French Prisoners Research Articles

Self‐reported injection practices among people who use drugs in French prisons: Public health implications (ANRS‐Coquelicot survey 2011–2013)

The aims of this study were to describe the prevalences of injection practices and needle/syringe sharing in people who use drugs in French prisons, and to investigate associated factors. Using the ANRS-Coquelicot survey (2011-2013), a random sample of 1718 people who used drugs in free society was included. Information regarding a history of incarceration, drug-injection practices inside prison and needle/syringe sharing was collected during interviews. In our sample, 65.5% reported a history of injection and 57.4% had been incarcerated at least once. Among those who reported both of these conditions, 14% reported injection practices inside prison, 40.5% of whom had shared needles/syringes. In the multivariable model, the following variables were associated with injection practices inside prison: being a Russian-speaking detainee, having spent more time in prison, and having started to inject before 1996 and especially before 1987. Being Russian speaking was also associated with needle/syringe sharing in prison. The prevalences of injection practices and needle/syringe sharing in prisons are alarmingly high. Effective interventions to prevent the transmission of infectious diseases among people who use drugs in the prison setting are essential. The implementation of international recommendations on the principle of equivalence between prisons and the community is still very limited in most countries, and should be complemented with tailored interventions for the most vulnerable prison populations, especially Russian-speaking detainees.

Traumatic brain injury among young offenders in France. Results of the Fleury TBI study

This study aimed to estimate the prevalence of TBI in a French prison population of young offenders and to study variables known to be associated with TBI. All young offenders (from 13 to 21) consecutively admitted to Fleury-Mérogis prison over a period of 3 months were included in the study. During the admission procedure, young offenders were interviewed by healthcare staff using a self-reported questionnaire. Comparisons between cases (history of TBI) and controls (no history of TBI) were performed. In all, 332 young offenders were included. The rate of self-reported TBI was high, with a prevalence of 24.5%. The first cause of TBI was violence-related outcomes (25%) and the majority of TBIs were sustained during adolescence (44/80). The first TBI occurred before the first imprisonment in 73/80 case (92.3%). Cases and controls were of the same age ( P = .19). Both had had their first contact with the prison around 18 ( P = .96). No differences were found regarding the number of times in custody and the total time spent in jail during the preceding five years ( P = .11 and P = .16, respectively). Young offenders who reported a TBI significantly accumulate multiple health problems including mental health problems (16.3%; P = .002) and a regular use of cannabis (28.7%; P = .02). These results provide further evidence that specific measures need to be developed such as, first of all, screening for TBI and related impairments upon arrival in prison. They are of a major interest to prevent re-offending among young people.

Prevalence and characteristics of prisoners requiring end-of-life care: A prospective national survey

Background: Ensuring adequate end-of-life care for prisoners is a critical issue. In France, data investigating the impact of laws allowing release of seriously ill prisoners are lacking. Aim: To assess the number and characteristics of prisoners requiring palliative care in French prisons. Design: A prospective, national survey collecting data over a 3-month period. Setting/participants: All healthcare units (n = 190) providing care for prisoners in France. The prison population was 66,698 during the study period. Data collection concerned prisoners requiring end-of-life care, that is, with serious, advanced, progressive, or terminal illness and life expectancy <1 year. Results: Estimated annual prevalence of ill prisoners requiring end-of-life care was 15.2 (confidence interval: 12.5–18.3) per 10,000 prisoners. The observed number of prisoners requiring palliative care (n = 50) was twice as high as the expected age- and sex-standardized number based on the general population and similar to the expected number among persons 10 years older in the free community. In all, 41 of 44 (93%) of identified ill prisoners were eligible for temporary or permanent compassionate release, according to their practitioner. Only 33 of 48 (68%) of ill prisoners requested suspension or reduction in their sentence on medical grounds; half (16/33) received a positive answer. Conclusion: The proportion of prisoners requiring palliative care is higher than expected in the general population. The general frailty and co-existing conditions of prisoners before incarceration and the acceleration of these phenomena in prison could explain this increase in end-of-life situations among prisoners.

Amy Chun Kim. Review of "They Shall Not Have Me: The Capture, Forced Labor, and Escape of a French Prisoner in World War II" by Jean Hélion.

