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. (c) 2022 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.

Objective. - The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners. Methods. - This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unites hospitalieres specialement arnenagees", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed. Results. - The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect. Discussion. - The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons. (C) 2020 L'Encephale, Paris.

Les personnes présentant des troubles mentaux sont surreprésentées en prison par rapport à la population générale. Dans une étude réalisée en Picardie en 2017, un quart des entrants avaient eu un contact avec un service de psychiatrie avant leur incarcération. En l’absence d’étude de ce type en France, nous avons mené une étude rétrospective dont l’objectif principal était d’estimer la probabilité d’incarcération de personnes souffrant de troubles mentaux. En utilisant les bases du Recueil d’informations médicalisé en psychiatrie (RimP), nous avons recherché, parmi les patients majeurs suivis en psychiatrie en milieu libre par l’Établissement public de santé mentale (EPSM) de l’Oise en 2015–2016, ceux qui avaient fait l’objet d’un enregistrement par le Dispositif de soins psychiatriques (DSP) en milieu carcéral, rattaché au même EPSM ; cet enregistrement, marqueur d’une incarcération, constituait l’événement étudié. Des analyses de survie (Kaplan-Meier), simples, puis stratifiées, par âge, sexe, antécédents, diagnostic principal et intensité de la prise en charge en milieu libre, ont été menées pour calculer les probabilités d’incarcération. Un modèle de Cox multivarié a été employé en vue d’identifier les facteurs associés à leur incarcération. Parmi les 25 029 personnes suivies en psychiatrie par l’EPSM de l’Oise en 2015-2016, 126 avaient connu une incarcération dans l’année suivant leur inclusion dans l’étude, soit une probabilité de 0,45 % (Intervalle de confiance à 95 % : 0,37–0,55 %). Les patients incarcérés étaient plus jeunes (36,6 ans en moyenne versus 44,7–p t-test < 0,0001), des hommes (96,8 % versus 43,7 % – p < 0,0001), avaient plus d’antécédents de détention (11,1 % versus 0,6 % – p <,0001) et d’hospitalisation en psychiatrie (20,6 % versus 10,1 % – p < 0,0001). La probabilité d’incarcération à 12 mois pour la population suivie en psychiatrie était 3,2 fois supérieure au taux de détention de la population majeure de l’Oise, sur la même période. Notre étude confirme la surincarcération des personnes présentant des troubles mentaux. Prévu à partir de 2020, le codage de l’identifiant-patient national unique dans tous les actes et séjours décrits dans le RimP, permettra la généralisation de la mesure de l’indicateur proposé à l’ensemble du territoire français. Compared to the general population, persons with mental disorders are overrepresented in prison. In a study carried out in Picardy (northern France) in 2017, a quarter of those entering prison had had contact with a psychiatric service prior to their incarceration. Since to our knowledge no work on this subject has been published in France, we conducted a retrospective study, the main objective of which was to propose an estimate measure of incarceration likelihood in people with mental disorders. Using data from a psychiatric hospital discharge database (Recueil d’informations médicalisé en psychiatrie, RimP), we searched for patients aged 18 and older who had received psychiatric care (except for those who were incarcerated at baseline) at the Oise psychiatric hospital in 2015-2016 and identified those who had also been registered by the psychiatric care tool (DSP) in liaison with the same hospital. As a marker of incarceration, registration was the event to be investigated. Survival analyses (Kaplan-Meier), first simple and then stratified by age, gender, past history, main diagnosis and intensity of care outside of prison were carried out to calculate likelihood of incarceration. A multivariate Cox model was used in order to identify the factors associated with incarceration. Among the 25,029 patients monitored in the Oise psychiatric hospital in 2015-2016, 126 had experienced incarceration during the 12 months following their inclusion in the study, i.e. an incarceration probability of 0.45% (95 % confidence interval: 0.37–0.55%). The incarcerated patients were younger (36.6 years in average versus 44.7–P t-test < 0.0001), more often male (96.8% versus 43.7% - P < 0.0001), and had a more frequent history of detention (11.1% versus 0.6% – P < 0.0001) and psychiatric care (20.6% versus 10.1% – P < 0.0001) than the general population. The probability of incarceration at 12 months for the population followed in the psychiatry unit was 3.2 times higher than the detention rate of the general population in Oise over the same period. Our study confirms the pronouncedly high incarceration rate of people with mental disorders. Scheduled to begin in 2020, coding in the RimP of a single nationwide patient identifier for all the procedures and stays described will allow the generalized measurement by means of the proposed indicator throughout France.

