Au-delà des grandes enquêtes épidémiologiques qui attestent de la prévalence élevée des troubles psychiques en population carcérale, la santé mentale des personnes détenues peut être étudiée à l’aide d’une approche sociologique attentive aux trajectoires biographiques et aux expériences singulières de la détention. Reposant principalement sur une campagne de 40 entretiens semi-directifs réalisés auprès de 26 personnes détenues, cet article mobilise une perspective compréhensive et longitudinale pour restituer les critères du mal-être et du mieux-être qui sont établis par les personnes détenues elles-mêmes. Ce faisant, il aboutit à quatre résultats principaux. Le premier tient à l’expérience éprouvante que constitue l’entrée en prison et le séjour au quartier arrivant. Le deuxième souligne le poids des inégalités sociales dans la capacité à obtenir des formes de soutien psychique et de réconfort. Le troisième s’intéresse à la façon dont les différentes architectures carcérales produisent le mal-être des personnes détenues. Le dernier éclaire les freins et les leviers qui favorisent ou entravent l’accès aux soins en prison. In fine, cet article conclut que des dispositifs instaurés afin d’améliorer les conditions d’incarcération participent à produire la souffrance qu’ils se donnent pour mission d’apaiser.

BACKGROUND:The mental health of incarcerated women is particularly poor, yet little is known about their condition during the prerelease period. This critical transition is shaped by stressors related to incarceration and the challenges of reintegration, raising important concerns. Notably, the release phase that follows is characterized by risks of rehospitalization, reincarceration and suicide among individuals with psychiatric disorders and/or substance use disorders (SUDs). The aim of this study was to estimate the prevalence of psychiatric disorders, SUDs and dual diagnoses (DDs, i.e., the combination of severe psychiatric disorder and SUD) among incarcerated women scheduled to be released soon. METHODS:We conducted a cross-sectional survey from April 2021 to September 2022 across 4 women's correctional facilities in Northern France. This study included all adult women identified by the prison administration as having a scheduled release date within 30 days. Each participant was interviewed via a structured interviewer-administered questionnaire, which included the Mini International Neuropsychiatric Interview. FINDINGS:Among the 248 women identified by the prison administration, 127 were ultimately enrolled in this study (mean age 36.3 years). We found high prevalences of psychiatric disorders (of the participants, 48.0% had current depressive episodes, 28.3% had current generalized anxiety disorder, and 26.8% had current posttraumatic stress disorder), SUDs (59.1%) and DDs (38.6%). INTERPRETATION:The alarming prevalences of psychiatric disorders, SUDs, and DDs among our sample highlight the urgent need for integrated care that bridges incarceration and postrelease psychiatric settings for incarcerated women. Combining psychiatric, addiction, and social support services is essential for addressing the complex mental health needs and improving reintegration outcomes in this population. FUNDING:This study was funded by the French Direction Générale la Santé - Directorate-General of Health (DGS) and Santé Publique France - Public Health France (SPF).

BACKGROUND:The mental health of incarcerated individuals is a widely recognized public health issue, but little is known about the mental health status of the incarcerated individuals upon release. This study aimed to measure the prevalence of psychiatric disorders and substance use disorders (SUDs) among incarcerated men scheduled to be released from jail soon. METHODS:We conducted a cross-sectional national survey from September 2020 to September 2022 across 26 jails (selected at random) in France. Each participant was interviewed within 30 days prior to their release via a structured questionnaire, including the Mini International Neuropsychiatric Interview. RESULTS:A total of 579 individuals were included in the analysis (participation rate: 66.2%). The prevalence of mood disorders, anxiety disorders, post-traumatic stress disorder, and psychotic episodes were 30.7% (95% confidence interval [CI]: 27.1%-34.6%), 28.7% (95% CI: 25.1%-32.5%), 11.1% (95% CI: 8.8%-13.9%), and 10.5% (95% CI: 8.3%-13.3%), respectively. Additionally, almost half of the individuals had an SUD, and dual disorders were identified in 21.9% (95% CI: 18.8%-25.5%) of the cases. The analysis of mental health care pathways raised questions about access to certain types of care, such as full-time psychiatric hospitalization while in prison, as well as questions about the continuity of care upon release. CONCLUSIONS:This study shows that the mental health of incarcerated men who are scheduled to be released soon is precarious. Complex mental health problems, particularly dual disorders, are common and require better coordination between mental health care systems in prisons and the community.

Les données épidémiologiques le montrent depuis le début des années 2000 : la population carcérale française est composée pour une part importante de personnes avec des troubles psychiatriques graves. Face à ce constat et forts de leur expérience respective de sociologue et de psychiatre en milieu carcéral, Camille Lancelevée et Thomas Fovet mènent l’enquête : pourquoi les prisons françaises semblent-elles devenues des asiles contemporains ? Peut-on désormais les considérer comme des lieux de soin ? Dans quelle mesure la peine de prison est-elle devenue un temps thérapeutique ? Cet ouvrage interroge les évolutions croisées de la psychiatrie publique et de la justice pénale pour comprendre la réalité complexe des troubles mentaux en prison et l’expérience de celles et ceux qui s’y trouvent confrontés.

