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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. 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. [ABSTRACT FROM AUTHOR]

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 École des Hautes Études en Santé Publique (EHESP) and of the Système 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., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

The number of suicide cases in Dubrava prison in Kosovo has increased from year to year. This study is based on the survey with 273 correctional officers at Dubrava Prison, aged 20–64-years-old, with 2 to 25 years of job experience. The aim of this article is to show the perception of the correctional officers about the motives that push prisoners through the suicide act. The objective of this study is to express the bi-variate correlation with the Pearson coefficient between independent variables of stigma, losing hope, correctional environment, court decision with the dependent variable of suicide behavior. Results shows that exist a strong positive correlation between the number of cases motivated by the correctional environment and court decision. Also, the study presents data about the season and time in which suicide cases are more present according to the experience of correctional officers. Results shows suicide cases occur after midnight and in the early hours of the morning, and most of them in the first part of spring. [ABSTRACT FROM AUTHOR]

Résumé: La France est régulièrement montrée du doigt pour les conditions de vie de ses détenus. Cet article propose d'explorer comment la confrontation des mondes du soin et de la peine génère, de facto, des discriminations dans la prise en charge sanitaire des personnes détenues. Opportunités ou pertes de chances, sans une attention particulière, ces discriminations traduisent l'irruption de la sanction dans le territoire du soin. French prisoner life conditions are currently pointed. This article suggests exploring how the confrontation of two worlds, the care and the sentence, are producing discriminations in the take care by the sanitary staff. New occasions or loss of opportunities, without specific attention, these discriminations reflect the sanction irruption in health's territory. [ABSTRACT FROM AUTHOR]

La honte, bien qu'omniprésente en prison, est souvent cachée ou masquée, enfouie derrière les barreaux. Elle reste peu étudiée par la recherche en psychologie. Nos travaux se sont intéressés à ce sentiment dans le cadre carcéral pour tenter d'en éclairer les visages et les cheminements. Notre recherche qualitative clinique a été menée dans une maison d'arrêt de la région parisienne, appuyée sur des entretiens de suivi psychothérapeutiques et des groupes de parole sur la parentalité avec des sujets incarcérés. La honte semble se manifester dès les premiers temps de l'incarcération à travers le corps et les non-dits. Puis elle se dessine plus nettement dans l'histoire des détenus, l'entrée dans la délinquance, ou encore le vécu de l'incarcération. Trois portraits nous permettent d'illustrer différents visages et cheminements de la honte. Nous faisons l'hypothèse du caractère central, répétitif et cumulatif de la honte chez les détenus, comme cinq poupées russes emboîtées : la honte germerait dans l'environnement socioculturel et familial ; elle prendrait racine dans la violence et les traumatismes ; elle se révélerait dans la psychodynamique délinquante ; elle serait amplifiée par l'incarcération ; et enfin elle serait transmise en héritage à la génération suivante. Cette recherche confirme l'importance structurelle de la honte chez les détenus, déterminant majeur dans leur parcours et semble requérir une approche psychothérapeutique spécifique. Shame is omnipresent in jail, often in the shadows or hidden behind the masks of other affects. However, psychological research in a forensic context has paid little attention to this feeling. This present qualitative study, conducted at a Paris suburban jail, is based on psychotherapeutic interviews and group discussions on parenthood with inmates. Shame first reveals itself silently through body language: shifty eyes, sweaty palms, stooped shoulders. Then it becomes more apparent when incarcerated individuals expose their personal background, the origin of their delinquent behavior, or their everyday life in prison. We posit that shame is structural and cumulative in the life of incarcerated individuals, nested like five Russian dolls in their psyche: first, shame germinates in their social and cultural environment; secondly, it roots itself in the experience of violence and trauma; then it is revealed at the heart of the psychodynamics of crime; it is amplified by imprisonment; and lastly, while still in jail, shame is transmitted to the next generation. Our research has demonstrated the prevalence of shame in the psychodynamics of inmates. Further research could focus on defining specific psychotherapeutic approaches that can help them overcome shame. [ABSTRACT FROM AUTHOR]

