Suicide in the mental health care of forensic patients: the Italian lesson.

Suicides occurring in forensic psychiatric care pathways raise important clinical and ethical issues. Indeed, suicidal risk increases under conditions of deprivation of liberty in prison. However, in the specific psychiatric facilities established in Italy since 2015 for patients subject to security measures (the so-called Residenze per l’Esecuzione delle Misure di Sicurezza, “REMS”), this risk is only slightly higher than found in individuals with mental disorders treated within community mental healthcare centers. In this regard, social disadvantages (poverty, unemployment, homelessness) and situational factors (overcrowding, early detention phase) are particularly relevant, but also coercive and liberty-restricting mental health interventions are crucial. The challenge for institutions lies in building alliances with individuals who are isolated and deprived of health, social, and legal resources. This manuscript examined suicidal factors in settings deprived of liberty, suggesting the promotion of mental healthcare that focuses primarily on the individual and their life plan, prioritizing protective and relational factors that generate hope and trust, rather than focusing solely on containment and risk reduction. In fact, safety is a relational construct, coproduced through relationships, connections, democracy, and freedom.