Valutazione e percorsi di trattamento del rischio autolesivo in carcere. L’esperienza nella Casa Circondariale di Monza

[Autom. eng. transl.] For inmates, the main self-harm risk factors described in the literature can be summarized in two categories: the situational one, relating to the detention event, and the import one with reference to socio-demographic variables, to the clinical characteristics of the individual prior to the detention. Due to the specificity of the detention context, considering self-injurious act as the result of the interaction between different categories of risk factors seems to be the most appropriate way to adequately guide clinical interventions. In the Monza Prison, since September 2012, a protocol aimed at preventing self / hetero-damaging action has been applied to all the population who access the institute within 72 hours of entering the New Joints Service. In addition to the clinical interview, a text assessment is administered, aimed at a multidimensional examination, with the following standardized tools on the detained population: i) Jail Screening Assessment Tool (J-Sat), a semi-structured interview that allows to investigate the legal situation (type of crime, detentions), history of aggressive acts (self / hetero directed), psychosocial evaluation (meaningful relationships, social support, work), substance use, presence of psychiatric disorder (in history and in actuality), suicidal / self-injurious risk, presence of anxious and depressive symptoms; ii) Barratt Impulsiveness Scale 11 (BIS11) self-administered scale aimed at measuring impulsiveness; iii) Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM), a self-administered scale that allows you to assess the level of psychological distress, also used as a tool for evaluating the outcome of the activated intervention. In the event of a positive screening, the inmate is taken into care by assessing the evolution of the clinical picture, a request for psychiatric evaluation and inclusion in a monitoring plan is carried out, with precautionary surveillance measures. Within 2 weeks of the first interview, the Millon Clinical Multiaxial Inventory-III (MCM-III) is administered, a questionnaire aimed at deepening the structure and functioning of the personality. The assessment protocol used makes it possible to investigate both situational and import factors as risk categories, as well as their interaction, on this basis the clinician proceeds to define the most appropriate intervention. The initial assessment phase makes it possible to identify the areas of weakness to be addressed and to define the objectives of the intervention, sharing them with the detained patient.