Psychiatric disorders are very common in newly incarcerated people -
© W. MacKinnon / Unsplash
Psychiatric disorders and addictive behavior are very common in people newly incarcerated in French prisons, according to our partner The Conversation.
The evolution of these disorders during the period of imprisonment remains poorly understood, which is why a study has been launched to assess the frequency of psychiatric disorders upon release.
The analysis of this phenomenon was carried out by Thomas Fovet, psychiatrist at the Pole of psychiatry, legal medicine and penitentiary medicine of the University Hospital of Lille, and Pierre Thomas, head of the Pole of psychiatry, legal medicine and penitentiary medicine of the University of Lille.
Since the start of the Covid-19 pandemic, many researchers have worried about the impact of the current health crisis and periods of confinement on the mental health of the prison population.
But what do we know today about the prevalence of psychiatric disorders in prisons?
Is this population particularly vulnerable, and in what way?
On these questions, the survey we recently conducted in several remand centers in northern France is instructive.
Very present psychiatric disorders
In practice, it is not easy to assess the mental health of the prison population.
In the prison environment, epidemiological studies come up against numerous obstacles, both logistically (constraints linked to the prison environment, access to prisoners, etc.) and regulatory (legislation and specific framework) or methodological (multiple difficulties). to obtain a “representative” sample of the entire prison population).
Video
: "Taking charge of mental health in prison" © Franceinfo & INA
These constraints probably explain why very few surveys on mental health have been conducted so far in prisons, in France in particular.
According to a systematic analysis of studies published between 1966 and 2010 in some twenty countries including France, it seems, however, that psychiatric disorders are present at high levels in prisons.
This is confirmed by the benchmark study in our country.
Published fifteen years ago by Bruno Falissard's team, it was based on the double interrogation, by two clinicians, of some eight hundred prisoners selected at random from twenty prisons.
According to his results, 36% of respondents had a psychiatric disorder of marked to severe severity.
The diagnoses retained by consensus among clinicians were mood disorders (28% including 24% depression), anxiety disorders (29%), psychotic disorders (17% including 6% schizophrenia) and disorders related to substance use (19%).
The work that our team published last spring, as part of the
Mental health in prison population
study
, completes these data.
A frequency multiplied by three
Rather than interviewing people who have been imprisoned for a varying length of time, as has been done in the past, we focused on the mental health of men and women upon their arrival in prison.
More precisely, we interviewed 653 people - randomly selected from eight remand centers in the Nord and Pas-de-Calais - in the first 72 hours of their incarceration, that is to say before the stress of everyday life. penitentiary does not intervene.
The Lille-Sequedin prison center © Fievez / SIPA
One of the advantages of the protocol chosen is to authorize the comparison, in a particular territory, of data on the prison population and the general population, based on the same evaluation methodology and taking into account the age and sex.
This enabled us to observe the very clear over-representation of psychiatric disorders, but also of addictive behavior, among recently imprisoned people.
On average, disorders linked to the use of substances (alcohol and other illicit substances) concern about one in two newcomers, which corresponds to a rate eight times higher than the general population.
As for psychiatric disorders, those that we have studied turn out to be three times more frequent on average.
This is particularly the case for psychotic syndrome (multiplied by 3.1) and characterized depressive disorder (2.9), the respective frequencies of which were measured at 7 and 27% on entry into detention.
Post-traumatic stress disorder appeared six times more common among people admitted to detention than in the general population.
All of these disorders increase the more or less long-term probability that a person will commit a suicide act.
In fact, this suicidal risk was identified in 31% of the detainees questioned.
Two or more disorders
If psychiatric disorders are very common in newly incarcerated people, we also note that as a general rule, they do not present just one, but several: we noted two disorders or more for nearly 42% of them. them, whereas in the general population, this is only observed for 10% of respondents.
Download the PDF "Prevalence of psychiatric disorders in prison" (April 2018)
This co-occurrence of several disorders has, as we know, a significant impact both on the management and on the repetition of incarceration, in people who are particularly vulnerable on the socio-economic level.
And while the Minister of Justice recently launched a new inspection mission on suicides in prison, our investigation underlines the need for efficient care in remand centers.
Obviously, access to quality psychiatric care must become one of the essential preventive measures to fight against suicides in prison populations: the suicide rate is currently seven times higher than that observed in the population. general, which makes it one of the main concerns of caregivers working in prisons.
Finally, in addition to a reflection on access to quality care, our study should lead to reflection on the absence of alternatives to imprisonment for people diagnosed with mental disorders in our country.
While our survey revealed very high prevalence rates for psychiatric disorders and addictive behavior among people newly incarcerated in French prisons, several questions nevertheless remain unanswered.
After prison: closely monitoring developments
Indeed, the evolution of these disorders during the period of incarceration remains little studied.
In other words, little is known about the impact of the prison environment on mental health.
This is why with the support of the General Directorate of Health, Public Health France and the Federation for Research in Psychiatry and Mental Health, a new study was launched to assess the frequency of psychiatric disorders during release. .
Entitled
Health in the outgoing prison population
, and carried out at the national level, this study also aims to determine the course of care for prisoners suffering from psychiatric disorders, whether before, during or after imprisonment.
Our "Prison" file
The thirty days immediately following release from prison constitute a critical period, with a significant risk of death by suicide or by overdose, but also of psychiatric decompensation.
Unfortunately, however, the articulation of psychiatric care between the period of incarceration and life outside the walls of the prison is today far from satisfactory.
It should be noted that the mental health of incarcerated people is often fragile.
This is an important public health issue which goes well beyond prison since all detained persons will, de facto, be released at the end of their prison sentence.
Psychiatric care in prisons should therefore be linked more to mental health care services outside prison walls.
So-called “interstice” devices could be devised, like the transitional mobile teams experienced in Lille, and soon in Toulouse.
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This analysis was written by Thomas Fovet, psychiatrist at the Pole of psychiatry, legal medicine and penitentiary medicine of the Lille University Hospital, and Pierre Thomas, head of the Psychiatry, legal medicine and penitentiary medicine pole of the Lille University Hospital.
The original article was published on The Conversation website.
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