Conducted by the Regional Federation for Research in Psychiatry and Mental Health Hauts-de-France (F2RSM Psy) at the request of the General Directorate of Health, the epidemiological study on mental health on release from prison is made public today. The results confirm the finding of poor mental health for a majority of inmates who present with a psychiatric or substance-related disorder. At the time of the development of the new roadmap 2023 – 2027 “Health of persons placed in the hands of justice”, which is the subject of interministerial work between the Ministry of Health and Prevention and the Ministry of Justice, these data confirm the orientations adopted and the necessary mobilization of all the players involved in prevention, support and care, for the benefit of the health of detainees.
The previous nationwide study [1] carried out in 2004, which focused mainly on the mental health of people on entering prison and during their incarceration, had highlighted an over-representation of psychiatric disorders, with varying severity, among people in prison compared to the general population.
The work of the 2019 – 2022 roadmap relating to the health of persons placed in the hands of justice has highlighted the need to improve knowledge of the state of health, in particular mental, of detainees. Thus, the General Directorate of Health has mandated the Regional Federation for Research in Psychiatry and Mental Health Hauts-de-France (F2RSM Psy) to conduct a new epidemiological study focusing on the mental health after prisonalso with financial support from Public Health France.
The report of this study is available on the F2RSM Psy website.
Main results of the study
Among the people who took part in the study, two-thirds of men detained in remand prisons and three-quarters of women released from prison present, on release from prison, a psychiatric or substance-related disorder..
Half of those surveyed have a substance-related disorder,
a third of men, and half of women, are affected by mood disorders (including depression),
a third of men, and half of women, are affected by anxiety disorders,
10% of men, and a sixth of women, are affected by a psychotic syndrome,
a quarter of men, and half of women, are prone to insomnia.
The study also makes it possible to characterize the severity of these mental disorders at discharge: 32.3% of men (and 58.8% of women) are considered moderately to seriously ill, while the suicide risk is estimated at 27 .8% for men (and 59.5% for women), with an estimated high risk of 8.2 and 19.1% respectively.
With regard to the course of care, the majority of participants were able to benefit from at least one consultation each year by a general practitioner and by a mental health professional (respectively 89.6% and 96.2%). More than a third were followed by a medico-social institution specializing in addiction (CSAPA, CAARUD). In the days preceding discharge, 22% of male respondents and 33.6% of female respondents reported having a scheduled appointment with a mental health professional, and 14% of male respondents and 27.5% of female respondents with a mental health professional. addictology.
It should be noted that the proportion of people treated by opioid substitution medications is equivalent at entry and during detention.
Another striking observation: prevalence of childhood trauma. 98.2% of men and 99.2% of women had been exposed to at least one childhood trauma (neglect or abuse).
With regard to the prison career, and despite the efforts made by the prison administration to maintain family ties and strengthen activities in detention, access to visiting rooms and to these activities, considered as a factor in the protection of mental health, remains insufficient, particularly in a context of prison overcrowding: 57.3% of men and 46.6% of women had access to visiting rooms, 66.6% of men and 40.5% of women had access to sports activities, 28.9% of men and 42.7% of women benefited from socio-cultural activities.
At the time of the development of the new interministerial roadmap “Health of people placed under the hand of justice” 2023 – 2027 which mobilizes all the actors of the prevention, the accompaniment and the care of persons placed under judicial control, the results of this study will be widely shared and, already, confirm the orientations adopted on:
Suicide prevention and improving suicide risk management prisoners, notably through the development of training for health and prison professionals and the improvement of the tools made available to them. Making 3114, the national suicide prevention number, accessible to prisoners, is part of this. The Directorate of Prison Administration also distributed to its services a national plan 2022-2023 relating to the prevention of suicide in prison;
Improving the mental health care pathway including in its dimension of continuity of care on release from detention, with in particular the development of transitional mobile teams (EMoT) to facilitate mental health care within six months of release;
The crucial issue of the prevention and management of addictive behavior in detention which mobilize associative and hospital players with a key role for health units, particularly for the coordination of interventions (CAARUD, CSAPA, etc.);
The development of health promotion in the prison environment following a national symposium organized in 2019: mental health, sexual health, prevention of addictive behavior, development of physical and sporting activity, promotion of a healthy diet, etc. These developments, worked in close collaboration with the prison administration, aim in particular to improve the conditions of detention in a context of prison overcrowding, which aggravates promiscuity and de facto reduces access to activities, thus contributing to additional risks for health: development of stress, sedentary lifestyle, etc.
The results of this study also plead in favor of a reflection on alternatives to incarceration for people with mental disorders. An experiment, co-piloted by the Directorate of Prison Administration, has been underway since 2022 in the Provence-Alpes-Côte d’Azur region (AILSI project, alternative to incarceration through housing and intensive monitoring).
The ambition of the new 2023 – 2027 roadmap relating to the health of persons placed in the hands of justice is thus to take up, for the benefit of the health of detainees, all of these challenges, in a spirit of dialogue, of cohesion and common construction between the different actors involved.
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Contacts presse :
General Directorate of Health
[email protected] / 01 40 56 84 00
Regional federation for research in psychiatry and mental health Hauts-de-France (F2RSM Psy)
[email protected] / 03 20 44 10 34