L'expertise dans le cadre de la loi de Défense Sociale en Belgique: repères diagnostiques et recommandations

Abstract: Under the Belgian Social Defence Law (1964), mentally disordered offenders who are deemed to lack criminal responsibility have to be interned in an ‘Institution of Social Defence’ rather than in a prison. There, they are supposed to receive specialised treatment before their rehabilitation and re-insertion into the community. This paper discusses expertise practice in relation to the Social Defence Law. The paper first gives a description of the requirements of the law. The paper then presents the prevalence of clinical syndromes (axis 1) and of personality disorders (axis 2) among a sample of internees (N =98). The sample presents a high co-morbidity (2.6) of axis I syndromes, and of axis 2 personality disorders (1.7), the majority of them (64%) present both axis diagnoses. The paper also discusses the prevalence of a high psychopathy as measured by the PCL-R among internees (5-8%) as compared to prison inmates given the aim of the law of protecting the society against dangerous individuals. The paper shows that the Social Defence Law embraces a very large spectrum of psychiatric diagnoses including personality disorders and psychopathy. The following recommendations could improve expertise practices: (a) the consideration of earlier propositions relating to the improvement of the Social Defence Law; (b) a comparative research between psychiatric diagnoses of internees and of inmates; (c) a better definition of clinical criteria relating to the application of the law; (d) the implementation of a specialised observation unit before the decision to intern; (e) the need to go beyond a dichotomous conception of the ability to control; (f) the consideration of contextual factor of dangerousness; (g) encouraging the use of validated risk and clinical assessment instruments; (h) a better financing for expert work. [Copyright &y& Elsevier]