Prevention of Suicidal Behavior in prison: first Italian results

Background Suicide is one of the most common causes of death in custody worldwide, with rates substantially higher than in the general population. In 2014 a new biphasic protocol was created in Tuscany (Italy) with the aim to develop new strategies for the prevention, monitoring and management of suicide risk in prison. The aim of our study was to describe the first results after the introduction of the protocol in the Penitentiary of Pistoia. Methods From April to June 2016, through a multidisciplinary staff, sociodemographic and health information of all new prisoners were collected. Everyone was screened for the suicide risk through the ‘Arboleda-Florez Check List'. A psychiatric counseling was offered to prisoners at risk in order to arrange their best management. Results 93 new prisoners (all males) were conducted in the Penitentiary of Pistoia. 36 were Italian; the others came from: Morocco (n = 12); Nigeria (n = 15); Iran (n = 1); Hungary (n = 1); Tunisia (n = 3); Dominican Republic (n = 1); Romania (n = 2); Albania (n = 6); Egypt (n = 1); Pakistan (n = 1); Brazil (n = 1). The mean age was 35 years (range 18-86 years). 16 were homeless, 52 unemployed, 1 retired. 77 resulted positive for at least 1 item of the Arboleda-Florez Checklist. After a further psychiatric evaluation, the big surveillance was ordered for 67 prisoners: 45 for the first incarceration, 1 for psychological distress, 6 for evaluation and monitoring of the adaptation, 4 for self-injurious risk, 1 for behavioral alterations induced by alcohol, 9 for toxic/alcohol dependence, 1 for the type of crime. The greatest surveillance measures for high suicide risk were ordered for 3 prisoners. Conclusions Preventing suicide is difficult, especially in a prison setting. Our results are cheering, but the impulsivity of prisoners makes suicides difficult to predict, and further researches are needed to develop more and more effective strategies for risk screening at reception for prisoners. Key messages: The new protocol let us classify the risk suicide of the prisoners, and adopt special measures for the inmates with a high/very high risk. Preventing suicide is difficult, especially in a prison setting and further researches are needed to develop more and more effective strategies to prevent it.