“Prison psychosis” is a historical concept that is still used in clinical practice, but little explored in research. In this short paper, we propose to revisit this concept by studying first-episode psychosis (FEP) in the prison population. We analyzed a series of incarcerated people who were hospitalized for a FEP from November 2020 to May 2021 in a French facility. We dated the onset of the first psychotic symptoms (PSs) in relation to the date of incarceration and of hospitalization and we calculated the duration of untreated psychosis (DUP). While the characteristics of our sample were consistent with what we know about people diagnosed with psychosis in correctional settings (young men with positive symptoms and psychiatric comorbidities), we found great heterogeneity in the DUP and in the chronological sequence between incarceration and the onset of PSs. This preliminary but original work shows the diversity of first diagnosis of psychosis in prison, reflecting the multiplicity and complexity of interactions between psychosis and incarceration.

In this paper, we show that the literature on the prevalence of psychiatric and susbtance use disorders in prisons is substantial. However, there are a number of difficulties one encounters in interpreting this literature: (i) there is considerable heterogeneity between countries' judicial and mental health care systems, and (ii) the specific features of the prison environment are sometimes overlooked in the methodology used to conduct such studies. With this in mind, we discuss a number of benchmark studies on the prevalence of psychiatric and substance use disorders in French prisons. Finally, we discuss the perspectives for psychiatric epidemiology in prisons. (C) 2023 Elsevier Masson SAS. All rights reserved.

Dans cette communication, nous montrons que la littérature sur la prévalence des troubles psychiatriques et liés à l’usage de substances en milieu pénitentiaire est riche. Son interprétation se heurte toutefois à plusieurs difficultés : (i) une grande hétérogénéité des systèmes judiciaire et de soins de santé mentale entre les pays et (ii) des spécificités de l’environnement carcéral parfois négligées dans la méthodologie des études. Forts de ce constat, nous développons les résultats d’un certain nombre de travaux de référence sur la prévalence des troubles psychiatriques et liés à l’usage de substances dans les prisons françaises. Nous discutons enfin les perspectives en termes d’épidémiologie psychiatrique en milieu pénitentiaire.

ObjectifLa santé mentale des personnes incarcérées est un enjeu majeur de santé publique dans le monde. Cette revue systématique de la littérature s’est intéressée à la prévalence des troubles psychiatriques dans les prisons de France métropolitaine et d’outre-mer.MéthodeLes bases de données Pubmed, Web of Science, Sudoc, EHESP ont été interrogées en septembre 2022 avec une sélection de mots clés en lien avec la prison, la psychiatrie et la France afin d’identifier des articles publiés en anglais et en français.RésultatsAu total, 35 articles publiés entre 1999 et 2022 portant sur 24 études épidémiologiques ont été inclus (16 études transversales, 7 rétrospectives et 1 mixte). L’échantillon était exclusivement masculin dans 11 études, mixte dans 10 (mais composé d’au moins 92 % d’hommes). Douze études portaient sur une population de personnes détenues arrivantes ; les autres portaient sur des personnes incluses quel que soit le moment de leur incarcération (n=6), incarcérées depuis au moins 5 ans (n=1) ou sur un autre groupe de personnes détenues. Neuf études utilisaient un outil diagnostique standardisé validé. Les 4 études réalisées en population pénitentiaire générale avec des outils diagnostiques validés ont montré les prévalences suivantes : 29,4–44,4 % de troubles anxieux, 5–14,2 % de TSPT, 28–31,2 % de troubles de l’humeur, 6,9–17 % de troubles psychotiques, 32 % de troubles de la personnalité et 11 % de TDAH.ConclusionMalgré leur grande hétérogénéité méthodologique, les études incluses dans cette revue confirment la prévalence élevée des troubles psychiatriques dans les prisons françaises.

