Prison, the difficulties of penitentiary medicine after the pandemic. “Suicides, systemic consequence”


Prison, the difficulties of penitentiary medicine after the pandemic.  “Suicides, systemic consequence”
Written by aquitodovale

The latest data on suicides in prisons and the tensions that have emerged represent only the tip of an iceberg which is also made up of the chronic limits of prison healthcare. Simspe – the Italian Society of Penitentiary Medicine and Health – has been working for years on the complex system of prisons, through which over 100,000 people transit every year, to whom the right to health must be constitutionally guaranteed, a goal that is not simple, complicated by an organization uneven, from the reference to two dicasteries, Justice and Health, and to the regional health organizations.

“The serious shortage of healthcare personnel and specific training, the operational difficulties for the nursing personnel, the absence of real coordination between the regions are today the main problems, which translate into healthcare marked by serious critical issues, first among all the shortage of personnel”. This is one of the main messages that emerged from the XXIII Simspe Congress – Penitentiary Agora -, held in Rome on 17-18 November. Infectious, psychiatric and dental diseases, social-health accreditation in confined communities in the spotlight.

“Covid-19 has affected prison medicine not only due to the number of infections and the complex prevention and vaccination activities, but due to the disruptive effect of the pandemic on the entire national health system and in particular on the territorial medicine of which prison healthcare is part of it – he underlined Luciano Lucanìa, president of Simspe –. The transfer of responsibilities from the Ministry of Justice to the NHS, which took place in 2008 in a disorderly way, has caused a fragmentation between the services that the various regions are able to provide. Added to this is the complex problem that emerged after the closure of the Judicial Psychiatric Hospitals in 2015: the subjects in a measure of safety should have flowed into the newly established Residences for the execution of the security measures (Rems), but the prisons still host prisoners awaiting Rems or other residential accommodation. These conditions affect not only the services, but also the willingness of doctors to agree to work in a system which at the moment presents very serious problems”.

“The pandemic has taken energy and resources away from prison activities – he explained Sergio Babudieri, scientific director of Simspe –. The health personnel working in prisons is not permanent and the other opportunities that have emerged have further impoverished this category. In recent years we have achieved important results: the data collected on Hepatitis C have made it possible to eliminate the virus in the prison population of various penitentiaries, HIV screenings have made it possible to start the related treatments. The inmates themselves proved to be collaborative, following the information activities that allowed them to understand the contribution offered to protect their health. The pandemic has interrupted this virtuous process and after the long stop we will have to restart with screening, information and training processes”.

The increase in suicides as a systemic consequence

There are 77 suicides in prison recorded in 2022 in just over 10 months. An impressive number, unmatched in recent times. “This data should make us think, but even more relevant are the data that we have partially or that we cannot find – explains Luciano Lucanìa – We need to know, for example, how many prisoners have attempted suicide without succeeding. Or even the statistics on Italians and foreigners, on those in pre-trial detention and those on expiation of their sentences, the conditions in which one lives in prison, between overcrowding, promiscuity, with feelings of despair and frustration. In these conditions it is not easy to identify who really has a mental illness that can lead to suicide. These gaps are not filled with bureaucracy, but with a system action, where SIMSPe and healthcare personnel can participate, even if a minority component: for scientific support to be concrete, it is necessary that the institutes are safe for healthcare personnel and equipped with the necessary resources. We need a new prison culture, based on a vision that allows the inmate to live the experience in a correct way”.

Dental problem as a real emergency

Among the various issues addressed in the Congress, the dental problem as a real emergency emerged with particular significance. Sometimes underestimated, dental problems represent a reality that weighs heavily on the health of prisoners. “The income of 90% of prisoners is below the poverty line and the same number have a low level of culture and education; 30-40% of prisoners are drug addicts and the same number use psychotropic drugs, elements that lead to a higher pain threshold with the consequent indifference to pain and lack of interest in any medical treatment – he underlines Mario Zanotti, ULSS 9 Verona outpatient specialist, dentist at the Montorio prison, Verona – From these data it is clear that a very large number of prisoners need dental care, often much more extensive and complex than civil society. Bruxism (teeth grinding) also affects 30% of the general population but rises rapidly to 70% in the prison population and can represent the emblem of the level of emotional tension of subjects deprived of their liberty. To deal with this, professionals and adequate structures are needed. In the study of some prisons (Verona, Cagliari, Potenza, Trento, Milan Bollate) in relation to the period 2017-2018 it appears that no prosthesis was manufactured at the prison level; only 6 mobile prostheses were packaged at the expense of the NHS (all in Potenza), but not in prison, but in hospital. However, the prosthetic needs were and remain infinitely greater. In short, a prisoner has no possibility of obtaining a prosthesis that is not paid for. The consequences of this situation are various: first of all, there is a physical aspect, for which these people cannot eat properly, but have to resort to minced or liquid foods (semi-solid diet), giving up their nutritional capacity as well as the pleasure of the table. Secondly, there is a psychological aspect: without teeth it is impossible to smile, self-esteem and self-esteem are reduced, in an environment which in itself causes difficult psychological conditions which often lead to depression and in several cases of suicide. The lack of dental care is not a direct cause of these phenomena, but it can be considered a contributing cause”. Dental care is therefore often underestimated, yet it has an effect on the physical and mental health of prisoners.

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