Mental health

Modena case, the axe on psychiatric centres: many give up treatment

The perpetrator of the massacre was reported to have been in treatment from 2022 to 2024 and then abandoned the drugs because - according to his lawyer - he said he was feeling better. Now the spotlight is shining on the lack of access to treatment for many psychiatric patients

by Letizia Giostra

18 May 2026

3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

No one knows what went through the head of Salim El Koudri, the 31-year-old Italian of Egyptian origin who last Saturday in Modena, while driving his car, plunged into the crowd and caused panic. Some speak of persecution mania and others of psychosis, but the prefect Fabrizia Triolo confirms the past diagnosis of schizoid personality disorder. The offender - who will now have to answer for strage and aggravated injury - was in treatment for two years, from 2022 to 2024, and then voluntarily discontinued the course. His defence lawyer, Fausto Giannelli, requested a psychiatric report.

In the meantime, Italy has split into two camps, namely those who recognise the man's illness as the trigger of the near tragedy and those who do not see a link between the two. What is certain are the numbers relating to psychiatric care: there are 845,516 users assisted in Italia, but problems such as long waits and a shortage of staff, which drive many to abandon the course (or not to start it at all).

Psychic disorder as the cause of the near massacre

After the search of Salim's home in Ravarino, no elements emerged that could suggest a religious radicalisation or links to subversive formations to explain what happened on the afternoon of 16 May. The most plausible hypothesis for investigators, therefore, is the mental instability of the bomber. A thesis supported both by the prefect and by the Minister of Defence Guido Crosetto himself, who speaks of an "event linked to the psychological sphere".

While his criminal record is clean, the man's mental problems are so debilitating that he is now undergoing treatment at the Castelfranco Emilia Mental Hygiene Centre, where investigators from the Digos and the Antiterrorism Unit went to acquire his medical records. The diagnosis would be schizoid personality disorder, defined in the DSM-5-TR as 'a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal contexts'. Salim's treatment plan also included medication, but he stopped taking it after two years because he felt he no longer needed it.

The health status of psychiatric care centres

With the Basaglia law, asylums closed in order to open psychiatric care centres. But where are they? They exist, but have shrunk over time due to high costs. The same applies to the acute shortage of staff, estimated at 30%. Between reductions and cutbacks, the result is a domino effect: patients' choice is either to turn to the private sector or not to go at all.

Now it is the turn of the National Mental Health Action Plan 2025-2030, approved on 29 December last year. With 80 million euros for 2026, 85 for 2027, 90 million for 2028, plus 30 million in the year 2029, the aim of the plan is to overhaul care centres, putting hands on mental health services so as to ensure uniformity throughout the country. This means remedying an organisational vacuum that has lasted 13 years, during which time a patchy situation with serious shortcomings has arisen in Italy.

What the Ministry of Health says

It was only last month that the Health Ministry published the Mental Health Report. The data collected are for the year 2024, the same year in which Salim decided independently to stop treating himself. The result is a mirror of the phenomenon: there are 845,516 psychiatric users assisted by specialist services. Cold numbers, but which tell the stories of the most fragile. With regard to the facilities active on the territory, the figure is 1,236, the residential ones 1,962 and 800 the semi-residential ones.

Expenses

For drugs such as antidepressants, the total gross expenditure is over 419 million euro, while for antipsychotics it is 89 million euro. The average annual cost per resident of psychiatric care is €75.2, while territorial care amounts to €3,572,433 (in thousands of euros). In the past, the Emila-Romagna has invested 1.3 million for the promotion of health and addictions, also focusing on thetraining of operators.

The few professionals

Then there is the problem of the shortage of staff, which in 2024 stands at 33,142 between psychiatrists (14.5%), psychologists (7%) and nurses (37%) followed by psychiatric rehabilitation technicians and social workers. According tothe National College of Directors of Mental Health Departments, there are approximately 25,000 operators in mental health centres, equal to 55 for every 100,000 inhabitants, 7,500 less than the standard of 83 for every 100,000 inhabitants adopted in the State-Regions Conference.

The most common disorders

Schizophrenia was the most common disorder among men who sought assistance, followed by substance abuse disorders and mental retardation. Women, on the other hand, turned to mental health centres mainly for affective, neurotic and depressive disorders.

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