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[Mental health care in French correctional facilities during the Covid-19 pandemic].
Encephale. 2020 Jun; 46(3S):S60-S65.E

Abstract

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 "unités hospitalières spécialement aménagées", 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.

Authors+Show Affiliations

CHU de Lille, Pôle de psychiatrie, 59000 Lille, France; Université Lille, Inserm, U1172 - Lille Neuroscience & Cognition - Équipe Plasticity & Subjectivity, 59000 Lille, France. Electronic address: thomas.fovet@chru-lille.fr.Fédération de recherches en psychiatrie et santé mentale des Hauts-de-France (F2RSM Psy), Saint-André-Lez-Lille, France.CHU de Lille, Pôle de psychiatrie, 59000 Lille, France.CHU de Lille, Pôle de psychiatrie, 59000 Lille, France.UHSA Simone-Veil, Pôle de Santé Mentale des Détenus et de Psychiatrie Légale, centre hospitalier le Vinatier, Bron, France.UHSA, pôle psychiatrie médicolégale, centre hospitalier Cadillac, Cadillac, France.Pôle 11 : psychiatrie médecine addictologie en détention, médecine légale, UMR ADES AMU, AP-HM, Marseille, France.Pôle de psychiatrie en milieu pénitentiaire, EPSM Georges-Daumezon, Loiret, France.Département santé mentale-justice, pôle SMPR, CPN Nancy Laxou, centre hospitalier Lorquin, Lorquin, France.CHU de Montpellier, Montpellier, France.UHSA de Rennes, pôle de psychiatrie en milieu pénitentiaire, Centre hospitalier Guillaume Regnier, Rennes, France.Pôle de psychiatrie et conduites addictives en milieu pénitentiaire, centre hospitalier Marchant, Toulouse, France.UHSA Paul-Verlaine, groupe hospitalier Paul-Guiraud, 94800 Villejuif, France.Association des secteurs de psychiatrie en milieu pénitentiaire et de la fédération française de psychiatrie et co-référent de l'atelier « psychiatrie en milieu pénitentiaire » du Comité de pilotage de la psychiatrie, France.CHU de Lille, Pôle de psychiatrie, 59000 Lille, France; Université Lille, Inserm, U1172 - Lille Neuroscience & Cognition - Équipe Plasticity & Subjectivity, 59000 Lille, France.

Pub Type(s)

Journal Article

Language

fre

PubMed ID

32475693

Citation

Fovet, T, et al. "[Mental Health Care in French Correctional Facilities During the Covid-19 Pandemic]." L'Encephale, vol. 46, no. 3S, 2020, pp. S60-S65.
Fovet T, Lancelevée C, Eck M, et al. [Mental health care in French correctional facilities during the Covid-19 pandemic]. Encephale. 2020;46(3S):S60-S65.
Fovet, T., Lancelevée, C., Eck, M., Scouflaire, T., Bécache, E., Dandelot, D., Giravalli, P., Guillard, A., Horrach, P., Lacambre, M., Lefebvre, T., Moncany, A. H., Touitou, D., David, M., & Thomas, P. (2020). [Mental health care in French correctional facilities during the Covid-19 pandemic]. L'Encephale, 46(3S), S60-S65. https://doi.org/10.1016/j.encep.2020.05.002
Fovet T, et al. [Mental Health Care in French Correctional Facilities During the Covid-19 Pandemic]. Encephale. 2020;46(3S):S60-S65. PubMed PMID: 32475693.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Mental health care in French correctional facilities during the Covid-19 pandemic]. AU - Fovet,T, AU - Lancelevée,C, AU - Eck,M, AU - Scouflaire,T, AU - Bécache,E, AU - Dandelot,D, AU - Giravalli,P, AU - Guillard,A, AU - Horrach,P, AU - Lacambre,M, AU - Lefebvre,T, AU - Moncany,A-H, AU - Touitou,D, AU - David,M, AU - Thomas,P, Y1 - 2020/05/08/ PY - 2020/04/30/received PY - 2020/05/06/accepted PY - 2020/6/2/pubmed PY - 2020/7/14/medline PY - 2020/6/2/entrez KW - Confinement KW - Coronavirus KW - Covid-19 KW - Epidemic KW - Lockdown KW - Milieu pénitentiaire KW - Pandemic KW - Pandémie KW - Prison KW - Psychiatrie KW - Psychiatry KW - SARS-CoV-2 KW - SARS-Cov-2 KW - Épidémie SP - S60 EP - S65 JF - L'Encephale JO - Encephale VL - 46 IS - 3S N2 - 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 "unités hospitalières spécialement aménagées", 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. SN - 0013-7006 UR - https://www.unboundmedicine.com/medline/citation/32475693/[Mental_health_care_in_French_correctional_facilities_during_the_Covid_19_pandemic]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-7006(20)30087-7 DB - PRIME DP - Unbound Medicine ER -