Nurses, a general practitioner, and a psychiatrist are required in each facility. Specialists (such as cardiologists, dentists, and ophthalmologists) can have regular office hours or can come to the prison for consultations. A prisoner can call upon an outside doctor at his or her own cost. ¹

Material differences exist from one region to another. In 2019, the CPT noted the alarming state of numerous infirmary sites.²

Prisoners for whom the pathology requires can be transferred to a regional civilian hospital.
Certain hospitals have a service adapted to receiving prisoners.

Article 11 of the Prison Rules provides for a continuity of care, despite transfers and changes in status. The respect for this continuity is, however, hindered by the limited number of health professionals.

Each prison has a pharmacy. Health care personnel are responsible for distributing medication. Access to medications not stocked within the pharmacy is limited.
As of 2019, prisoners taking psychotropic medications (antidepressants, sleep aids, anti-anxiety medicine) represent 30% of the incarcerated population.

Hospitalisation is provided when care cannot be administered in prison. Transfers to and consultations in a hospital are often slowed by the lack of penitentiary police staff.¹

Around 70% of prisoners suffer from one or more illnesses.
Drug addictions, psychiatric disorders, dental problems, respiratory or cardiovascular problems, and hepatitis C are the most common. Tuberculosis and HIV/AIDS both affect a relatively large part of the prison population. Health professionals regularly point to the pathogenic nature of the prison environment.

Sick prisoners generally receive proper treatment. Disparities exist among the various regions, and transfers can cause breakdowns in care.
Antigone notes the lack of psychological support in the handling of certain treatments.

There are regular prevention campaigns waged against HIV/AIDS, hepatitis C, and other communicable diseases.

Measures for reducing risk (condoms, syringes, etc.) are not implemented.

Prisons
A significant portion of the prison population suffers from mental illness. The NGO Antigone reports, in 2021, that 7% of prisoners had a serious psychiatric diagnosis and that 26% used mood stabilisers, antipsychotics or antidepressants.
Many patients are locked up in disciplinary cells without furniture (celle liscie) or in ordinary wards.¹ Twenty-five “ATSM” (articolazioni per la tutella della salute mentale) wards are dedicated to the care of people with severe mental disorders. These wards, located within prisons, have teams composed of nurses and social workers. Diagnosis of “mental infirmity” can be carried out to detect the presence of mental disorders in a detainee. Few therapies are provided; medication is the preferred treatment.
The ATSMs are under the authority of the Ministry of Justice, while the medical staff is under the Ministry of Health. The prison administration has the authority to decide whether to transfer an inmate to an ATSM.
Prisoners may be placed in continuous isolation or in the infirmary while awaiting a place in an ATSM. These measures are frequently used.

In the view of the CPT, prisons do not provide an adequate therapeutic environment. The Committee judges that those in need of specialised psychiatric treatment should not be imprisoned in correctional facilities.

Two members of the association Antigone visited, in 2021, the prison of Turin (Il Sestante). They deplore the disastrous conditions of detention in the psychiatric ward and report a strong shortage of psychiatrists. Seventeen people were placed there at the time of the visit. The ward had 20 cells that were narrow and dirty. The beds were fixed to the floor with little or no bedding. The inmates had no privacy to shower. One inmate had no light for several days. Another had no access to his lawyer. One young inmate was not supposed to be in the facility as he was awaiting transfer to a REMS residence.

Dedicated psychiatric facilities
Persons deemed irresponsible and dangerous are placed in “residences for the execution of security measures” (residenze per l’esecuzione delle misure di sicurezza, REMS). REMS are under the authority of local health agencies, under the Ministry of Health.² There were 31 in the territory in 2020.³ The number of people placed in REMS as of January 31, 2020 was 616.
These institutions were created after the gradual abolition, until 2015, of the judicial psychiatric hospitals (ospedali psichiatrici giudiziari, OPG). According to the CPT, the Italian authorities and NGOs are concerned about the significant increase in violent behavior by detainees. Attacks on guards, self-harm and inter-prisoner violence have been common since the closure of the OPGs.⁴

General psychiatric hospitals
Detainees can be transferred in emergency to the “protected medicine” departments of general hospitals, dedicated to detainees, or to the “Psychiatric Unit for Diagnosis and Care” (SPDC) in Turin.

According to a January 2022 judgment by the European Court of Human Rights (Sy v. Italy, in French), continuing to hold a person with a mental disorder in the ordinary prison regime despite a transfer decision for a residence for the execution of preventive measures (REMS) constitutes inhuman or degrading treatment (Article 3 of the Convention). The transfer in this case was not carried out due to insufficient space in the REMS. The mental health of the prisoner was deemed incompatible with the ordinary prison regime.

Several prison unions have denounced the over-representation of people suffering from psychological disorders and the lack of personnel training.
Antigone notes the lack of specialised medical personnel.

Local health agencies (ASL) offer methadone-based substitution treatments to drug-addicted prisoners. Professionals from the drug addiction service (SerT) regularly visit prisoners with addictions and offer pharmacological and psychosocial treatment as well as group therapy. There were 1,647 prisoners receiving opioid substitution treatment in 2014.¹ The CPT recognises this method as an example in the treatment of addictions.²

Prisoners with addictions can be placed in REMS if they also have a mental disorder. The SerTs are also responsible for follow-up in these facilities.

In 2022, Antigone noted that 18.9% of prisoners were receiving treatment for substance addiction.