Objective. - Any French psychiatrist can be appointed by the district prosecutor or the judicial police officer to perform medical examination of people kept in police custody. After this examination, the doctor decides whether the person's state is compatible or not with detention in a police station. A medical certificate is attached to the case file. Regarding the high prevalence of psychiatric disorders among people kept in police custody and the large number of mentally ill people imprisoned without having been properly examined, this examination is of particular importance. However, it remains difficult and sometimes tricky. The main objective of this descriptive study is to evaluate knowledge of French psychiatrists about this examination, its goals and limits, and about how to produce a suitable medical certificate. The secondary objective is to identify the variables associated with a good knowledge of this examination. Methods. - A questionnaire was submitted by e -mail to a sample of French psychiatrists from March to May 2021. It allowed us to collect data on their socio-demographic and professional characteristics. Then 12 questions were specially conceived to evaluate their knowledge about the psychiatric examination of people kept in custody. Finally, participants were also questioned about their experience in the area of medical intervention in police custody and how they felt confident about performing such an examination. Based on their responses to the 12 knowledge questions, participants have been separated into two groups ("high level of knowledge" versus "low level of knowledge"). The two groups' characteristics have been compared through a bivariate then a multivariate analysis. Results. - 183 psychiatrists completed the questionnaire (50.8% women and 49.2% men; mean age 47.6; mean experience 18.1 years). The legal frame of the examination in police custody was well known by the participants (> 70% good answers), as well as the rules of confidentiality (> 80% good answers). By contrast, only 59% of participants knew that the determination of the person's state compatibility with detention in a police station was the main objective of this examination. Nearly all participants knew that it is possible to decide involuntary hospitalizations of people kept in custody (93%), but a less proportion of them knew that all means of hospitalizations, voluntary and involuntary, are possible if needed. Few participants knew the addresses (or even probably the existence) of the second page of the document they need to complete after the examination (the first page consisting in the medical certificate transmitted to the police and the second page constituting the confidential medical record). Having received a specific teaching about forensic psychiatry was the only variable significantly associated with good knowledge of the specificities of the examination in police custody (OR = 2.90; P = 0.006). The variable significantly associated with poor knowledge was the doctor's experience (OR = 0.94; P < 0.001). Conclusion. - The rules of good practice regarding psychiatric examination of people kept in police custody are not fully known by French psychiatrists. According to the results of our survey (even if these results cannot be generalized due to a small sample size), it appears essential to provide specific education about forensic psychiatry, not only to young doctors but also to all doctors throughout their careers. (c) 2022 Elsevier Masson SAS. All rights reserved.

Introduction. - The prevalence of psychiatric disorders among prisoners remains a major public health issue worldwide. In France, despite the increasing number of persons who are incarcerated (+30% between 1992 and 2002 with a 120% prison overcrowding), and a historical concern about the mental health of persons in detention and its management, no systematic review has been published on this subject. The aim of this article is to present the results of a systematic review of the literature on the prevalence of psychiatric disorders in French prisons. Method. - The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. We searched the PubMed and Web of Science databases. We used combinations of keywords relating to prison (prison*, jail*, inmate*), to psychiatry ("mental health", psychiatr*), and to France (France, French). This work was completed with a search through the digital libraries of the & Eacute;cole des Hautes & Eacute;tudes en Sant & eacute; Publique (EHESP) and of the Syst & egrave;me Universitaire de Documentation (Sudoc) to obtain data from academic works and the gray literature. References cited in studies included in this review were also examined. All references published up to September 2022, written in English or French, presenting the results of original quantitative studies on the prevalence of psychiatric disorders in correctional settings were included. Two researchers independently extracted data from included references according to a pre-established protocol. Results. - Among 501 records identified, a total of 35 papers based on 24 epidemiological studies met the eligibility criteria for inclusion in this review: 16 were cross-sectional, 7 retrospective and 1 both cross-sectional and retrospective. All papers were published between 1999 and 2022. We found one European study, 5 international studies, 18 regional or local studies. Of these, 21 studies had all-male or mixed gender samples (but when the sample was mixed gender, it was always at least 92% male). Almost half of the studies (n = 11) involved a small sample of fewer than 500 persons. Half of the studies involved a sample of recently incarcerated persons: 6 involved a random sample of persons in detention, and 1 involved a sample of people incarcerated for more than 5 years. The last 5 studies focused on persons aged over 50 years and incarcerated for more than one year (n = 1), incarcerated for sexual offences (n = 2), placed in disciplinary cells (n = 1) or in a special wing for radicalized or suspected radicalized individuals (n = 1). Nine studies used standardized and validated diagnostic tools. According to the 4 studies involving representative samples and using standardized and validated diagnostic tools, the prevalence of the following psychiatric disorders was: 29.4-44.4% for anxiety disorders, 5-14.2% for PTSD, 28-31.2% for mood disorders, 6.9-17% for psychotic disorders, 32% for personality disorders and 11% for ADHD. Conclusion. - This systematic review of the literature highlights the high prevalence of psychiatric disorders in French prisons. The data collected are in line with international studies. The great methodological heterogeneity of the papers included in this review calls for further rigorous research to better understand the rates of mental disorders in French prisons and to explore their determinants.

