental Illness

This study aimed to investigate attitudes toward personal recovery in a sample of 436 healthcare professionals and students of psychiatric rehabilitation techniques through the Italian version of the recovery knowledge inventory (RKI). The sample in our study showed a good global orientation toward recovery. Statistically significant differences were found among mental health professionals based on gender difference, professional role, and level of experience. Women seemed more inclined to accept users' decision-making processes, including therapeutic risk-taking. Nurses seemed more cautious in considering the users able to "live beyond their illness". Professionals with fewer than 15 years of experience had more favorable attitudes and expectations than the more experienced respondents. Students had more optimistic expectations regarding recovery than nurses and social workers. Academic curriculum development for students and training courses for mental health professionals could further improve the homogeneity in attitudes and skills in the support of users' "unique" recovery processes.

Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York

The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model-including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests-was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.

Homicide committed by psychiatric patients: Psychiatrists' liability in Italian law cases

Interest in psychiatrists' professional liability in Italy has increased in recent years because of the number of medical malpractice claims. Professional liability for failure to prevent violent behaviour by psychiatric patients is particularly debated. This study describes three Italian cases in which health professionals - physicians and nurses - were found guilty of manslaughter for murders committed by psychiatric patients. Examination of the cases focuses on claims of malpractice, patients' characteristics, the circumstances of the homicide and the reasons for the court's judgment. In particular, the predictability of violent behaviour and the concept of causal links are examined in detail. The cases provide an opportunity for a study of comparative jurisprudence. The topics discussed are relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of criminal acts committed by psychiatric patients.