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

Main risk factors of self or to others injurious behaviors in prison settings, as describing by researches, could be divided in situational factors, related to the prison environment and importation factors, related to the socio-demographic status and clinical characteristics prior the imprisonment. Related to the specificity of prison setting, considering self or others injurious behaviors in prison settings as the outcome of composite combinations of multiple risk factors is more appropriate for orienting the clinical interventions. Considering guidelines a specific protocol actuated at the Monza Prison to assess and prevent risk for harm in prisoners. It has been applied since September 2012 and within 72 hours from the entrance in prison every prisoner has a clinical session with a psychologist where some screening tools are administered: i) Jail Screening Assessment Tool (J-SAT), used to explore juridical situation, history of aggressive acts, psychosocial evaluation, drug assumption, presence of psychiatric disorder, suicide or self-harm risk, presence of anxious and depressive symptomatology; ii)Barrat Impulsiviness Scale-11 (BIS-11), a rating scale to evaluate the impulsiveness; iii)Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM), a rating scale to evaluate the distress' level. It could be used also to evaluate outcome of treatment. When the psychologist detect the risk by J-SAT and/or by BIS-11's score above cut-off, it's possible a psychiatric advice and the prisoner is included in a monitoring and treatment plan which is dependent on the development of the clinical conditions. In these prisoners, Millon Clinical Multiaxial Inventory-III (MCM-III) is also administered within 2 weeks from first clinical session, to investigate the structure and the functioning of personality.This protocol allows to investigate both situational and importation risk factors and how they interacting with each other and the psychologist could use these information for orienting the clinical interventions.