Cela fait plus de cinquante ans que l'Administration Pénitentiaire (AP) française fait de la prévention des risques suicidaires en détention. Elle est sans doute l'une des administrations qui prend le mieux en compte ces risques aujourd'hui. Elle en a même fait l'une de ses priorités. Cela passe, d'une part, par l'élaboration d'un dispositif de formation initiale et continue sur cette thématique et, d'autre part, par la mise en place de mesures de prévention basées sur l'évaluation du potentiel suicidaire de toute personne arrivant en prison. Elle a ainsi mis en place des dispositifs de prévention et de postvention face au risque suicidaire qui lui sont propres. Si l'ensemble de ces mesures donnent des signes encourageant en termes de résultats, il n'en demeure pas moins qu'un certain nombre de décès par suicide en prison se produisent encore chaque année. Il est donc nécessaire pour l'AP de prendre également des mesures de postvention afin d'en diminuer au maximum l'impact psychologique sur la détention et sur les personnels directement concernés par la découverte d'un détenu suicidé. The French Prison Administration has been doing suicide prevention in prison for over 50 years. It is undoubtedly one of the administrations, which best takes these risks into account today. She even made it one of her priorities. On the one hand, by developing an initial and continuous training system on this subject, and on the other hand, by implementing preventive measures based on the assessment of the suicidal potential of anyone arriving in prison. It has thus set up prevention and postvention devices in the face of its own suicide risk. While all of these measures give encouraging signs in terms of results, the fact remains that a certain number of deaths by suicide in prison still occur each year. It is therefore necessary for the prison administration to also take postvention measures in order to minimize the psychological impact on prisoners and on personnel directly concerned by the discovery of a suicide prisoner. The prison staff has an obligation of means with regard to the medical care of detained persons. Several legal texts, European and French, legislate this obligation and lay down the broad outlines. The prevention of suicidal risks in the prison environment is based on the assessment of the suicidal potential of detained persons, upon their arrival in detention. Each inmate is assessed for the risk, urgency and suicidal dangerousness he presents during this incoming interview. Depending on the results, measures specific to the prison administration can be taken to limit, or even prevent, any risk of suicide. All personnel in initial training at the national school of prison administration (ENAP) are made aware of this evaluation method. There after, additional training, throughout their career, is offered to them in continuous training so that they develop their skills in this area. But when a suicide, or an attempt, occurs in detention, postvention measures are put in place for all those affected by this event, in particular prison staff, fellow prisoners and families. The prison administration has been working on suicide prevention in detention for over fifty years, making it one of the French administrations most involved in suicide prevention. [ABSTRACT FROM AUTHOR]