ObjectifEn France, les mesures de confinement ont été accompagnées de dispositions spécifiques pour les prisons : suspension des activités, parloirs et interventions extérieures. Plus de dix mille personnes détenues ont en outre été libérées pour diminuer le taux d’occupation des établissements et limiter la propagation du virus. L’objectif de cet article est de décrire la réorganisation des soins psychiatriques en milieu pénitentiaire en contexte de pandémie de Covid-19 et d’interroger les conséquences du confinement et des libérations anticipées sur la santé mentale des personnes détenues.MéthodeCe travail s’appuie sur une enquête menée en avril 2020 auprès des soignants de 42 unités sanitaires en milieu pénitentiaire et des 9 unités hospitalières spécialement aménagées en France. Une synthèse de la littérature internationale sur la question des soins psychiatriques en milieu pénitentiaire durant l’épidémie de Covid-19 a également été réalisée.RésultatsL’épidémie de Covid-19 semble avoir été plutôt contenue dans les prisons françaises au cours de la période de confinement mais le poids des mesures mises en place sur la population carcérale est important. Les 3 niveaux de soins psychiatriques en milieu pénitentiaire ont instauré des mesures spécifiques pour assurer la continuité des soins, accompagner les personnes incarcérées et contenir l’épidémie. Parmi les plus importantes, on note la restriction des consultations, la création de « secteurs Covid », la déprogrammation des hospitalisations non urgentes, le renforcement des mesures d’hygiène et le remaniement des effectifs. Actuellement, les soignants sont principalement confrontés à des sevrages forcés, des symptomatologies anxieuses et des décompensations de troubles psychiatriques chroniques. Certaines libérations anticipées sont aussi très préoccupantes, pouvant entraîner des ruptures de soins, par manque de préparation des relais de prise en charge.DiscussionLes remaniements en lien avec le confinement donnent une visibilité accrue au fossé qui sépare la psychiatrie en milieu libre de la psychiatrie en milieu pénitentiaire. Il nous apparaît important de rappeler la vulnérabilité des personnes incarcérées qui doivent impérativement être considérées dans les politiques de santé publique.

Introduction. - Compared to the general population, persons with mental disorders are overrepresented in prison. In a study carried out in Picardy (northern France) in 2017, a quarter of those entering prison had had contact with a psychiatric service prior to their incarceration. Since to our knowledge no work on this subject has been published in France, we conducted a retrospective study, the main objective of which was to propose an estimate measure of incarceration likelihood in people with mental disorders. Methods. - Using data from a psychiatric hospital discharge database (Recueil d'informations medicalise en psychiatrie, RimP), we searched for patients aged 18 and older who had received psychiatric care (except for those who were incarcerated at baseline) at the Oise psychiatric hospital in 2015-2016 and identified those who had also been registered by the psychiatric care tool (DSP) in liaison with the same hospital. As a marker of incarceration, registration was the event to be investigated. Survival analyses (Kaplan-Meier), first simple and then stratified by age, gender, past history, main diagnosis and intensity of care outside of prison were carried out to calculate likelihood of incarceration. A multivariate Cox model was used in order to identify the factors associated with incarceration. Results. - Among the 25,029 patients monitored in the Oise psychiatric hospital in 2015-2016, 126 had experienced incarceration during the 12 months following their inclusion in the study, i.e. an incarceration probability of 0.45% (95 % confidence interval: 0.37-0.55%). The incarcerated patients were younger (36.6 years in average versus 44.7-P t-test < 0.0001), more often male (96.8% versus 43.7% - P < 0.0001), and had a more frequent history of detention (11.1% versus 0.6% - P < 0.0001) and psychiatric care (20.6% versus 10.1% - P < 0.0001) than the general population. The probability of incarceration at 12 months for the population followed in the psychiatry unit was 3.2 times higher than the detention rate of the general population in Oise over the same period. Conclusion. - Our study confirms the pronouncedly high incarceration rate of people with mental disorders. Scheduled to begin in 2020, coding in the RimP of a single nationwide patient identifier for all the procedures and stays described will allow the generalized measurement by means of the proposed indicator throughout France. (C) 2020 Elsevier Masson SAS. All rights reserved.

The peer review history for this article is available at https://publons.com/publon/10.1111/acps.13227.