Home » Offenders with mental disorder? This is how we treat them. by Veronica Rossi – Mental Health Forum

Offenders with mental disorder? This is how we treat them. by Veronica Rossi – Mental Health Forum

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VITA’s series on mental health within Italian penitentiaries continues, with an interview with Giuseppina Paulillo, director of the complex operational unit “Psychiatric residences and forensic psychopathology” in Parma, who explains how the treatment of those who has a psychiatric problem before entering prison and of those who develop it within the walls of the cell

How are – or should be – looked after offenders with mental disorders? Whether the problems arose within the walls of the penitentiary, or whether they preceded the arrest – and therefore possibly led to a sentence of non-indictability – there should be care for these people, in order to ensure that they the fundamental right to health and care. Giuseppina Paulillo, psychiatrist of the Local Health Authority of Parma and director of the complex operational unit “Psychiatric residences and forensic psychopathology”, which also welcomes criminals, explained to us how this care takes place in her Region.

Doctor, what is the path for those with a psychiatric disorder within Italian prisons?

Inmates who enter prison without a diagnosis and whose imprisonment unfortunately causes them to develop a psychiatric pathology are taken care of by the mental health services which – with organizational and operational differences – are present in almost all Italian prisons. If the conditions can be compatible with the prison regime, an attempt is made to treat the person in prison, providing planning support that includes psychiatric and psychological interviews and an educational project, oriented towards the work and socializing dimensions. Group activities can be envisaged, aimed at preventing relapses into drug use or programs aimed at working on the dimension of mistreating men, depending on the psychological and behavioral framework of each individual. Of course, the substantial critical issue is that maximum collaboration must also be found with the prison administration, because in fact the health dimension is in some way a guest within the institution. If things work, the person is involved in a support process, which brings benefits from different points of view.

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What you describe is an ideal picture. However, many speak of inmates’ conversations with psychiatrists who are almost absent and we often hear about suicides in cells…

Distinctions need to be made. We often talk about psychiatric diagnoses referring to what for us is the most critical diagnosis, which can be related to schizophrenia spectrum disorders. The main problems in prison are represented by substance abuse – therefore drug addiction -, which occurs outside or inside the walls, which can be associated in comorbidity with a personality disorder. The number of prisoners with a diagnosis of schizophrenia spectrum disorder is small compared to those with personality disorders or drug addictions, who in the Parma penitentiary are mostly represented by homeless foreigners or who in any case are not guaranteed to have a permit of stay. They are characterized by extreme poverty and, sometimes, psychotropic drugs become an object of sale and profit, so there is a tendency to manipulate the system to obtain more and more drugs to be used improperly. Even when we talk about suicides in prison, we need to look at when and how they happen. They do not always fall within a psychiatric dimension, there are conditions that can lead to risk factors that go beyond it. Usually the reasons are more linked to the type of detention, the length of the sentence, poverty, the absence of a family support network and a difficulty in having a suitable defense that should guarantee the rights of the prisoner.

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