Le vieillissement de la population pénale en France pose un véritable problème de santé publique. Or, il existe très peu de recherches sur la santé mentale des détenus âgés. L'objectif de cette étude était d'évaluer l'effet de l'âge et de la durée de détention sur les troubles mentaux et sur les performances cognitives de sujets âgés incarcérés. Nous avons recruté 138 détenus de sexe masculin âgés de 50 ans et plus dans sept établissements pénitentiaires français. Le protocole de recherche comprenait un entretien semi-directif, le Mini International Neuropsychiatric Interview (MINI DSM-IV) pour l'évaluation des troubles mentaux ainsi que la Batterie Rapide d'Efficience Frontale (BREF) et le Mini Mental State Examination (MMSE) pour l'évaluation des performances cognitives. Les résultats ont mis en évidence une prévalence très élevée des troubles mentaux, notamment de la dépression et de l'anxiété, et des troubles cognitifs. Toutefois, la probabilité de survenue de certains diagnostics psychiatriques diminue avec l'avancée en âge (épisode dépressif majeur, agoraphobie, état de stress post-traumatique et anxiété généralisée). Par ailleurs, les estimations effectuées par régression logistique n'ont montré aucun lien significatif entre la durée de détention et les troubles mentaux. En revanche, il existe un lien significatif entre la durée de détention et la déficience cognitive. Ces résultats mettent en évidence une très grande vulnérabilité des détenus âgés sur le plan de la santé mentale et soulignent la nécessité de mettre en œuvre des mesures adaptées de dépistage et de soins pour répondre aux besoins spécifiques de cette frange de la population pénale. Inmate aging is considered to start at the age of 50, which is early in relation to aging in the general population. The aging of the criminal population in France poses a real public health problem. There is very little research on the mental health (mental and cognitive disorders) of older inmates. The objective of this study was to evaluate the effect of age and time spent in prison on mental disorders and cognitive performance of elderly prison inmates. We put forward the hypothesis that age and amount of time spent in prison are associated with the deterioration of older inmates' mental health, that is, an increase in the prevalence of psychiatric disorders and a decrease in cognitive performance. We recruited 138 men aged 50 and over in seven French prisons. The research protocol included a semi-directive interview, the Mini International Neuropsychiatric Interview (MINI DSM-IV) for the assessment of mental disorders, as well as the Rapid Battery for Frontal Efficiency (BREF) and the Mini Mental State Examination (MMSE) for the evaluation of cognitive performance. The average age of the inmates (N = 138) was 59.7 years (range 50–84, SD = 8.02). The average sentence was approximately 13.5 years (SD = 7) and the average time spent in prison was 6.9 years (SD = 5.9). The results showed a very high prevalence of mental disorders, notably depression and anxiety, and cognitive disorders. However, the probability of occurrence of certain psychiatric diagnoses decreases with age (major depressive episode, agoraphobia, post-traumatic stress disorder and generalized anxiety). In addition, logistic regression estimates showed no significant relationship between time spent in prison and mental disorders. However, there is a significant link between time spent in prison and cognitive impairment. Our hypothesis is partially validated. Indeed, age is not associated with mental or cognitive disorders. However, the amount of time spent in prison has an effect on the deterioration of certain cognitive functions. It appears that after the age of 50, it is not chronological age but environmental factors that mainly explain cognitive decline. Our study shows that the longer the detention period, the greater the inmate's cognitive decline. These results highlight the very high vulnerability of elderly prisoners in terms of mental health and emphasize the importance of implementing appropriate detection and care measures to address the needs of this segment of the criminal population. Routine screening for cognitive impairment in all older prisoners should be carried out by caregivers in penitentiary institutions. Furthermore, better follow-up and cognitive assessment of prisoners aged 50 or more and whose length of incarceration exceeds five years could make it possible to detect subjects at risk and to propose appropriate activities to reduce and/or delay the effects of aging in detention. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude exploratoire était d'appréhender les facteurs de risque de récidive violente auprès d'une population d'hommes incarcérés (n = 21), à travers une investigation du rôle des traits psychopathiques, de l'hétéro-agressivité pro et réactive, de l'auto-agressivité et des tentatives de suicide. L'analyse de nos résultats permet de mettre en exergue différents facteurs de vulnérabilité associés à une probabilité accrue de récidive. Facteurs parmi lesquels nous retrouvons : (1) une prédominance de la sphère comportementale de la psychopathie (Facteur 2) ; (2) la présence de comportements hétéro-agressifs, et plus particulièrement (3) de types réactifs ; et pour finir, (4) la présence d'antécédent(s) de tentative de suicide. Cette étude répond à son objectif principal en cernant certaines modalités psychopathologiques jouant un rôle clé dans le processus de récidive violente. En ce sens, une focalisation sur les différentes expressions de l'agressivité ainsi que sur les traits psychopathiques se révèle être un prisme intéressant pour appréhender la problématique de la récidive de nature violente. Une lecture clinique de nos données nous conduit à formuler l'hypothèse selon laquelle des carences des représentations et des processus mentaux d'élaboration constitueraient des éléments cruciaux permettant de comprendre la répétition d'un agir violent. The objective of this exploratory study was to understand the risk factors for violent recidivism in a population of incarcerated men (n = 21), through an investigation of the role of psychopathic traits, proactive and reactive hetero-aggressiveness, self-aggressiveness and suicide attempts. The analysis of our results highlights various vulnerability factors associated with an increased probability of recidivism. Factors among which we find: (1) a predominance of the behavioural sphere of psychopathy (Factor 2); (2) the presence of hetero-aggressive behaviours, and more particularly (3) reactive types; and finally, (4) the presence of a history of suicide attempt(s). This study fulfills its main objective by identifying certain psychopathological modalities that play a key role in the process of violent recidivism. In this sense, a focus on the different expressions of aggressiveness and on psychopathic traits is an interesting prism for understanding the problem of violent recidivism. A clinical reading of our data leads us to formulate the hypothesis: deficiencies in representations and mental elaboration processes are crucial elements in understanding the repetition of violent action. [ABSTRACT FROM AUTHOR]

