Clinical and forensic characteristics of patients admitted to a high-intensity psychiatric residential facility before and after the Italian Law 81/2014: A retrospective cohort study

Background The transition from Judicial Psychiatric Hospitals (OPGs) to the post-OPG system provides a historical context for examining psychiatric residential care in Italy. We described differences in the characteristics of admissions to one high-intensity psychiatric residential facility across two recorded periods surrounding this transition. Methods This retrospective single-centre study included 117 consecutive patients admitted to SRP1 “Tiziano” in Tuscany (40 in the earlier cohort and 77 in the later cohort). The cohorts were defined by admission before versus on or after 31 March 2015, the statutory OPG-closure deadline; this date serves as a historical reference point rather than an instantaneous intervention. Referral sources, diagnoses and available outcomes were compared descriptively. A post hoc exploratory logistic regression with three covariates was fitted in 116 complete cases; the originally submitted eight-covariate model was retained as sensitivity analysis. Results OPG/REMS referrals accounted for 22/40 (55.0%) earlier and 20/77 (26.0%) later admissions; referrals from acute psychiatric wards (SPDCs) accounted for 5/40 (12.5%) and 40/77 (51.9%), respectively (overall referral-source comparison p < 0.001). Multiple psychiatric diagnoses were recorded in 22/40 (55.0%) and 61/77 (79.2%) ( p = 0.006); the dedicated personality-disorder indicator was positive in 11/39 (28.2%) and 45/77 (58.4%) ( p = 0.002). In the exploratory model, SPDC referral (adjusted odds ratio [aOR] 11.50, 95% CI 3.61–36.67), personality disorder (aOR 5.95, 95% CI 2.20–16.13) and age (aOR 1.05 per year, 95% CI 1.01–1.10) were associated with later-cohort membership. At the 31 December 2025 cut-off, 105 patients had been discharged and 12 later-cohort patients were still admitted. Completed-stay durations were available for all 105 discharged patients, including one duration of 784 days recovered from source clarification; seven discharge destinations were unrecorded or coded as missing. Conclusions In this single facility, admission pathways and recorded diagnostic characteristics differed across historical periods surrounding the Italian forensic psychiatric transition. Findings are descriptive and exploratory; they neither establish effects of Law 81/2014 nor support nationwide generalization. At data closure, 12 later-cohort admissions were ongoing and seven of 105 discharged patients had an unavailable destination. Comparisons restricted to completed stays do not estimate overall time to discharge. Multicentre studies with verified dates, standardised outcome coding and appropriately censored follow-up are needed.