After the 2008 reform, prison healthcare was removed from the competences of the Ministry of Justice.
Every prison facility has a health care unit
Prisons are generally equipped with an infirmary. Some prisons, however, have better equipped clinics than others. In some prisons, there are services of microsurgery.
Antigone considers the Italian prison healthcare system to be characterised of general poor conditions and lacking medical staff and suitable equipment.
Every region has the competence to recruit staff; there is no national plan implemented regarding this aspect. Also in this instance, differences in quality of the medical staff are reported depending on the region where the prison is located.
There is a special section for inmates in certain public hospitals.
Access to health care
Health care is free
Inmates must pay for some specific treatments that are not provided by the prison administration.
A medical examination is performed upon admission
A medical file is opened upon admission
Medical records are generally difficult to access and poorly kept. The National Preventive Mechanism has recommended the implementation of a digital medical record.
Out of the 86 prisons visited by Antigone, 59 did not have a computerised medical record system.
Prisoners can access health care units after
a written request
Medical examinations are carried out on a confidential basis
Medical examinations are sometimes performed in the presence of the supervisory staff.
Persons receiving a specific treatment before they enter prison face difficulties to continue once imprisoned. They cannot be regularly visited by the doctor they used to consult before they were in prison. Medical appointments with external doctors are at the expense of the inmate1.
Medical, surgical and psychiatric services are considered to be insufficient. Furthermore, there is no medical attention available 24 hours a day in every prison.
Due to the lack of medical staff, sick inmates are sometimes taken care of by fellow inmates employed by the prison administration. They receive a salary called piantone.
Medications are generally available in prisons and they are distributed by the medical staff. Some treatments are not available in prison. Inmates must buy them outside but face long waiting lists and strict procedures to ask for permission.
Inmate requiring special treatments should be hospitalised. However, transfers are not carried on time, due to long waiting lists and the lack of police staff.
According to a study on the ethical issues of prison nursing in Northern Italy, the prisons of the Liguria region privilege security over health. There are not enough dedicated medical areas and a high turnover of medical staff. Foreign inmates have difficulties to access healthcare because of the language barrier. Nurses easily mistake their names and identifications, making difficult to provide proper healthcare.
Dental diseases are widespread. The pathologies produced by the detention itself are numerous: depressive pathologies, for example, are the norm. In some institutions, up to 90% of prisoners take psychotropic drugs.
In the Liguria region, the most common health diseases are psychiatric disorders (88%) and drugs addiction (30%).
Mental health care
Until 2016, persons declared legally irresponsible during trial were placed in special facilities named “Criminal Mental Asylums” (known as OPGs in Italy). The REMS (Residences for the execution of security measures) are the new facilities that replaced the OPGs. These centres offer better psychological treatment and focus on the recovery of each inmate. These facilities cannot host persons whose mental disorders appeared while serving their sentences. In those cases, there are special “mental health and patient safety units” in some prison facilities.
REMS show high occupancy rates. Inmates with mental disorders are treated with high doses of sedatives.
Inmates suffering from mental illness should be placed in safety blocks within the prison facility. These blocks remain under the authority of the Ministry of Justice but the medical staff depends on the Ministry of Health.
Psychiatric care is usually provided in a claustrophobic environment. Instead of been placed in safety blocks, inmates are often placed in cellaliscia or smooth cells. They are isolated within those cells that do not contain any furnishing.
The National Guarantor also pointed the lack of activities in the safety blocks.
The safety blocks are managed by a medical staff composed mostly of psychiatrics. They provide an individual medical plan for each sick inmate.
The CPT pointed the fact that the psychiatric staff was not properly trained to apply regular medical treatments. The delegation received complaints regarding inmates that had been locked up in seclusion rooms wearing only their underwear and sometimes handcuffed to beds1.
The REMS employ armed guards in spite of the fact that they are mental care centres. The recruitment procedure is not adequate and the staff does not receive appropriate regulations on their duties.
The REM of Castiglione delle Stiviere was criticised by the CPT after a visit to the establishment. The delegation pointed a number of complaints about the disrespectful behaviour of some members of the staff, as well as poor living conditions in one of the buildings of the centre. Moreover, patients spent most of the day inside their rooms and general punitive environment was prevalent2.
Inmates who show drug dependency are held in special blocks in order to create a positive environment without criminogenic influence.
The psychiatric care provided in some prison facilities is considered to be inadequate.
In May 2017, the National Guarantor visited the Psychiatric Observation Department of “Il Sestante” prison in Turin. The National Guarantor noticed that cells were not properly equipped and were in poor hygienic conditions. Some cells had no bed linens because inmates refused or were under the psychiatric supervision (as disciplinary sanction). Bed linens had to be brought by family members in some cases.