Context. - The high prevalence of psychiatric disorders among people in prison is well documented, and several hypotheses have been proposed to explain this overrepresentation. In France, the decrease in the number of people found by the judge to be not criminally responsible on account of mental disorder after a psychiatric expertise could play a crucial role. The Chateau-Thierry prison is a high-security correctional facility where prisoners whose integration into a "standard" prison is complicated because of behavioural problems, reside. We conducted the first study to describe the judicial and healthcare trajectories of people incarcerated in this facility.Method. - All the people incarcerated in the Chateau-Thierry prison between May and September 2019 were included in this cross-sectional study. In addition to sociodemographic characteristics, data on the psychiatric care before and during incarceration as well as information on the judicial and prison history were collected. We also analyzed all the pre-sentencing psychiatric reports in order to collect the Results. - Sixty-eight (97%) of the 70 people detained at the Chateau-Thierry prison during the study period were included and 92 pre-sentencing psychiatric reports were analyzed. The population studied was exclusively male, with an average age of 40 years, low socio-economic status and frequent criminal history (79%). About half of them (46%) had already been hospitalized in a psychiatric community hospital prior to incarceration, and 79% have been hospitalized in a psychiatric facility during their incarceration. Disciplinary sanctions were frequent (72%) as well as convictions for offenses committed while in prison (57%). When at least one pre-sentencing psychiatric report was carried out (29 persons had a single psychiatric forensic evaluation and 27 ones had multiple evaluations), at least one psychiatric expert had concluded to a diminished (but not lack of) criminal responsibility in almost half of the cases (44%).Conclusion. - This study shows the extent to which people incarcerated in the Chateau-Thierry prison are affected by psychiatric disorders. It also highlights the difficulties of coping with the prison environment for people suffering from psychiatric disorders. Finally, it raises the question of the lack of diversion programs for the individuals in France with mental health problems whose responsibility has

High levels of substance-related disorders among incarcerated people have been documented and there is a lot of drug users in French prisons. Several health and social workers are involved in the management of people dealing with addictions in prison. The coordination between substance use and mental health services in correctional settings and in the community is fundamental to ensure treatment continuity for these people.

High levels of substance-related disorders among incarcerated people have been documented and there is a lot of drug users in French prisons. Several health and social workers are involved in the management of people dealing with addictions in prison. The coordination between substance use and mental health services in correctional settings and in the community is fundamental to ensure treatment continuity for these people.

