from newspapersanita.it, 3 April 2024
In the first three months of 2024 there were 28 suicides in prisons. Suicide rates 20 times higher than the general population. An alarming and complex phenomenon for which simplistic readings are not adequate and which sometimes fuel the stigma of mentally ill people held responsible for both internal disorders in prisons and suicides. The data from the National Guarantor’s Report offer important reflections.
a) It should be remembered first of all that there is a difference between being affected by mental disorders and mental infirmity (non-imputability). Only a limited part of people with mental disorders are legally “mentally ill”: people with a definitive detention order in REMS are 331 and occupy 51% of REMS places. It follows that if these were used only for “permanent” workers, the current REMS places would be more than sufficient.
b) Persons arrested in prison, even before the trial, may be subject to the application of temporary detention security measures. This makes them become prisoners “sine titulo” as the security measure from a legal point of view cannot be carried out in prison.
These are people who are presumed innocent and whose illness is often yet to be ascertained. In November 2023 there were 42. Even one is too many. To prevent these situations, a coordination of times could be adopted between judges, lawyers, experts and the DSMs for the purpose of transfer to other health centers or to home according to the indications of the DSMs (who on the national territory follow approximately 6,000 people with judicial measures) or as an extreme ratio in REMS. Operational protocols and appropriate use of REMS places are needed according to the State-Regions agreement of 30 November 2022.
c) In prisons there are people with attributable mental disorders serving a sentence. Mental health and pathological addiction services ensure treatment activities in penal institutions. There are the Mental Health Protection Units (ATSM) which host around 230 people. There are 350 people detained with an “established psychiatric diagnosis” (out of around 56,000 inmates) but the prevalence is certainly higher (around 20%).
The study by the National Guarantor highlights that in 2022, out of 85 suicides, 11 (13%) were suffering from certified psychiatric pathologies and one was waiting for a place in REMS. 28 people out of 85, equal to 33% of the total, had already attempted suicide. At the time of suicide, 19 out of 85 people were subject to high surveillance which makes us reflect on the effectiveness of this tool and more generally on preventive models.
d) About a third of prisoners have substance use problems and it is these situations that are relevant both for life in penal institutions and for the purpose of preventing suicide. The difficulties are also demonstrated by the use of psychotropic drugs in prisoners, 5 times higher than the general population as highlighted by the research by Altreconomia n. 263/2023. People with psychopathy or substance use cannot and must not be sent to REMS but alternative measures can be activated (in therapeutic communities or in the local area).
e) Social issue The issue of suicides has a large social aspect as 68 people out of 85 (equal to 80%) were in vulnerable conditions and 20 (23.5%) suicides out of 85 were homeless foreign people.f ) Gender issue: 5 suicides out of 85 involved female people, an apparently low percentage and yet higher (2.1 per thousand prisoners) than the male one (1.48 per thousand prisoners) when compared to the total female prison population (2,372). It should also be remembered that there are still 20 mothers with 21 children in prison.
g) Legal position: 54% are people with non-definitive measures and 37% are awaiting the first judgement. For prevention, the relevance of critical periods (hearings, end of sentence and others), places of detention (medium security etc.) and peer support is known.
Finally, it should be remembered that penitentiary police officers have suicide rates double that of other law enforcement agencies and triple that of the general population. A further element to reflect on the effects of the deprivation of liberty and the conditions of detention. The number of prisoners is reaching around 61 thousand with an increase of 400-500 people per month.
To conclude. It is clear that it is not a question of increasing REMS but suicide prevention can only occur through concerted inter-institutional work, with multi-level actions. Given the seriousness of the data and the reminder of the President of the Republic Sergio Mattarella, a common political will is needed which leads to the approval of laws on pardons, amnesties, early release (Giachetti bill), alternative measures, houses for alternative measures, the overcoming of the double track (Magi law proposal 1.119/2023), the reforms of the legislation on drugs, migration and poverty. Measures that would have the aim of reducing the number of people detained, creating alternatives, improving quality of life and giving hope. In this context, telephone calls, emotional and sexual relationships are fundamental in implementation of ruling 10/2024 of the Constitutional Court. Health, social and judicial resources are needed to adequately staff staff (and their training) and promote rights, fight poverty and social and health deprivation to prevent suicides during detention but also before and after.