Amy Chun Kim. Review of "They Shall Not Have Me: The Capture, Forced Labor, and Escape of a French Prisoner in World War II" by Jean Hélion.

Forensic care in France

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

Sleep Disorders and Therapeutic Management: A Survey in a French Population of Prisoners.

In a French prison, most inmates reported not being satisfied with their sleep. Life habits between good and bad sleepers were not significantly different except for television and smoking. The most frequently reported symptom of insomnia was several awakenings at night, and the most frequently cited etiologies were rumination of thoughts and noise. Most patients reported that their sleeping problems began or worsened after incarceration. A quarter of the inmates were following a hypnotic treatment, and most of these treatments began in prison. Only 42% of patients were satisfied with its effectiveness. These observations enabled us to make recommendations for healthy sleep patterns such as respecting normal night-and-day cycles, encouraging to stop smoking, and promoting appropriate use of hypnotic treatments.

Cognitive impairment, self-perceived health and quality of life of older prisoners.

There is a wealth of studies of somatic and mental illness among prisoners, but little on older prisoners and their cognitive aging. Our study examines the cognitive performance of older male prisoners and its effect on their perceived health and quality of life. A total of 138 men aged 50 or over were recruited in seven French prisons and 138 men of similar ages from the general population. Two assessments of executive cognitive functions - the mini-mental state examination and the frontal assessment battery - were administered to each participant, together with self rating schedules of health (Nottingham Health Profile), subjective state of mental health and quality of life (the brief World Health Organisation Quality of Life Questionnaire). There were very significant differences between the two groups in terms of cognitive performance, perceived health and quality of life. There was, however, no significant association between cognitive impairment and perceived health or quality of life. We found evidence that about a fifth of male prisoners in France had executive function test scores suggestive of at least moderately severe dementia and many others some evidence of cognitive impairments. Prisoners suffering from cognitive impairment do not necessarily seek help, perhaps not even considering that their health or quality of life to be affected. Communication deficits may also prevent their participation in prison activities which could prevent, slow or halt cognitive decline. Consequently, it is important that systematic screening for cognitive disorders is offered to men over 50 in prison. Copyright © 2017 John Wiley & Sons, Ltd.

Mental disorders, perceived health and quality of life of older prisoners in France.

People serving prison sentences have major needs in terms of their physical and mental health. However, little is known about the prevalence of mental disorders affecting older prisoners and about how they evaluate their state of health and their quality of life. The aim of our study is to identify whether there is a link between mental disorders and the level of perceived health and quality of life of older prisoners. For the group 1, we recruited 138 male prisoners aged 50 and over in 7 French prisons. The control group was composed of 138 community-dwelling men aged 50 and over. The research protocol comprised four scales (The mini international neuropsychiatric interview, The French version of the Nottingham health profile, The scale of the subjective state of mental health, The WHOQOL-BREF). The results reveal a very high prevalence of mental disorders among older prisoners, notably depression and anxiety. The evaluation of perceived health and quality of life is also significantly lower in the group of older prisoners. We discuss the link between having one or more mental disorders and a negative evaluation of perceived health and quality of life.

Évaluation des troubles du langage oral chez des mineurs incarcérés et leurs impacts sur le déroulement de la détention

ObjectivesNumerous studies in the United Kingdom, the United States and Australia have shown that the prevalence of language impairment is much higher amongst young offenders than in the general population. To our knowledge, no such study has ever been undertaken in France. The goal of this pilot study was to bring greatly needed information on language difficulties among a small group of young offenders going through the French prison system and to raise awareness on their communication difficulties. MethodsFormal and functional oral language assessment was conducted on a small sample of 19 subjects. Productive and receptive tasks were used to investigate the two sides of language faculty. Six core tasks were used as markers for language difficulties. Language production measures: morphology and syntax were measured using a sentence repetition task, a sentence completion task and a discourse task using a reminder of an oral story. Language reception measures: receptive vocabulary was measured using a French adaptation of the PPVT, a comprehension of instructions test and a short debate, both based on functional situations. Further analysis was used to compare language difficulties and progression through the prison system. ResultsSome subjects did not complete the protocol. However, main results are as follows: 15 out of 19 subjects scored below 1.65 SD or below C10 on one or several of the six core tasks; a comparison made between subgroups shows that, among the 19 subjects assessed, those with the most difficulties on the receptive vocabulary task and the narration task are those who spent more time serving a punitive sentence within the prison and those less likely to live in a responsibility unit. ConclusionThis study confirmed that a high level of oral language difficulties was present in the population assessed. It was also partially confirmed that these difficulties might have an impact on young offenders’ progression inside the prison system. Issues regarding the assessment of oral language abilities in teenagers and the relevance of the protocol used in this study are discussed. The limitations of the study and indications for further research are also explored to consider a further study on a larger sample.

