Prisons are worse than refugee camps: they're supposed to re-educate, but overcrowding and a lack of planning are the main causes.

After many years of experience as a doctor on missions in Africa, Afghanistan , and Iraq, working in hospitals and refugee camps, in Italy's migrant labor zones, and in the central Mediterranean, I thought I'd seen enough of the degradation our (in)civilization has succeeded in spreading. But when, with Hands Off Cain , I had the opportunity to visit our prisons, I realized I hadn't yet seen the worst. It was shocking to enter, as a doctor, institutions officially created to contain, but also to re-educate and reintegrate those who have made mistakes, and to see how they have instead been transformed into places where human dignity has no place, where overcrowding, a lack of staff, resources, and planning make the lives of prisoners and detainees a constant affliction.

A significant portion of our prison inmates are substance addicts, driven to crime by their addictions; immigrants who have not found a reception system, forced to commit crime to survive and remain incarcerated because they have no place to serve their time under house arrest; and people with psychiatric illnesses. These illnesses, even if not evident before entry, are exposed by detention, leading to inappropriate behavior (and therefore further punishment) or self-harm. If these people were not locked up, the main problem—overcrowding—could already be solved. But the pathogenic nature of prisons would still not be overcome. In the briefings preceding NTC visits, operators inform us of the presence of few inmates with psychiatric problems, meaning those with a specific diagnosis (schizophrenia, bipolar disorder, etc.), often prior to their arrest. It is self-evident that they should not be held in prison, but rather be cared for by psychiatric services.

But if we then look at how many inmates take psychotropic drugs to combat system-induced anxiety and depression, the percentage easily reaches around 90%. This indicates that prison itself is pathogenic, that is, it generates mental illness, and it's not surprising: in many cases, cells are locked 20 hours a day, access to work is limited to a few, treatment options are limited by staff shortages, and so on. The very sad statistics on suicides (20 times the rate of the general population) testify to how imprisonment is inevitably pathogenic. But our Constitution ( Article 32 ) mandates " the protection of health as a fundamental right of the individual and a collective interest" and does not permit, beyond the restriction of personal freedom, undermining the health of persons entrusted to state custody. Its protection is now entrusted to the health authorities, but the few doctors available, with their limited resources, can only try to limit the damage caused by imprisonment, certainly not aspire to prevent it.

Prison conditions in various institutions can vary greatly: I recently visited the prisons of Trapani and Favignana. The range goes from the total degradation of Trapani, where treatment or work, whether internal or external, is a pipe dream, to that of Favignana, where, despite being a "closed" prison, approximately half of the inmates enjoy treatment or work inside or outside the prison. Not that everything is rosy: the cells, though larger than those in other institutions, are designed for three inmates, but are occupied by four or five, and that's no small change. It's also unclear why a prison where conflict is minimal and access to "rewarding" measures is high should still maintain a "closed" regime. How is it possible, I wonder, that we can still tolerate the fact that, I fear, the majority of institutions in our country are simply places of punishment and affliction, despite the fact that there are institutions that—with all their problems and flaws—seem to respect the dignity of inmates, tend to comply with the constitutional and regulatory mandate of re-education and reintegration, and safeguard a work environment that, if not rewarding, is at least acceptable for inmates.

We hope that the monitoring activity that NTC also carries out for the DAP will be an incentive to standardize and improve conditions across all institutions. It is also well-established that, where inmates are respected as individuals, the likelihood of reoffending decreases, with clear benefits for society as a whole, even from a strictly " economic" perspective. Investing in prisons (facilities, personnel, activities) means not only improving outcomes but also reducing costs. As a physician, it is clear to me that prevention is much better than cure, both in terms of outcomes and costs. I don't think it's any different in prison administration.

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Mimmo Risica