Psychiatry needs of men in Spoleto Prison

Introduction Prevalence studies on psychiatric morbidity among prisoners are important for determining the psychiatric treatment needs inside the prisons, identifying inmates suffering from mental illness, and developing the best possible forensic-psychiatric support (Andersen 2004). The responsibility for penitentiary health services in Italy has recently shifted from the Ministry of Justice to the Azienda Sanitaria Locale, Regional Health Service. In light of what we know about health care needs of prison population, and the tendency for prisoners to avoid health services (Bridgwood & Malbon, 1994), it is critical to assess their mental health needs. Such data will allow us to implement suitable screening procedures aimed at better identifying inmates’ needs, and to develop therapy plans and for each responsible territorial service. This study has two aims: 1. To determine the mental health needs of men in an Italian prison; and 2. To determine whether mental health needs of inmates differ across key correctional subpopulations. Methods Design Interviewers conducted semi-structured clinical interviews with n=526 convicted males incarcerated in the Spoleto Prison from October 2010 through September 2011. Site This study was conducted at the Spoleto prison under an agreement with the Psychiatric Functional Area (ASL 3 Umbria Region –University of Perugia). The Spoleto Prison processes about 700 male detainees each year. The sociodemographic characteristics of detainees at the Spoleto Prison are representative of other medium and maximum security prisons in the Umbria region of Italy (cites). The Spoleto Prison is subdivided into 4 sections according to crime and inmate type: (1) Common Criminals section; (2) High Surveillance section, for dangerous inmates sentenced for mafia crimes who are not, however, leading figures in organized crime; (3) Protected section, for inmates whose personal safety would be endangered if allowed into the general prison population due to the nature of their offense (social censure for pedophilia and rape) or due to their sexual orientation; and (4) Section “41 bis”, for leading figures in organized crime. Measures Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II). Addiction Severity Index-Expanded Version (ASI-X; Oberg et al., 1999; Italian translation; Carrà et al., 2004a). The ASI-X is a semi-structured interview that measures drug and alcohol use as well as functioning in areas often affected by substance abuse: medical status, employment and support, legal status, family/social status and psychiatric status. Deliberate Self- Harm Inventory (DSHI) (Gratz 2001). The DSHI is a self-report measure composed by 17 items that evaluate all the aspects of self-injury behaviours. This questionnaire is the only linguistic and culturally validated measure of self-injury for the Italian population (Rossi Monti & D’Agostino 2010). Statistical Analysis To compare means, we used ANOVA one way for continuous variables and Kruskall-Wallis-test for nonparametric variables. The categorical variables were analysed by X2-tests and Fisher’s exact tests. The results for all tests were considered to be significant for p values of less than 0.05. Statistical analyses were conducted with a standard SPSS software package (version 12.0). Results and discussion Inmates tended to be poorly educated, underemployed prior to their incarceration. Significantly more Common Criminals had been unemployed prior to their incarceration. High Surveillance inmates were the oldest, more likely to be married and more likely to be Italian than either Common Criminals or Protected inmates. Mental health needs are prevalent. Half of inmates have an Axis I disorder and two-thirds have either an Axis I or an Axis II disorder. Rates of disorders across groups were similar for psychosis, mood and anxiety disorders; Common Criminals were more likely to have substance use and personality disorders than other groups. Over one third of inmates have comorbid types of disorders. The most common diagnostic profiles are personality disorder only, comorbid anxiety and personality, comorbid substance and anxiety, comorbid substance and personality, and anxiety only. Medical problems are prevalent, particularly among High Surveillance inmates. Common Criminals were more likely to have had detoxification services and less likely to have had outpatient psychiatric services than other inmates. One out of every 20 inmates had seriously thought about suicide in the prior 30 days; 1.1% had made an attempt in the past 30 days. Directions for Future Research Assess needs of all inmates and determine if generalizable to other prisons in Italy.