Obesity in French Inmates: Gender Differences and Relationship with Mood, Eating Behavior and Physical Activity.

ContextInmates, notably women, are at greater risk for obesity and metabolic complications than the general population according to several studies from high income countries. Data regarding French correctional institutions are lacking so far. To fill this gap, we have assessed in a sample from a French prison (33 females and 18 males) the gender-specific effect of incarceration on weight and body mass index (BMI) and examined their current metabolic status. Furthermore, to reveal the possible determinants of increased obesity, we analyzed emotional vulnerability, eating behavior and physical activity using self-reported questionnaires.ResultsIn this sample, obesity (BMI≥30 kg/m2) was already frequent in women (18.2%) but rather scarce for men (11%) at prison entry. Incarceration worsened the rate of obesity in both genders (21.2% and 16.7% respectively). At the time of study, abdominal obesity estimated through waist circumference was particularly prevalent in women (69.7%) versus men (27.8%) and metabolic syndrome was detected in 33% of female against none in male inmates. Abdominal obesity was associated with female sex (p<0.03), low physical activity (p<0.05) and eating disorder (p = 0.07) in univariate analyses. Low physical activity remained significant as an explanatory factor of higher abdominal obesity in multivariate analysis. A marked difference between genders was found for practice of physical activity with a higher proportion of women compared to men being inactive (37.9% vs. 11.8%) and fewer women being very active (17.2% vs. 41.2%).ConclusionThis study revealed that a significant proportion of women of this correctional institution combined established obesity, a metabolic syndrome and very little practice of physical activity which put them at high risk of cardiovascular disease. Thus, obesity should be better surveyed and treated in prison, especially for female inmates. Increased physical activity, adapted to obese women, would be the first mean to decrease obesity and gender differences.

SAT-285 - Feasibility of anti-HCV direct acting anti-viral agents in French prison settings

SAT-285 - Feasibility of anti-HCV direct acting anti-viral agents in French prison settings

Traumatic brain injury among young offenders in France based on the results of the Fleury TBI study

AbstractObjective: This study aimed to estimate the prevalence of traumatic brain injury (TBI) in a French prison population of young offenders and to study variables known to be associated with TBI. It also aimed to study whether TBI was associated with younger age at entry into prison; longer period of custody and re-offending. Participants: All young offenders (from 13 to 21) consecutively admitted to Fleury-Merogis prison over a period of 3 months were included. Method: During the admission procedure, young offenders were interviewed by healthcare staff using a self-reported questionnaire. Comparisons between cases (TBI+) and controls (TBI−) were performed. Results: Three hundred thirty two young offenders were included. The prevalence of self-reported TBI was 24.5%. The first cause of TBI was violence-related outcomes (25%). No differences were found regarding the number of times in custody and the total time spent in prison during the preceding five years. Cases accumulated multiple health problems ...

The French cartographer and the clan chief

In June 1763 a Frenchman, identifiable as the cartographer Louis Stanislas De la Rochette, journeyed from Edinburgh into Perthshire in the company of Sir James Macdonald, eighth baronet of Sleat in Skye. Visits were made to the Roman sites at Ardoch, Kaims Castle, Strageath and Dalginross. Bound up with De la Rochette’s manuscript accounts of his journey to and sojourn in Scotland are a finished drawing of Ardoch and three of the fort and temporary camp at Dalginross, the latter valuably annotated with measurements, including those of the camp’s ‘Stracathro-type’ gates. The drawings can be compared with those made only a few years earlier by William Roy. De la Rochette, who had come to Scotland in 1763 ostensibly to see to the repatriation of French prisoners of war, became a well-known mapmaker in late 18th-century London.