Les blessures auto-infligées aux yeux sont des actes rares que l'on retrouve dans plusieurs pathologies (psychiatriques, neurologiques, etc.) entraînant des conséquences gravissimes. Peu de données sont retrouvées dans la littérature à ce sujet. À partir d'une approche historique, nous constatons que les représentations symboliques de l'œil sont fréquentes dans la mythologie et ont gardé des significations importantes de nos jours. À partir des différentes classifications des blessures auto-infligées à l'œil, nous nous intéressons de manière spécifique aux énucléations ou œdipismes chez les patients atteints de troubles psychiatriques, à partir du cas clinique de M. S. Il s'agit d'un détenu qui s'est auto-énucléé au quartier disciplinaire lors d'un épisode psychotique aigu. Nous détaillons alors les données épidémiologiques, les principaux facteurs de risque et la conduite à tenir en cas d'auto-énucléation chez les patients atteints de psychose à partir d'une revue de la littérature systématique sur PUB MED. Le cas clinique de M. S. reprend les caractéristiques décrites dans la littérature des patients qui s'infligent des énucléations. La place de la prévention de la récidive et celle du suicide sont les enjeux majeurs de leur prise en charge, étant donné les conséquences dramatiques et handicapantes de ces blessures. Self-inflicted injuries to the eyes are rare acts that are found in several pathologies (psychiatric, neurological, etc.) with very serious consequences. Few data are found in the literature on this subject. From a historical approach, we find that the symbolic representations of the eye are frequent in mythology and have important meanings still today. From the different categories of self-inflicted wounds to the eye, we are specifically interested in enucleations or oedipisms of patients with psychiatric disorders from the clinical case of Mr S. who is a prisoner who is self-enucleate at the disciplinary ward during an acute psychotic episode. We then detail the epidemiological data, the main risk factors and the action to take in case of auto enucleation in patients with psychosis from a review of the systematic literature on PUB MED. The clinical case of M. S. resumes the features described in the literature of patients who inflict enucleations. The place of prevention of recidivism and suicide are the major issues in their care, given the dramatic and disabling consequences of these injuries. [ABSTRACT FROM AUTHOR]

Résumé En France, la question des troubles mentaux présentés par les détenus, prévenus ou condamnés, est un sujet de préoccupation ancien et récurrent. Des réponses sanitaires successives ont été apportées pour les prendre en charge. La dernière de ces réponses institutionnelles est la création des unités hospitalières spécialement aménagées (UHSA). Ces nouvelles unités de santé mentale, comme les soignants qui y travaillent, sont implantées dans des hôpitaux psychiatriques au cœur d'enceintes pénitentiaires. Dans cet entretien, Anne-Hélène Moncany et Dominique Dandelot, psychiatres responsables des UHSA de Toulouse et de Cadillac, évoquent les origines de ces structures, les profils des détenus/patients accueillis, les prises en charge qui y sont pratiquées et font un bilan de leur fonctionnement. Abstract In France, the question of mental disorder presented by detainees is an old, recurring subject of preoccupation. Successive healthcare responses have been provided in order to treat them. The latest of these institutional responses has been the creation of specially equipped hospital units: SEHU, in French 'Unités hospitalière spécialement aménagées' or UHSA. These new mental health units are – along with those who work in them – located in psychiatric hospitals inside prison enclosures. In this interview, Anne-Hélène Moncany and Dominique Dandelot, psychiatrists in management roles at two such units in Toulouse and Cadillac evoke the origins of these structures, the profiles of the detainees/patients looked after there and treatments administered there, taking stock of their respective establishments. [ABSTRACT FROM AUTHOR]

