Forensic care in France

Abstract

In France, the number of inmates with psychiatric disorders has grown substantially during the last two decades. In this context, significant changes occurred in France's forensic psychiatry service provision in recent years. Especially, full-time inpatient units for inmates (called unités d’hospitalisation spécialement aménagées, UHSA) have been created in 2010. These changes clearly improved access to mental health care for inmates. Moreover, some recent trends in indicators such as the suicide rate in French prison, which has fallen slightly, are promising [1].However, the practice of psychiatry in prisons is a subject of debate between the proponents of the development of a specific care system for inmates and those considering that psychiatric teams must stay out of prison. One should insist on the dichotomy between the justice system and the health system, which appears constitutional in France. Indeed, the professional independence of caregivers from the judiciary system and the medical confidentiality are fundamental values on which French model has been built. Furthermore, the improvement of the quality of health care in prisons could alarmingly lead the judges to preferentially choose imprisonment for patients suffering from mental disorders committing offences while prison should in no way be considered as a patient care setting. This trend is evidenced by the low rate of individuals judged irresponsible for their crime because of mental health status currently observed in France.Disclosure of interestThe authors have not supplied their declaration of competing interest.e