The dance of change in penitentiary care: window dressing or a new penitentiary care recipe?

This paper examines the complex and ongoing process of institutional and organizational change which concerns the provision of health services to inmates hosted by Italian prisons. In particular, the reality and the appearance of organizational change are confronted. The Law no. 419, dated November, 30th 1998 launched a deep reconfiguration of penitentiary health services, in an attempt to: 1) guarantee the provision of appropriate care to inmates; 2) merge the former Italian Penitentiary Health Care System and the Italian National Health Service (INHS); 3) introduce innovative organizational models to meet the special health needs of the imprisoned population; and 4) increase the timeliness and effectiveness of health and social services provided to inmates. The contents of the Italian reform are consistent with the worldwide transition from an approach that conceives imprisonment as a mere punishment to the guilty toward an understanding of personal detention as a process of inmates’ rehabilitation. However, the drawbacks of the reform on the ability of penitentiary health care units to factually meet the inmates’ health needs have been overlooked. Also, the potential clash between the penal institutions and the entities operating within the INHS has been neglected by both scholars and practitioners. This paper tries to fill this gap, discussing the illustrative experience of a penal institution operating in Southern Italy. The reform of penitentiary care proposed an innovative recipe for health protection and promotion. Nonetheless, the lack of some essential ingredients of this recipe leads to question whether the organizational change of penitentiary care is real or it is merely apparent.