Dans cet article nous analysons dans une première partie la transformation du système pénitentiaire turc en partant de deux évènements historiques : l’intervention militaire de 1980 et les opérations de « retour à la vie» de l’année 2000. Dans la seconde partie, nous caractérisons les conditions de détention actuelles dans les prisons turques en développant une analyse sociodémographique de la population carcérale à partir des données statistiques partagées par l’Administration pénitentiaire. In this article we will analyze in the first part, the transformation of the Turkish prison system from two historical events: the military coup of 1980 and the operations “back to life” in 2000. In the second part we will develop the current detention conditions in Turkish prisons and a socio-demographic analysis of the prison population from statistical data shared by the Prison Service.

Résumé La mise en place du plan de lutte antiterrorisme dans l’administration pénitentiaire a permis l’étude de paramètres cliniques et criminologiques de 112 personnes radicalisées placées sous main de justice (milieux ouvert et fermé). L’analyse de leur profil clinique et criminologique a permis de mettre en évidence l’importance de la criminalité de droit commun (75 % des sujets) ainsi que quatre profils criminologiques particuliers : délinquants ambitieux, criminels prosélytes en réseau, personnes en situation de précarité, malades mentaux graves. On constate des invariants sur le plan du fonctionnement psychique de ces personnes : un axe psychopathologique (conflit identitaire, colère, haine) et des facteurs fragilisants (mère qui présente une pathologie somatique, père souvent absent, grande fratrie, niveau scolaire faible, fréquentations délinquantes, antécédents judiciaires). Une évolution de l’expression de leur radicalisation a également pu être observée et discutée à la lumière des postures professionnelles en présence. The implementation of the anti-terrorism plan in the prison administration allowed the study of clinical and criminological settings of radicalized 112 people placed in open and secure custody. Analysis of their clinical profile and criminological helped to highlight the high rate of common crime (75% of subjects) as well as four special criminological profiles: ambitious offenders, criminal network converts, people in precarious situations, severely mentally ill. Finally, we observe commonalties in terms of psychic functioning: a psychopathological axis (identity conflict, anger, hatred) and vulnerability factors (mothers with somatic diseases, absent fathers, large family, low educational level, delinquent contacts, criminal records). A change in the expression of their radicalization has also been observed and discussed in the light of professional postures involved. [ABSTRACT FROM AUTHOR]

Résumé L’évaluation de la psychopathie en milieu carcéral est importante et le recours à plusieurs outils diagnostiques est conseillé. Notre étude évalue la validité prédictive de huit variables du test de Szondi pour les trois scores de la Psychopathy CheckList-Revised sur un échantillon de 30 détenus belges. Les résultats indiquent qu’une seule variable est significativement corrélée ( r = 0,44) avec les scores de la PCL-R mais pas les sept autres. Ce résultat intéressant invite à la réplication. En attendant, nous proposons d’être très prudent dans l’utilisation du test de Szondi pour évaluer les caractéristiques de la psychopathie. Objectives The assessment of psychopathy in prison is important and the use of several diagnostic tools is recommended. Besides the use of the Psychopathy CheckList-Revised (PCL-R), projective tests may be part of the personality assessment. Among these projective tests, the Szondi test lacks psychometric data concerning its predictive validity. We have found no quantitative study that gives this kind of information. Method We chose eight Szondi test variables supposed to assess psychopathic features according to the Szondi theory: (a) social index, (b) number of accentuations, (c) acting index, (d) number of [e –] reactions, (e) pleasure principle, (f) number of empty reactions in the central vectors, (g) number of negative reactions in the central vectors and (h) number of empty reactions in the test foreground. Our study evaluates the predictive validity of these eight variables of the Szondi test for the three scores of the PCL-R (total score of the PCL-R, score of the emotional factor 1 and score of the antisocial factor 2). Our sample was made of 30 Belgian prisoners. We received a psychosocial report containing a thorough clinical assessment, which was used to score the PCL-R, and the results of the Szondi test for each prisoner. We scored the PCL-R prior to receiving the Szondi test protocol. We compared the two data sets with each other using a non-parametric correlation index (Spearman's r ). Results The results showed that only one variable of the eight was significantly correlated ( r = 0.44) with PCL-R scores. This significant variable was the pleasure principle and refers to simultaneous positive reactions in three vectors: [p+], [d+] and [m+]. Conclusions Our result casts doubt on the predictive utility of the Szondi test in predicting psychopathy on its behavioral side as well as on its emotional side. With regard to this interesting result, we clearly need to repeat this analysis. In the meanwhile, we propose to be very careful in using the Szondi test to evaluate psychopathic patterns. [ABSTRACT FROM AUTHOR]

