Emergency psychiatry for prisoners

The EPSNF (Etablissement Public de Sante National de Fresnes) is a general hospital which admits patients incarcerated in prisons all over France. Most of the EPSNF emergencies come from prisons in the Paris area. The activity breaks down as follows: 1) psychiatric emergencies represent 15% of total hospital activity, 35% of the activity in the psychiatric unit, and 30% of that in the general emergency unit; 2) somatic disorders associated with psychiatric emergencies are noted in 90% of the cases, with endangerment to life in 60%; 3) psychiatric emergencies consist mostly in self-injuries (suicide attempts and self-mutilations) and other behavioral disorders; 4) using the ICD-10, the most frequent disorders are acute anxio-depressive disorders (60%), acute psychotic disorders (20%), and disorders with a somatic origin (20%). The prisoner population is characterized by: 1) a frequency of suicides 10 times higher than in the general population; the frequency of suicides showed a 3-fold increase over the last five years; 2) a high rate of accompanying somatic disorders; 3) these characteristics in turn may be related to: a vast number of social, psychiatric, addictive, personality and psyche-traumatic factors, factors existing prior to incarceration; 4) the present specific status of the prisoner, related to his crime, the judiciary process, the stress and violence of life in jail. Close collaboration is needed between physicians, psychiatrists and emergency practicioners to address the crisis and refer this special patient to an appropriate unit, for follow-up care.