Tout psychiatre peut être requis par l'autorité judiciaire pour examiner une personne placée en garde à vue (GAV). Au vu des enjeux de santé publique que cet examen soulève (protéger la santé des personnes placées en GAV, maintenir la continuité des soins, éviter l'incarcération de personnes présentant des troubles psychiatriques décompensés), cet examen revêt une importance particulière. Il demeure pourtant difficile, et parfois piégeux. L'objectif de cette étude descriptive est d'évaluer les connaissances des psychiatres français sur les conditions de cet examen, ses objectifs et ses limites, ainsi que sur les règles de rédaction du certificat médical à délivrer à l'autorité judiciaire. L'objectif secondaire est de dégager les variables associées à la bonne connaissance de cet examen. Un autoquestionnaire a été diffusé par mail à un échantillon de psychiatres français, entre février et mai 2021, pour évaluer leurs connaissances sur l'examen psychiatrique d'une personne placée en GAV, leur expérience dans ce domaine et leur niveau de compétence estimé. Un score de performance, basé sur la réponse aux questions de connaissances, a été calculé. Les caractéristiques des participants ayant un « haut score de performance » ont été comparées à ceux ayant un « bas score de performance ». Une analyse bivariée, puis une régression logistique ont été réalisées. Nous avons obtenu 183 réponses (50,8 % de femmes et 49,2 % d'hommes, âge moyen : 47,6 ans, 18,1 années d'expérience en moyenne). Le cadre légal de la réquisition était globalement bien connu des psychiatres (> 70 % de bonnes réponses), de même que l'application du secret professionnel (> 80 % de bonnes réponses). Ce n'était pas le cas des objectifs de la réquisition : pour 59 % seulement la compatibilité de l'état de santé mentale de la personne examinée en GAV était l'objectif principal de la réquisition. Si pour la grande majorité des psychiatres interrogés (93 %), il était possible d'instaurer une hospitalisation sans consentement sur décision du représentant de l'État, les autres modalités d'hospitalisation n'étaient possibles que pour une proportion moindre de répondants (< 58 %). Peu de psychiatres connaissaient les destinataires (et probablement l'existence) du deuxième volet du certificat médical. La médiane du score de performance était de 9,3/12 (min : 3,8 ; max : 12). Le fait d'avoir une formation en psychiatrie légale était le seul facteur significativement associé à un haut score de performance (OR = 2,90 ; p = 0,006). La variable associée à un moins bon score de performance était l'expérience du clinicien (OR = 0,94 ; p < 0,001). Les modalités de réponse à une réquisition de l'autorité judiciaire pour examiner une personne placée en GAV sont encore imparfaitement connues. À la lumière de nos résultats, sous réserve de la petite taille de notre échantillon, il paraît important de proposer à tous les psychiatres français une formation en psychiatrie légale, dès les premières années de l'internat et tout au long de leur carrière. Any French psychiatrist can be appointed by the district prosecutor or the judicial police officer to perform medical examination of people kept in police custody. After this examination, the doctor decides whether the person's state is compatible or not with detention in a police station. A medical certificate is attached to the case file. Regarding the high prevalence of psychiatric disorders among people kept in police custody and the large number of mentally ill people imprisoned without having been properly examined, this examination is of particular importance. However, it remains difficult and sometimes tricky. The main objective of this descriptive study is to evaluate knowledge of French psychiatrists about this examination, its goals and limits, and about how to produce a suitable medical certificate. The secondary objective is to identify the variables associated with a good knowledge of this examination. A questionnaire was submitted by e-mail to a sample of French psychiatrists from March to May 2021. It allowed us to collect data on their socio-demographic and professional characteristics. Then 12 questions were specially conceived to evaluate their knowledge about the psychiatric examination of people kept in custody. Finally, participants were also questioned about their experience in the area of medical intervention in police custody and how they felt confident about performing such an examination. Based on their responses to the 12 knowledge questions, participants have been separated into two groups ("high level of knowledge" versus "low level of knowledge"). The two groups' characteristics have been compared through a bivariate then a multivariate analysis. 183 psychiatrists completed the questionnaire (50.8% women and 49.2% men; mean age 47.6; mean experience 18.1 years). The legal frame of the examination in police custody was well known by the participants (> 70% good answers), as well as the rules of confidentiality (> 80% good answers). By contrast, only 59% of participants knew that the determination of the person's state compatibility with detention in a police station was the main objective of this examination. Nearly all participants knew that it is possible to decide involuntary hospitalizations of people kept in custody (93%), but a less proportion of them knew that all means of hospitalizations, voluntary and involuntary, are possible if needed. Few participants knew the addresses (or even probably the existence) of the second page of the document they need to complete after the examination (the first page consisting in the medical certificate transmitted to the police and the second page constituting the confidential medical record). Having received a specific teaching about forensic psychiatry was the only variable significantly associated with good knowledge of the specificities of the examination in police custody (OR = 2.90; P = 0.006). The variable significantly associated with poor knowledge was the doctor's experience (OR = 0.94; P < 0.001). The rules of good practice regarding psychiatric examination of people kept in police custody are not fully known by French psychiatrists. According to the results of our survey (even if these results cannot be generalized due to a small sample size), it appears essential to provide specific education about forensic psychiatry, not only to young doctors but also to all doctors throughout their careers.