The history of psychiatric care in prisons is relatively recent, and the regional medical-psychological services - initially called regional medical-psychological centers - were established in the different regions of France from 1977 onwards. Their main missions are the prevention and treatment of mental illnesses and addictions, as well as the organization of post-prison psychiatric care. Composed of multidisciplinary teams, they offer individual or group assessments and follow-up, as well as more specific care for certain penal populations., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The prison population in France is mostly composed of young but aging men, in relatively good health but vulnerable. In order to ensure optimal health care for this population, several levels of health care organization - somatic and psychiatric - have been set up since 1994. The different structures created since then allow incarcerated patients to benefit from care adapted to their particular conditions., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The ten French units for difficult patients are secure psychiatric services which receive people suffering from mental pathologies who could have committed or have committed dangerous acts. Among the mental health structures presented in this dossier, the units for difficult patients are those which admit prisoners with psychological disorders and problems of dangerousness for the longest period of time. As fully-fledged care facilities, they offer intensive and multi-professional care., (Copyright © 2022. Published by Elsevier Masson SAS.)

The intensive psychiatric care units are intermediate health structures between the sector psychiatric services and the units for difficult patients. Prisoners can be treated there under article D. 398 of the Code of Criminal Procedure., (Copyright © 2022. Published by Elsevier Masson SAS.)

The specially equipped hospital units (UHSA) receive detainees in the region (men, women, minors) requiring full psychiatric hospitalization, either in free care or in care by decision of the State representative. They are located on the site of hospitals, but a penitentiary enclosure allows for the control of the entry and exit of patients, as well as the security of the perimeter. To date, nine UHSAs are in operation in France., (Copyright © 2022. Published by Elsevier Masson SAS.)

Since the publication of the law of 18 January 1994, health care for detainees has been entrusted to public health establishments, and no longer to the prison administration. This is a real step forward insofar as individuals placed in the hands of justice now benefit from care provided by health professionals, who officiate within health units in prisons. Today, these professionals work in particular to promote preventive and health promotion actions, thereby helping to restore the detainee's place as a subject with a view to reintegrating him or her into the community., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The mission of the inter-regional secure hospital units is to care for incarcerated prisoners. There are eight of them in metropolitan France, one in each prison region. They are jointly managed by the health establishments for care and by the prison administration for security. Each prisoner receives care equivalent to that provided to the rest of the population., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The objective of our study is to prevent pathological outcomes of the institutional abuse in a prison facility, which can trigger a psychotic breakdown of inmate patients, by enhancing a healthy communication between penitentiary staff and medical team despite the fact that they both adopt two opposite approach of inmates. In France, since 1994, public health institution took in charge medical and psychological penitentiary follow-up through Counseling and Ambulatory Care Units (UCSA). Composed of a multi-field team (psychiatrists, psychologists, medical staff), those care units have to constantly deal with security and normative issues specific to the prison facility. Usually, it is difficult to keep the psychotherapy setting safe from external "attacks" inflicted by penitentiary staff. Moreover, admitting UCSA within prison walls raises the eternal conflicting issue between two opposite logics: punishment (related to guilt) and treatment (related to illness and suffering). Whereas, UCSA staff perceives inmates as patients (to be cured), penitentiary staff perceives them as "cons" or out-laws (to be punished). The daily confrontation of such opposing logics not only affects the quality of communication between health team and penitentiary staff, but it also triggers acting-outs which put to the test the feasibility of psychotherapy in a prison setting mainly with mentally vulnerable inmate patients. Our method is based upon a case study of an inmate patient, C., who suffered a psychotic break down as a consequence to the unannounced renovation of the office dedicated to his psychotherapeutic sessions. Though, it is true that C., a former addict, had already a psychotic predisposition, his encounter with the intrusive and arbitrary authority of the penitentiary institution triggered his mental breakdown while undergoing psychotherapy. The result of our study emphasizes upon the necessity to establish a true communication between the medical team and the penitentiary staff and a mutual understanding of the value of their professional task in order to contain any conflict issues or misjudgment that may affect the progress of the most vulnerable inmate patients. Our study concludes to the importance of a complementary, cooperative, comprehensive and balanced approach of mental health problems in a prison facility through continuous training courses and discussions involving both penitentiary staff and medical teams whose roles, despite their differences, revolve around the same goal: the social and mental rehabilitation of inmates. [ABSTRACT FROM AUTHOR]

