Mental health care in French correctional facilities during the Covid-19 pandemic

被引:26
|
作者
Fovet, T. [1 ,2 ]
Lancelevee, C. [3 ]
Eck, M. [1 ]
Scouflaire, T. [1 ]
Becache, E. [4 ]
Dandelot, D. [5 ]
Giravalli, P. [6 ]
Guillard, A. [7 ]
Horrach, P. [8 ]
Lacambre, M. [9 ]
Lefebvre, T. [10 ]
Moncany, A-H [11 ]
Touitou, D. [12 ]
David, M. [13 ]
Thomas, P. [1 ,2 ]
机构
[1] CHU Lille, Pole Psychiat, F-59000 Lille, France
[2] Univ Lille, U1172 Lille Neurosci & Cognit Equipe Plastic & Su, INSERM, F-59000 Lille, France
[3] Federat Rech Psychiat & Sante Mentale Hauts Franc, St Andre Lez Lille, France
[4] Ctr Hosp Vinatier, Pole Sante Mentale Detenus & Psychiat Legale, UHSA Simone Veil, Bron, France
[5] Ctr Hosp Cadillac, Pole Psychiat Medicolegale, UHSA, Cadillac, France
[6] AP HM, UMR ADES AMU, Med Legale, Pole Psychiat Med Addictol Detent 11, Marseille, France
[7] EPSM Georges Daumezon, Pole Psychiat Milieu Penitentiaire, Loiret, France
[8] Ctr Hosp Lorquin, Dept Sante Mentale Justice, Pole SMPR, CPN Nancy Laxou, Lorquin, France
[9] CHU Montpellier, Montpellier, France
[10] Ctr Hosp Guillaume Regnier, Pole Psychiat Milieu Penitentiaire, UHSA Rennes, Rennes, France
[11] Ctr Hosp Marchant, Pole Psychiat & Conduites Addict Milieu Penitiair, Toulouse, France
[12] UHSA Paul Verlaine, Grp Hosp Paul Guiraud, F-94800 Villejuif, France
[13] Assoc Secteurs Psychiat Milieu Penitentiaire & Fe, Paris, France
关键词
Coronavirus; SARS-Cov-2; Covid-19; Epidemic; Pandemic; Psychiatry; Prison; Lockdown; PRISON;
D O I
10.1016/j.encep.2020.05.002
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
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 "unites hospitalieres specialement arnenagees", 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. (C) 2020 L'Encephale, Paris.
引用
收藏
页码:S60 / S65
页数:6
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