La présence de personnes détenues souffrant de troubles psychiatriques est observée depuis la naissance de la prison moderne, et a fluctué depuis, au gré des évolutions institutionnelles psychiatriques et du cadre législatif français. Au 1 er janvier 2022, près de 70 000 personnes sont incarcérées dans les 187 établissements français de métropole et d’outre-mer. Dans cette population, une surreprésentation par rapport à la population générale est établie pour de nombreux troubles psychiatriques : le trouble dépressif caractérisé, les troubles psychotiques, le trouble bipolaire, le trouble de stress post-traumatique, les troubles de l’usage de substances et les troubles neuro-développementaux comme le trouble du déficit de l’attention avec/sans hyperactivité. Dans cet entretien avec Jean-Pierre Bouchard, Thomas Fovet et Marion Eck discutent de ce phénomène à partir de données épidémiologiques récentes et de leur expérience personnelle. Certains aspects cliniques spécifiques de la psychiatrie en milieu pénitentiaire sont également abordés. The presence of detainees suffering from psychiatric disorders has been observed since the birth of the modern prison system, and the numbers have fluctuated since then, depending on the evolution of psychiatric facilities and the French legislative framework. As of January 1, 2022, almost 70,000 people were incarcerated in the 187 French correctional institutions in metropolitan and overseas France. Many psychiatric disorders are over-represented in the correctional population compared to the general population, and they include disorders such as depressive, psychotic, bipolar, post-traumatic stress, and substance abuse disorders together with neurodevelopmental disorders such as attention deficit disorder with/without hyperactivity. In this interview with Jean-Pierre Bouchard, Thomas Fovet and Marion Eck discuss this phenomenon based on recent epidemiological data and their personal experience. Some specific clinical aspects of psychiatry in the correctional environment are also discussed. 

/pdf/de-quels-troubles-psychiatriques-souffrent-les-personnes-3glyjtka.pdf

De quels troubles psychiatriques souffrent les personnes détenues en France ?

Purpose The prison-to-community transition period is one of high risk and need, particularly for those with mental illness. Some individuals cycle in and out of prison for short periods with little opportunity for mental health stabilization or service planning either in prison or the community. This study describes the socio-demographic, clinical and criminal justice characteristics of individuals with mental illness and frequent, brief periods of imprisonment, examines continuity of mental health care between prison and the community for this group, and reports on their post-release mental health and criminal justice outcomes. Design/methodology/approach This study examined a sample of 275 men who had recently entered prison in New South Wales (NSW), Australia, who had been charged with relatively minor offenses and had been identified on reception screening as having significant mental health needs. Baseline demographic and mental health information was collected via interview and file review and contacts with the prison mental health service were recorded for the period of incarceration. Follow-up interviews were conducted 3 months post-release to determine level of health service contact and mental health symptoms. Information on criminal justice contact during the 3 month period was also collected. Findings The majority (85.5%) of the sample had contact with a mental health professional during their period of incarceration. Mental health discharge planning was, however, lacking, with only one in 20 receiving a referral to a community mental health team (CMHT) and one in eight being referred for any kind of mental health follow-up on release. Of those followed up 3 months post-release (n = 113), 14.2% had had contact with a CMHT. Of those released for at least 3 months (n = 255), one in three had received new charges in this period and one in five had been reincarcerated. Conclusion Continuity of mental health care for those exiting prison is poor, particularly for those with mental health needs experiencing brief periods of imprisonment, and rates of CMHT contact are low in the immediate post-release period. These findings suggest a need for early identification of individuals in this group for timely commencement of intervention and release planning, and opportunities for diversion from prison should be utilized where possible.

/pdf/continuity-of-mental-health-care-during-the-transition-from-244ez0hn.pdf

Continuity of mental health care during the transition from prison to the community following brief periods of imprisonment