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.(c) 2022 Published by Elsevier Masson SAS.

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 1er 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.

Australian & New Zealand Journal of Psychiatry, 55(12) Rosen et al. (2020) proffer an alternative point of view. They defend the participation of experts in deciding the NMHSPF’s algorithms, but strongly object to comparing their low targets with the international benchmarks. International comparisons are complex due to variations in health systems and data definitions (Allison et al., 2020), and Rosen et al. (2020) cite methodological issues as a rationale for avoiding these comparisons. Instead, they focus on the largely untested field of ‘mental healthcare ecosystems’ and regional atlases. However, they acknowledge that regional atlases also indicate that Australia has fewer beds per capita than Western Europe. And policymakers find international comparisons to be useful signposts for Australia’s performance. Australia is honoured to be a top-20 country in the rankings for government, human development, global citizenship, the economy, education, health and lifestyle (Australian Department of Foreign Affairs and Trade: www.dfat.gov.au/ trade/resources/publications/Pages/ australia-is-a-top-20-country). Thus, the World Health Organization should continue to refine their Mental Healthcare Atlas, rather than abandon the project due to the methodological challenges. In their response, Whiteford and Diminic (2020) acknowledge the role of expert opinion, given ‘data gaps in efforts to set targets for the appropriate number of mental health beds in an integrated system’. They suggest that the NMHSPF’s modelling will improve as the evidence strengthens. Research on inpatient care lapsed during the era of de-hospitalisation. Future studies of the 24-hour care needs of people with severe mental illness (SMI) should include their requirements for community residential and hospital non-acute beds. To this end, we suggest conducting a snapshot survey of people with SMI across Australia’s local health areas and correctional facilities. This survey would need to be formally agreed to and funded by Australian governments. Thus, a renewed commitment to expanding the evidence base for inpatient care would improve the accuracy of the NMHSPF estimates.

In the context of the Covid-19 pandemic, teleconsultation is an obvious solution in psychiatry to ensure continuity of care and facilitate access. However, the digitisation of ambulatory practices raises a certain number of reservations, in particular concerning the remote management of psychiatric emergencies. These situations, because of the specific aspects they cover, are in fact upsetting texts and recommendations of good practice in terms of teleconsultation. Thus, the questions of eligibility of people suffering from psychiatric disorders, the identification of an immediate self- or hetero-aggressive risk during teleconsultation and the establishment of a measure of psychiatric care without consent at the end of a teleconsultation require specific reflection in order to allow the practitioner to anticipate and manage the situation in the best possible way.