The purpose of this article is to describe the implementation of clinical pharmacy activities in a psychiatric hospital. These activities, which aim to improve the quality and safety of prescriptions by encouraging the integration of hospital pharmacists into the healthcare teams, present a potential encroachment of the pharmacist's territory on the terrain of the prescribing physician. The article shows how pharmacists accompany this implementation through diplomatic activities at the boundary between their jurisdiction and that of physicians, in order to avoid possible tensions and to favour their reception. We define this diplomacy as a way of asserting oneself within the healthcare teams, by putting forward one's added value during the clinical decision-making, and avoiding any head-on confrontation with pre-eminence of the doctors in these teams, by defusing the potential sources of conflicts relating to jurisdiction or authority. We show that this diplomacy is played out both in the face-to-face interactions between healthcare professionals and in the institutional arrangements that frame and perpetuate these activities.

L’article a pour objet le déploiement d’activités dites de pharmacie clinique dans un établissement spécialisé en psychiatrie. Ces activités, qui visent l’amélioration de la qualité et de la sécurité des prescriptions en favorisant l’intégration des pharmacien·nes hospitalier·es au sein des équipes de soin, constituent un empiétement potentiel du territoire du pharmacien sur celui du médecin prescripteur. L’article montre comment les pharmacien·nes accompagnent ce déploiement par des activités de diplomatie qu’iels mènent à la frontière de leur juridiction avec celle des médecins, et ce afin d’éviter d’éventuelles tensions et favoriser leur réception. Nous définissons cette diplomatie comme une manière de s’imposer dans les équipes de soin, en mettant en avant sa plus-value dans la décision clinique, sans s’opposer frontalement à la prééminence des médecins dans ces équipes, en déminant les sources potentielles de conflits de juridiction ou d’autorité. Nous montrons que cette diplomatie se déploie à la fois dans les interactions de face à face entre les professionnel·les de santé et dans des dispositifs institutionnels qui encadrent et pérennisent ces activités.

Although it is constantly under fire, prison remains the main form of punishment in France’s justice system. How are we to explain the longevity of this controversial institution? How can the reality of prison be described? What is a prison sentence in today’s France? This paper reconsiders prison by focusing on its paradoxes. The authors question the place of prison in society, reframe the debates on prison and shed light on everyday life in prison in France. Ultimately, they call for contextualizing the analysis of contemporary prison within a broader reflection on our society.

Although it is constantly under fire, prison remains the main form of punishment in France's justice system. How are we to explain the longevity of this controversial institution? How can the reality of prison be described? What is a prison sentence in today's France? This paper reconsiders prison by focusing on its paradoxes. The authors question the place of prison in society, reframe the debates on prison and shed light on everyday life in prison in France. Ultimately, they call for contextualizing the analysis of contemporary prison within a broader reflection on our society.

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 amenagees, 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.

Many facilities involved in caring people diagnosed with mental health disorders who committed crime had to adapt to COVID-19 pandemic in France. Particularly, the impact of the COVID-19 pandemic on incarcerated people was the subject of many concerns. The COVID-19 pandemic also posed major challenges in secure psychiatric hospitals and for psychiatrist experts. Rapid changes in working practices occurred. Finally, the lockdown period was associated with an increase in domestic violence, especially gender-based violence and child abuse and neglect. Overall, the COVID-19 pandemic emphasized the well-known limitations of the French mental health system to manage people diagnosed with mental health disorders who committed crime and the urgent need for better recognition of forensic psychiatry in France.

The treatment of people diagnosed with mental disorders who committed crimes differ greatly in countries around the world because of the long histories of criminal justice and psychiatry specific to each country. As a result, it is often difficult to grasp the specificities of each system. The main objective of this paper is to provide a narrative review of the interactions between the French mental health and judicial systems. Subsequently, we will discuss how the concept of forensic psychiatry does not yet exist in France and how it can be applied.

Dans un univers academique ou regnent la course a la productivite, l’injonction a la coherence des parcours et le formatage croissant des travaux, Lorna Rhodes occupe une place singuliere. Sa carriere s’organise autour de trois ethnographies longues portant sur des sujets eloignes. Apres un sejour dans un village au Sri Lanka, qui donne lieu a sa these sur les rituels de guerison, elle frequente longuement, dans les annees 1980, un service d’urgence psychiatrique situe a Baltimore (Maryland),...

En France, les rapports entre la justice et la psychiatrie attirent l’attention des sciences humaines et sociales a partir des annees 1970. Ces relations sont alors principalement etudiees a partir d’une scene principale : celle de la rencontre entre juges et expert·e·s psychiatres, aux assises notamment, qui passionne par ailleurs les medias, la litterature et le cinema. La ou Le juge et l’assassin fait figure de reference cinematographique, les medias temoignent d’un interet frequent et ren...