In the last two months in the San Vittore prison in Milan, the number of psychologists available to over a thousand inmates has almost halved: there were nine, there are still five, and on some days there are only two operators on duty .
Over 200 people diagnosed with mental disorders are detained in San Vittore, and several hundred more people have mental disorders linked to drug addiction. It is among the most overcrowded prisons in Italy: in the cells designed for two people there are often five. The rate of foreign detainees is very high and complaints against ‘inhuman and degrading treatment’ in violation of Article 3 of the European Convention on Human Rights on the Conditions of Prisoners have increased significantly since the beginning of the year. Despite all these problems, psychological assistance is almost at a standstill.
According to the same psychologists and various associations that protect the rights of detained people, this serious shortcoming – which already compromises the health of hundreds of people – is a consequence of the fear and uncertainty generated by a recent investigation launched by magistrate Francesco De Tommasi. The investigation concerns four psychologists who assisted Alessia Pifferi in different ways, accused of letting her 18-month-old daughter die of starvation in July 2022.
De Tommasi is the public prosecutor in the main trial against Pifferi, but he opened a parallel investigation into the four psychologists and the woman’s lawyer, Alessia Pontenani, accusing them of having manipulated Pifferi with the aim of ascertaining his inability to understand and of wanting and therefore avoiding detention in prison. It is an anomalous investigation especially due to the methods, contested by the criminal chamber of Milan, the association of criminal lawyers who organized a day of abstention from work in protest on March 4th.
– Read also: The case of Alessia Pifferi and the protest of Milan’s lawyers against the prosecutor’s office
Two of the psychologists under investigation requested the transfer, a third alternated between prison and the Santi Paolo e Carlo social health company, the fourth psychologist under investigation works exclusively for the social health company and has never met Pifferi. Both Pifferi’s lawyer and the two psychologists serving in San Vittore claim to have simply done their job by applying correct practices, without any type of manipulation.
It is a thesis also supported by other psychologists. At the beginning of February they wrote a letter to the general prosecutor of Milan Francesca Nanni and to the president of the supervisory court Giovanna Di Rosa to denounce the methods of investigation and the consequent climate of tension in which they are forced to work: the public prosecutor De Tommasi In fact, he requested and obtained environmental interceptions in prison and a search of the offices. “In addition to being almost halved compared to before, those of us who remain work with fear,” says Alberto Astesano, a psychologist and psychotherapist who works in San Vittore. «I work with the fear of highlighting a psychic vulnerability, for fear that the report will be labeled as a form of manipulation. This is also why everything is slower and more tiring.”
In San Vittore, as in other Italian prisons, psychological assistance is roughly divided into three areas: the interview at the entrance, emergency situations, constant prevention of the risk of suicide. The interview at the entrance is very important, especially for people who have never been in prison: there are many of them in San Vittore because people awaiting trial are taken there. During the interview they are asked what type of crime they committed, whether they had had psychopathologies in the past, whether they had been hospitalized and whether they had been in a position to think about harming themselves or committing suicide. The answers are used to identify the possible risk of suicide which is followed by an initial indication of therapy, which will then be evaluated by one of the five psychiatrists who alternate in prison.
Suicide prevention should be done constantly during detention, through observation of risk signals. “There are four of us left and with so many people to assist it is impossible to prevent,” continues Astesano. «We cannot cope with the demand for psychological assistance, which is enormous. We are in a total emergency and what’s more we work in a climate of heavy intimidation.”
Antonella Calcaterra, an expert in penitentiary law and the management of psychiatric patients in prison, uses the adjective “paralysed” to define the situation of psychological assistance in San Vittore. «After an investigation that has entered so decisively into the merits of assistance, many operators are wondering what they can do and what not», says Calcaterra. «Already under normal conditions there would have been a need to increase health and psychiatric interventions, which instead have decreased».
According to data from the Ministry of Justice updated to February 29, 1,146 people are detained in San Vittore, 151 percent of the permitted capacity of 754 people. Over 200 have been diagnosed with mental disorders, while many others have mental health problems due to their past: drug addiction, traumatic migration paths, compromised family situations, periods spent on the streets. “The situation is also serious because the number of healthcare workers is established on the basis of the regulatory capacity, not the number of actual prisoners: I have been reporting this for years”, says Francesco Maisto, guarantor of prisoners for the municipality of Milan. «The investigation has altered the environment and has a significant impact. Operators continually question whether their actions are legitimate. In fear of doing something wrong they limit their work. The prisoners pay the consequences: there is the risk of underestimating psychiatric problems.”
Since the beginning of the year, the Milan supervisory court has received 555 appeals against “inhuman and degrading treatment” presented by prisoners in all prisons in Lombardy, including San Vittore. In the entire twelve months of 2023 there were 477. Many of these appeals are a consequence of the new rules which limited the so-called open custody, i.e. the possibility for prisoners to move within the section – between the corridors, in the other cells and in the social rooms, where they are there – for more than eight hours a day.
Following the circular signed in 2022 by the then head of the Department of Penitentiary Administration (DAP) Carlo Renoldi, this possibility was severely limited: since last October, when the circular became operational, the cells are much more closed than the recent years and prisoners have less opportunity to move. When the appeals are accepted, i.e. in the majority of cases, the prisoners have the right to obtain a reduction in the sentence to be served equal to one day for every ten days of detention. If in the meantime the prisoners have served their sentence they are entitled to compensation of 8 euros for each day of detention in degrading conditions.
The closure of cells and living in tight spaces have consequences on the mental health of prisoners, with foreseeable risks also for safety. «The largest prison in Lombardy finds itself without psychological assistance at a time when it has the most fragile population in its entire history, in a situation of overcrowding, after many suicides committed in recent years», says Valeria Verdolini, president of the Lombard section of the Antigone association, which deals with the protection of detained people.
– Read also: What life is like for mothers detained in Italy
At the moment San Vittore is the prison where psychological assistance is most lacking, but even in other Italian facilities the protection of prisoners’ mental health has its problems and in some cases is quite poor. According to data released by Antigone, in 2022 in Italian prisons 9.2 percent of prisoners had a serious psychiatric diagnosis. Twenty percent of prisoners took mood stabilizers, antipsychotics or antidepressants, and 40.3 percent took sedatives or hypnotics. The hours of service of psychiatrists were on average 8.75 per 100 prisoners, those of psychologists were 18.5 per 100 prisoners. Only 247 people – 232 men and 15 women – were housed in the ATSM (Article for the protection of mental health), sections of the prison designed to accommodate patients with mental health problems.
Since the beginning of the year, 28 people have committed suicide in prison in Italy. Another 38 died from other causes: disease, overdose, homicide. In all of 2023, 69 people committed suicide and 88 died from other causes.
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Where to ask for help
If you are in an emergency situation, call 112. If you or someone you know is having suicidal thoughts, you can call the Helpline at 02 2327 2327 or via the internet from hereevery day from 10am to midnight.
You can also call the association Samaritans to the number 06 77208977every day from 1pm to 10pm.