In the context of the Covid-19 pandemic, teleconsultation is an obvious solution in psychiatry to ensure continuity of care and facilitate access. However, the digitisation of ambulatory practices raises a certain number of reservations, in particular concerning the remote management of psychiatric emergencies. These situations, because of the specific aspects they cover, are in fact upsetting texts and recommendations of good practice in terms of teleconsultation. Thus, the questions of eligibility of people suffering from psychiatric disorders, the identification of an immediate self- or hetero-aggressive risk during teleconsultation and the establishment of a measure of psychiatric care without consent at the end of a teleconsultation require specific reflection in order to allow the practitioner to anticipate and manage the situation in the best possible way.

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.

Background. - In French prisons, psychiatric care for inmates is organized into three levels: ambulatory care within each jail in "unites sanitaires en milieu penitentiaire" (USMP: sanitary units in correctional settings), day hospitalizations in the 28 services medico-psychologiques regionaux (SMPR, "regional medical-psychological services") and full-time hospitalizations in one of the nine "unites d'hospitalisation specialement amenagees" (UHSA: specially equipped hospital units). Despite high prevalence of mental disorders among French prisoners, the efficiency of these specialized psychiatric care units has been insufficiently studied. The main goal of this study is to describe full-time psychiatric hospitalizations for inmates in the twenty prisons located in the North of France. Methods. - We conducted a descriptive study based on medical and administrative data and survey results. The following data were collected for each prison regarding 2016: 1) number and occupancy rates for mental health professionals and 2) psychiatric hospitalization rates (in the UHSA of Lille-Seclin and the general psychiatric hospitals). Results. - Provision of care is incomplete: the vacancy rate in the health units studied reaches 40 %. Moreover, access to UHSA is unequal: it varies pronouncedly according to the location of the prison; only inmates in prisons close to the UHSA benefit from satisfactory access. Conclusion. - Access to psychiatric care for inmates remains problematic in France, particularly due to a lack of mental health professionals in USMPs, the overload of patients in UHSAs and the distance of theses facilities from certain prisons and jails. (C) 2020 Elsevier Masson SAS. All rights reserved.

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.

When facing ambiguous images, the brain switches between mutually exclusive interpretations, a phenomenon known as bistable perception. Despite years of research, a consensus on whether bistability is driven primarily by bottom-up or top-down mechanisms has not been achieved. Here, we adopted a Bayesian approach to reconcile these two theories. Fifty-five healthy participants were exposed to an adaptation of the Necker cube paradigm, in which we manipulated sensory evidence and prior knowledge. Manipulations of both sensory evidence and priors significantly affected the way participants perceived the Necker cube. However, we observed an interaction between the effect of the cue and the effect of the instructions, a finding that is incompatible with Bayes-optimal integration. In contrast, the data were well predicted by a circular inference model. In this model, ambiguous sensory evidence is systematically biased in the direction of current expectations, ultimately resulting in a bistable percept.

In French prisons, psychiatric care for inmates is organized into three levels: ambulatory care within each jail in "unités sanitaires en milieu pénitentiaire" (USMP: sanitary units in correctional settings), day hospitalizations in the 28 services médico-psychologiques régionaux (SMPR, "regional medical-psychological services") and full-time hospitalizations in one of the nine "unités d'hospitalisation spécialement aménagées" (UHSA: specially equipped hospital units). Despite high prevalence of mental disorders among French prisoners, the efficiency of these specialized psychiatric care units has been insufficiently studied. The main goal of this study is to describe full-time psychiatric hospitalizations for inmates in the twenty prisons located in the North of France.We conducted a descriptive study based on medical and administrative data and survey results. The following data were collected for each prison regarding 2016: 1) number and occupancy rates for mental health professionals and 2) psychiatric hospitalization rates (in the UHSA of Lille-Seclin and the general psychiatric hospitals).Provision of care is incomplete: the vacancy rate in the health units studied reaches 40 %. Moreover, access to UHSA is unequal: it varies pronouncedly according to the location of the prison; only inmates in prisons close to the UHSA benefit from satisfactory access.Access to psychiatric care for inmates remains problematic in France, particularly due to a lack of mental health professionals in USMPs, the overload of patients in UHSAs and the distance of theses facilities from certain prisons and jails.