Abstract: The latest hospital admission device aimed at inmates (the special forensic hospital units [UHSI]) updates the issues relating to the security aspects of the inmates’ medical care. Since 1994, medical care of inmates is under responsibility of hospitalize personals. The main objective of this article is to analyse the consequences of the new way of inmate''s hospitalization. Literature shows some difficulties when sanitary exigencies must be articulated with security interests: limitation in relation between nurses and inmates, conflicts between medical and penitentiary staff… In order to spot the subjective and professional positioning of a UHSI''s medical team, we led some interviews, which enabled to carry on a thematic and clinical analysis (location research of the defence mechanisms). We proceeded first to the descriptive and thematic analysis of the data obtained according to the aspects developed during the interviews. Then we conducted a clinical analysis to identify the defensive level (DSM IV) used by caregivers according to the different dimensions of care at the UHSI. The systematic tracking of defence mechanisms in the caregivers’ speech was then ordered by the dimensions of care. The outcomes are a clinical reading of the conflicts the medical team meets when medical care has both to cope with security requirements and to deal with the hospitalized inmates. Carers mobilized significantly more adaptive mechanisms of high-level and significantly less mechanisms of minor level of distortion of the image for the professional organizational dimensions. While mention of the elements relating to prisoners (clinical dimensions) increases the use of mechanisms of the level of disavowal and significantly reduces the use of high-level adaptive mechanisms. The elements analyzed encourage us to believe that caregivers make a defensive regression when the relationship with the detainee is evoked. If the structural and organizational aspects (professional practices) are the subjects of tailored strategies, the clinical dimensions (representation of the detainee, the relationship to detainee and experience in hospital by the detainee) foster among the caregivers the use of mechanisms very close to division. Moreover, caregivers demonstrate an important empathy in respect of detainees in hospital, especially compared to the experiences of safety rules and transfer to the prison staff the aggressiveness generated by the frustrations linked to security constraints. Some recommendations are made in order to improve among the medical team the collaboration with the prison service staff as well as to develop the relation with those inmates. It is necessary to support professionals with a vulnerable population and potentially dangerous. First, training in psychopathology provides an opportunity for caregivers to liberate and develop their affects on the care of this population. This work will contribute to building a professional practice based on greater ownership of the special care to detainees. Then, in the form of an analysis group practice, support would improve collaboration with the team prison by an exchange around representations of detainees hospitalized and missions of UHSI. The creation of a space dedicated to groups of health care and prison improve mutual recognition of different identities and their characteristics. [Copyright &y& Elsevier]

In Canada, the number of pre-trial detention cases in provincial/territorial custody has soared dramatically. The traditional proportion of sentenced to remand in the inmate population, 75% sentenced to 25% remand, has now become a 50/50 split, and this trend has been accelerating. This paper explores possible reasons for this dramatic shift, focusing particularly on the two-for-one time served credit available to offenders upon conviction. Using content analysis of open-ended survey responses, we provide a “convict” perspective both on explanations for the rise in remand rates and on potential solutions to the problem. The formal position of justice officials on use of the two-for-one policy is compared and contrasted with inmate perceptions. Study findings indicate some consistency between official and inmate explanations, but also show considerable divergence, particularly in whether or not the accused or the prosecution seek to delay the trial process. We conclude with suggestions for policy development and future research. [ABSTRACT FROM AUTHOR]

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