Examen psychiatrique des personnes placées en garde à vue en France : une enquête nationale auprès d’un échantillon de psychiatres

Abstract

ObjectiveAny French psychiatrist can be appointed by the district prosecutor or the judicial police officer to perform medical examination of people kept in police custody. After this examination, the doctor decides whether the person's state is compatible or not with detention in a police station. A medical certificate is attached to the case file. Regarding the high prevalence of psychiatric disorders among people kept in police custody and the large number of mentally ill people imprisoned without having been properly examined, this examination is of particular importance. However, it remains difficult and sometimes tricky. The main objective of this descriptive study is to evaluate knowledge of French psychiatrists about this examination, its goals and limits, and about how to produce a suitable medical certificate. The secondary objective is to identify the variables associated with a good knowledge of this examination. MethodsA questionnaire was submitted by e-mail to a sample of French psychiatrists from March to May 2021. It allowed us to collect data on their socio-demographic and professional characteristics. Then 12 questions were specially conceived to evaluate their knowledge about the psychiatric examination of people kept in custody. Finally, participants were also questioned about their experience in the area of medical intervention in police custody and how they felt confident about performing such an examination. Based on their responses to the 12 knowledge questions, participants have been separated into two groups (“high level of knowledge” versus “low level of knowledge”). The two groups’ characteristics have been compared through a bivariate then a multivariate analysis. Results183 psychiatrists completed the questionnaire (50.8% women and 49.2% men; mean age 47.6; mean experience 18.1 years). The legal frame of the examination in police custody was well known by the participants (>70% good answers), as well as the rules of confidentiality (>80% good answers). By contrast, only 59% of participants knew that the determination of the person's state compatibility with detention in a police station was the main objective of this examination. Nearly all participants knew that it is possible to decide involuntary hospitalizations of people kept in custody (93%), but a less proportion of them knew that all means of hospitalizations, voluntary and involuntary, are possible if needed. Few participants knew the addresses (or even probably the existence) of the second page of the document they need to complete after the examination (the first page consisting in the medical certificate transmitted to the police and the second page constituting the confidential medical record). Having received a specific teaching about forensic psychiatry was the only variable significantly associated with good knowledge of the specificities of the examination in police custody (OR=2.90; P=0.006). The variable significantly associated with poor knowledge was the doctor's experience (OR=0.94; P<0.001). ConclusionThe rules of good practice regarding psychiatric examination of people kept in police custody are not fully known by French psychiatrists. According to the results of our survey (even if these results cannot be generalized due to a small sample size), it appears essential to provide specific education about forensic psychiatry, not only to young doctors but also to all doctors throughout their careers.