Prison: Mental illness, infectious diseases, and cancers on the rise

Cases of tuberculosis, hepatitis and cancer are increasing in Italian prisons, and psychological distress is on the rise. Problems are also due to a patchy medical assistance service that does not ensure timely intervention. For this reason, the Italian Society of Prison Medicine and Health (SimsPe) presented to the Ministry of Health a national project of prison health, with a multidisciplinary approach for the care of prisoners by a single service and no longer delegated to various ASLs. And the need to make prisoner care more efficient stems from the data collected in 2024, anannus horribilis for Italian prisons. Starting with the record number ofsuicides, 86 as of 10 December, higher than the 80 of 2023 and above the sad record of 85 deaths in 2022.

On the occasion of the XXV national conference "Agorà Penitenziaria 2024", promoted by SimpsPe, medics, psychiatrists and psychologists shone a spotlight on the management of the right to health in Italian prisons, where more than 100,000 people pass through every year, characterised by operational difficulties and fragmentation on a national scale. According to data from the Ministry of Justice, there were 226,280 persons with restrictive measures of liberty on 30 October 2024, a population similar to that of Molise.

"In order to protect the health of prisoners, it is necessary to take care of the prisoner when he enters detention,' emphasises Antonio Maria Pagano, SimpsPe President, Medical Director Psychiatrist in charge of the UOSD, Protection of Adult and Juvenile Health in the penal area at the Salerno Asl; followed by gastrointestinal diseases, including obesity and diabetes, due to an insufficient or incorrect diet or a lack of vitamin D, which together with a sedentary lifestyle also leads to osteoporosis. Lack of dental care is at the root of diseases affecting the mouth and the gastro-oesophageal tract. The lack of screening leads to diagnostic delays on tumours and infectious diseases. Unfortunately, there is no scientific data on the diseases from which prisoners suffer. It is emblematic that the latest report on drug addiction produced by the Ministry of Health and the State-Regions Conference notes the absence of this phenomenon, whereas in our experience we can estimate that at least 30 per cent of prisoners are drug addicts. A systemic intervention is therefore needed to ensure prevention, treatment and rehabilitation'.

The SimpsPe proposal aims at the creation of a national network of hospital wards for prisoners, the strengthening of networks for the protection of mental health and addictions both within and outside prisons for persons who are not detained but are deprived of their liberty, together with a legislative revision of the relevant legal institutions, as well as initiatives to support the recognition of the specificity of prison medicine. This implies working in synergy between the National Health Service, the Prison and Judicial Administration and Welfare.

"In Italy, prison health care is fragmented among various services," Antonio Maria Pagano emphasises. "The national prison health project (Pnsp) that we are proposing envisages several points: first of all, there must be a service in each health authority that acts as a single interface with the prison administration and with the guarantor authority to ensure consistency between security and health protection measures. Secondly, each health authority needs a single prison health service that incorporates the competences for prevention, treatment, rehabilitation, basic and specialised care, social dentistry, drug addiction, mental health, and minors in the penal area. In addition, these prison health units: must involve professionals dedicated exclusively to the care of persons deprived of their liberty; they must be based on a multidisciplinary approach and create university courses in the specialist schools most closely related to the prison reality (psychiatry, infectious diseases, hygiene, forensic medicine, clinical pharmacology and toxicology, dentistry), to make people understand the specificity of prisons and the services needed in prisons. This is our project that we hope will be taken into consideration for the next national health plan'.