L'expertise psychiatrique pénale : audition publique de la Fédération Française de Psychiatrie selon la méthode de la Haute Autorité de Santé

The French Federation of Psychiatry, at the request of the General Direction of Health, was at the origin of a public audition on the penal psychiatric expertise practice according to the method of the High Authority of Health. The hearing commission, made up of 20 members, psychiatrists, professionals of justice, sociologists and representatives of families of patients and the civil company studied the problem arising in France by the evolution of the practice of the expertise penal and suggested a whole of recommendations for the practice of the expertise.     

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.     

Pregnancy Outcomes of Incarcerated Women

Many women in prison are of reproductive age and therefore may be pregnant at some time during their incarceration. To assess the effect of incarceration on pregnancy outcome, 76 pregnant women imprisoned during their gestation were compared to a control group of 117 nonincarcerated women. Various risk factors including substance abuse, sexually transmitted diseases, urinary tract infections, and outcome variables including premature birth, cesarean section, and neonatal birth weight were analyzed. There was a statistically greater number of drug abusing patients in the incarcerated group as expected (P < 0.001). When length of incarceration is excluded, only a greater prevalence of low birth weight (P < 0.04) and premature birth (P = 0.05) in the former group is noted. However, pregnancy outcome, with respect to cesarean section, premature birth, and low birth weight, significantly improved with increasing duration of gestation spent in prison. Therefore, enforced provision of prenatal care and cessation of high risk behavior appears to have a beneficial effect on maternal and fetal outcome.     

Risk factors for developing tuberculosis in remand prisons in St. Petersburg,Russia — a case-control study

Background Detainees have a substantial risk to develop tuberculosis (TB) due to a higher incidence of TB in remand prison compared to the civil community. They develop TB during incarceration not only due to poor living conditions in remand prison, but also due to some factors affecting their life before imprisonment. Prevention measures against TB spread from penitentiary institutions to society include study of factors, which contribute to TB development. Current study aims at identification of important risk factors of TB development in remand prison in St. Petersburg, Russia. Methods A retrospective matched case–control study was performed from May 2002 to May 2003 in two remand prisons in St. Petersburg. One hundred and fourteen prisoners (57 cases, 57 controls) were interviewed by using standardised questionnaire. Logistic regression analysis was performed to identify risk factors. Results Six factors were significantly linked to the risk of developing TB: narcotic drug use (odds ratio (OR): 2.6, 95% confidence interval (CI): 1.0–6.9), low income (OR: 3.2, CI: 1.2–8.6), high ratio of prisoners per available bed (OR: 4.0, CI: 1.1–15.0), not having own bed clothes (OR: 13.0, CI: 2.7–61.6), and little time outdoors (OR: 3.3, CI: 1.3–8.5). However, good housing before imprisonment (OR: 4.2, CI: 1.1–15.7) was a separate risk factor for TB. Conclusions Three of the risk factors (high number of prisoners per bed, not having own bed clothes, and little time outdoors) are certainly possible to approach by improvement of conditions in remand prisons. The remaining three factors (narcotic drug use, good housing before imprisonment, and low income) provide knowledge about study population, but cannot be intervened by prison’s medical staff.     

The impact of substitution treatment in prisons--a literature review

Substitution treatment (ST) has established itself as a generally recognised type of treatment for opioid dependence worldwide. Although the number of countries providing ST in prison has slowly started to grow over the last years, its application in the custody setting remains controversial. ST in prison is mainly employed in form of detoxification. Maintenance treatment is provided in only a limited number of international prisons.This literature review is centred around the question: “What is known about the effectiveness of prison based ST?” Furthermore, it investigates how this knowledge can be applied to improve treatment scope and quality. Effectiveness, as defined by the examined studies, refers to short- and long-term reduction of drug use and relapse, reduction in drug use related risk behaviours, reduction in criminal conduct and recidivism, facilitating the manageability of drug using prisoners and improving their physical stabilisation. In this context, substitute dosage, treatment duration, patient retention rates, complementary psycho-social care and the effects of disrupting maintenance treatment when entering the institution are scrutinised.Results show that prison-based ST and especially prison-based methadone maintenance treatment (PMMT) can reduce drug use and injection in penal institutions. Moreover, PMMT provision can reduce injecting risk behaviours as well as drugs charges and re-admission rates. However, for PMMT to retain patients in treatment and reduce illegal drug use and criminal behaviour a sufficiently high dose of methadone (e.g., >60 mg) and the treatment duration lasting the entire period of imprisonment appear crucial.On the basis of the analysed results the authors recommend the provision of PMMT for individuals with long-standing opioid dependence and suggest major expansions of prison based ST in many countries.     

Contraception services for incarcerated women: a national survey of correctional health providers

Background

Incarcerated women have had limited access to health care prior to their arrest. Although their incarceration presents an opportunity to provide them with health care, their reproductive health needs have been overlooked.

Study Design

We performed a cross-sectional study of a nationally representative sample of 950 correctional health providers who are members of the Academy of Correctional Health Providers.

Results

A total of 405 surveys (43%) were returned, and 286 (30%) were eligible for analysis. Most ineligible surveys were from clinicians at male-only facilities. Of eligible respondents, 70% reported some degree of contraception counseling for women at their facilities. Only 11% provided routine counseling prior to release. Seventy percent said that their institution had no formal policy on contraception. Thirty-eight percent of clinicians provided birth control methods at their facilities. Although the most frequently counseled and prescribed method was oral contraceptive pills, only 50% of providers rated their oral contraceptive counseling ability as good or very good. Contraception counseling was associated with working at a juvenile facility, and with screening for sexually transmitted infections.

Conclusions

Contraception does not appear to be integrated into the routine delivery of clinical services to incarcerated women. Because the correctional health care system can provide important clinical and public health interventions to traditionally marginalized populations, services for incarcerated women should include access to contraception.     

Dual Diagnosis: Prevalence, Risk Factors, and Relationship With Suicide Risk in a Nationwide Sample of French Prisoners

Background:  Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care.
Objectives:  The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison.
Method:  A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used.
Results:  Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7–4.6)].
Conclusion:  DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.     

Entre lecture et témoignage,l’oubli de notre histoire

Psychiatrist practicing in prison, I propose to mix the testimony of my daily practice with the reading of two texts, one of Lacan, the other of Foucault. Indeed, I consider that psychiatry in prisons has no specificity. It merely refers the enlarged but always exact image of the ambiguities and structural aporias of psychiatry. I will begin by mentioning the Law on Constrained Hospitalizations, which potentially concerns all patients hospitalized in the public hospital, and then recall the lineaments in the history of our discipline and the consequences of what the psychiatrists have forgotten and the consequences the very fact of forgetting.     

Epidemiology of Physically Disabled Offenders

While most of the literature on the experiences of physically disabled offenders in prison is legal or anecdotal, there is next to no epidemiological exploration of this special population in our state and federal correctional facilities. This is particularly troubling because it is estimated that there are over 220,000 inmates who have some degree of physical impairment. The purpose of this article is to set the stage for such future research. This article examines the importance of epidemiological research, problems with existing research, prevalence of the prison population that are physically disabled, characteristics of these offenders (e.g., age, sex, race), the correctional environments in which they are placed, and suggestions for future research. This research was supported by a fellowship from the David and Minnie Meyerson Foundation (Richard J. Morris, Ph.D., Project Director) to the first author