DOI: 10.1192/j.eurpsy.2026.11714 ISSN: 0924-9338

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

G. Listanti, S. De Persis, D. Tripi, S. Ferracuti

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:

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Staff well-being and safety

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Hospital-community continuity

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Forensic patients management

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Informed consent

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Training and guidelines

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

Table 1.

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

Table 1. Long description.

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

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

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