La prise en charge des personnes souffrant de troubles psychiatriques et ayant commis une infraction pénale est extrêmement variable dans le monde. Cette problématique complexe vient, en effet, s’inscrire au croisement de la longue histoire du système pénal et du système de soins de chaque pays. Cet article propose une synthèse des liens entre santé mentale et justice pénale en France. Après une rapide contextualisation historique, les trajectoires possibles des personnes souffrant de troubles psychiatriques ayant commis une infraction sont décrites à partir de la décision judiciaire concernant la responsabilité pénale. L’organisation des soins psychiatriques aux personnes détenues est exposée ainsi que les dispositifs psychocriminologiques mis en place par l’administration pénitentiaire et les mesures de soins pénalement ordonnés. L’articulation complexe entre le système de santé mentale et la justice pénale mais aussi les nombreuses problématiques émergentes sont finalement abordées. La prévalence élevée des troubles psychiatriques sévères dans les prisons soulève, en effet, de multiples inquiétudes, en particulier en ce qui concerne la situation de l’expertise psychiatrique, le manque de formation des soignants et l’absence d’alternative à l’incarcération pour les personnes souffrant de troubles psychiatriques sévères. La reconnaissance de la psychiatrie légale dans la formation des psychiatres français pourrait constituer un facteur d’amélioration pour l’avenir. The treatment of people suffering from mental disorders who committed a criminal offence differs greatly in countries around the world because of the long histories of criminal justice and psychiatry specific to each country. This complex issue arises at the intersection of the long history of each country's criminal justice and health care systems. The present article provides an overview of the relationship between mental health care and judicial systems in France. After a brief historical contextualisation, the possible trajectories of people diagnosed with mental disorders who committed crimes are described, based on the judicial decision of criminal irresponsibility or not. The organisation of psychiatric care for incarcerated people in France is described, as well as the psychocriminological programs implemented by the prison administration and the management of court-ordered treatment. Finally, emerging issues are addressed. The current high prevalence of severe psychiatric disorders in French prisons raises multiple concerns, particularly regarding the practice of psychiatric expertise, the lack of training of mental health professionals and the absence of diversion programs for people suffering from severe psychiatric disorders in prison. We think that recognizing forensic psychiatry in the training of French psychiatrists could be a key factor in improving these issues in France. 

Santé mentale et justice pénale en France : état des lieux et problématiques émergentes

La prévalence des troubles psychiatriques et des addictions est particulièrement élevée en population carcérale. Souvent perçue comme une problématique spécifique et « à part », la question du soin en détention a, en fait, une dimension évidente de santé publique puisque la quasi-totalité des personnes incarcérées seront in fine libérées. La période entourant la sortie de prison est une période de vulnérabilité marquée, tout particulièrement pour les personnes souffrant de troubles psychiatriques. Dans ce contexte, des équipes mobiles transitionnelles (EMOT) ont été récemment créées afin de limiter le risque de rechute et de décès au cours de cette période sensible mais aussi d’assurer un relais des soins psychiatriques vers les dispositifs de droit commun pour cette population. Dans cet entretien avec Jean-Pierre Bouchard, Thomas Fovet, Tatiana Scouflaire, Bettina Belet, Estelle Demeulemeester, Matthieu Paindavoine, Claire Gibour, Vincent Claeyman, Laureen Ghislain, Clara Narguet, Oumaima El Qaoubii, Niels Martignène, Marielle Wathelet, Maxime Védère, Anne-Hélène Moncany proposent un premier retour d’expérience de la création de ces équipes mobiles. Psychiatric disorders and addictions are highly prevalent in the prison population. Often perceived as a specific and “separate” problem, the issue of care during detention has, in fact, an obvious public health dimension since almost all people in prison will eventually be released and return to their communities. This is particularly important because the health of people released from incarceration is characterized by a range of negative outcomes, particularly in people suffering from psychiatric disorders. In this context, the Equipes Mobiles Transitionnelles (EMOT) have recently been created in France to limit the risk of relapse and death during this high-risk period but also to ensure the links between psychiatry in prison and community psychiatry. In this interview with Jean-Pierre Bouchard, Thomas Fovet, Tatiana Scouflaire, Bettina Belet, Estelle Demeulemeester, Matthieu Paindavoine, Claire Gibour, Vincent Claeyman, Laureen Ghislain, Clara Narguet, Oumaima El Qaoubii, Niels Martignène, Marielle Wathelet, Maxime Védère, Anne-Hélène Moncany provide some initial feedback on the creation of these mobile teams. 

Soins psychiatriques et sortie de prison : des équipes mobiles transitionnelles pour atténuer le « choc post-carcéral » ?

Quelles perspectives pour la santé et les soins en prison ?

Background For incarcerated people, the immediate post-release period is characterized by a range of negative outcomes. The appointment scheduling delay for a psychiatric community consultation in this period is unknown. Methods A fictional 24-year-old patient with a diagnosis of bipolar disorder with comorbid cannabis use disorder was created and implemented in two different contexts: (1) a release from a prison of the French North district within 48 h (prison-released patient), (2) a move from another district to the French North district within 48 h (outpatient-moving patient). An independent investigator called the 39 outpatient psychiatric clinics of the French North district to get an appointment as quickly as possible for the two fictional patients. Results In 12 centers out of 39, no appointment could be scheduled for the prison-released patient. For the 27 other centers, there was no statistical difference between the 2 fictional patients’ delay. Three centers refused to make an appointment for the prison-released patient while an appointment was given for the outpatient-moving patient. For the prison-released patient, the median delay was 21 days, which is not consistent with optimal support during the high-risk period of release. Limitations Only outpatient psychiatric clinics of the French North district were called. Caution is then needed before generalizing the results. Conclusions French mental health system does not allow for a proper management of the transition from prison to the community for people with mood disorders during the immediate post-release period.

Access to a scheduled psychiatric community consultation for prisoners with mood disorders during the immediate post-release period

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Access to a scheduled psychiatric community consultation for prisoners with mood disorders during the immediate post-release period