Drug-addicted inmates? Let's release them and treat them at home...
The prison plan
I'd go further: as health workers, we should have the courage to say that no patient should remain in prison, because it's a place that makes people sick and doesn't heal.
It seems that Minister Nordio and his ministry have finally acknowledged that severe prison overcrowding can only be resolved by releasing prisoners. This should include the approximately 10,000 inmates serving sentences of less than two years, who will be allocated to alternative measures. It is estimated that 25% of them are substance addicts, and for them the Minister envisions a therapeutic community.
Therapeutic communities are a health treatment, which must meet clinical appropriateness criteria assessed by healthcare teams. Community care is not necessarily the most clinically appropriate intervention for all incarcerated substance abusers: for many, an outpatient or day program, with placement in their own homes, may be more appropriate. Furthermore, treatment must be available: it's pointless to offer an Italian patient the latest cutting-edge drug for cancer if it's only available in the US. We know full well that places in therapeutic communities are far below demand. Appropriateness and availability impact equity: in a healthcare system with limited resources, it's important to provide each patient with only the right treatment, so as not to deprive others who could benefit from it or have a greater need. All of this leads to one conclusion: the release of substance abusers from prison to alternative treatment programs should be done without preconceptions, based on clinical evaluations, and considering the possibility of outpatient and day programs with return to home.
A therapeutic community shouldn't be offered to a prison addict, because we wouldn't recommend it if they weren't incarcerated. This cautious attitude of inappropriately recommending a therapeutic community to incarcerated patients is unfortunately widespread even among SerD workers. But it doesn't respond to a rationale of care, but rather to social control, which a healthcare provider shouldn't engage in. This type of attitude, in my opinion, hides a prejudice against substance addicts and communities: that a prison addict must serve his sentence locked up somewhere , and that the community can be a place of coercion. We don't like the idea of a substance addict on alternative measures who receives outpatient treatment, who can go shopping alone at the supermarket, and who serves his sentence at home, perhaps socializing with neighbors and volunteering at the parish where our children play. It's natural for the Minister of Justice to think so, though: he's in charge of justice.
The tragedy is when health professionals, who should be solely concerned with healthcare and not meddling in the justice system, much less playing the role of judge, think so. Starting from the assumption that no health professional can be in favor of prison, because no health professional can agree with a system that exposes its patients to an iatrogenic environment, I believe it's time for us, as health professionals, to reclaim our political role and not limit ourselves to acting as technicians for the survival of the convicted. This means welcoming the possibility, raised by Minister Nordio , of freeing our patients from the iatrogenic environment in which they are held, but also recognizing that treatment and recovery do not necessarily require coercion, much less by inappropriately occupying places in therapeutic communities, and that treatment and recovery can also be achieved by returning home, through day and outpatient programs that include social participation and do not unreasonably prolong isolation.
I'd go further: as healthcare professionals, we should have the courage to say that no patient should remain in prison, because it's a place that makes people sick, not healed. And if outpatient care is the most appropriate for the majority of non-prisoner substance abusers—these are the statistics for the population served by SerDs —there's no reason why the same statistics shouldn't apply to our incarcerated patients. Epidemiology doesn't discriminate. People do.
* SerD psychologist manager
l'Unità
