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Italy pioneered deinstitutionalization 4O years ago, with the famous Law no. 180 in 1978. The mental health reform law abolished the psychiatric hospitals and gave back to people with mental issues the full right to citizenship. Law no. 81 of 2014 set the deadline of 1 April 2015, for the closure of the Forensic Psychiatric Hospitals (Opg), ending a complex legislative path that began with Law 9 of 2012. Since that date no citizen, male or female, has been sent in custody as a security measure to the Opg. As mandated by the law, thirty regional health Residences for the implementation of safety measures (Rems) have been established on the national territory. The recent Constitutional court ruling no. 99 in 2019 has made an important step to guarantee the fundamental right to health: from now on the court can decide, for individuals that manifest a serious psychiatric illness while incarcerated (rei folli), to convert the penalty into alternative measures to prison (e.g. mandatory postponement, optional deferment, home detention, assistance or residential facilities). After this important ruling inmates, with supervening mental illness will be granted the same rights of inmates with serious psychic illness. The constitutional court with this ruling strikes a balance between safety and treatment.