Traumatic brain injury among female offenders in a prison population: results of the FleuryTBI study.

AimThe study was designed to estimate the prevalence of traumatic brain injury (TBI) in a French prison population of female offenders, study the variables known to be associated with TBI, and compare our results with those obtained among male offenders as described in a previous paper.ParticipantsAll female offenders (adults and juveniles) consecutively admitted to Fleury‐Mérogis prison over a 3‐month period were included in the study.MethodDuring the admission procedure, female offenders were interviewed by healthcare staff using a self‐reported questionnaire.ResultsIn all, 100 female offenders were included. The rate of self‐reported TBI was high, with a prevalence of 21%. The first cause of TBI was violence related (35%) and a majority of female offenders with a history of TBI reported having sustained more than one TBI. When compared with those who did not report a TBI, epilepsy and use of alcohol were higher among female offenders with a history of TBI. Perceived health was significantly worse for women who reported a TBI.ConclusionsThis study findings provide additional evidence that TBI among offender populations is serious and that specific actions need to be developed and implemented in correctional settings such as screening for TBI upon arrival.

Mental disorders and cognitive impairment in ageing offenders

The aim of our study was to identify psychiatric and cognitive disorders among older prison inmates and to investigate whether there is an association between mental disorders and cognitive impairment. 138 men aged 50 and over were recruited in seven French prisons (Group 1) and 138 men aged 50 and over were recruited from the general public (Group 2). Participants were assessed using the Mini International Neuropsychiatric Interview, the Mini Mental State Examination, and the Frontal Assessment Battery. The results reveal very significant differences in the incidence of mental disorders and in cognitive performance between the two groups. However, there does not appear to be a significant link between mental disorders and cognitive performance. We discuss the risk factors for mental disorders and cognitive impairment. We raise particularly the issue of depression, which is the most common pathology in this population and which is generally associated with the risk of suicide.

« Radicalisation djihadiste » et psychiatrie de l’adolescent

Introduction“Jihadist radicalization” has never been more urgent than today, receiving attention from several specialists including social scientists. They recently highlighted new terrorist methods (especially to shun intelligence services) and a new profile of the radicalized: young, middle class, with no Muslim origin, who quickly convert to Islam and commit themselves radically through Internet or within French prisons. Some questions appear: how does the signifier of “radicalization” emerge in our patient's symptomatology? Among these teenagers, what does the radical Islamic speech echo? ObjectiveThe aim of this work is to study the place of “jihadist radicalization” within teenager's psychiatric care. The purpose is to participate in the understanding of these young people who are converted and join the “jihadist radicalization” under a psychopathologic shape or not. MethodsThis topic is tackled with a complementarist approach, in an adolescent department of psychiatry, specialized in transcultural psychiatry. Two parts are presented: first, a literature review on “radicalization” and psychiatry; then, two clinical cases concerning teenagers undergoing religious conversion and potentially “radicalization”, collected directly or from medical records and discussions with psychiatrists. ResultsThe literature review concludes to the absence of a specific link between “jihadist radicalization” and psychopathology. A psychological vulnerability could be involved in some cases into the violent radicalization process. Clinical cases allow to discuss several key points: religious conversion, “radicalization”, specific sense of commitment. The transversal analysis of the cases highlights specific points, well known in teenage psychiatry: identity and identification issues, ego ideal, research for authority and question of filiation. ConclusionPsychiatrists are concerned by the “radicalization” topic, which appear starkly within teenager and young adult symptomatology. Concern about how “radicalization” is psychologically negotiated by some vulnerable young people is inevitable among clinicians, even if underlying psychopathology is not necessary heavy. Psychiatrists have to deal with individual fates, to help young people giving meaning to their commitment (religious or not), to help restoring continuity into a period of discontinuity caused by pubertal reorganizations, to help him or her to access to adult's status without hindering its identity maturation. The understanding of this complex and global phenomenon has to be multidisciplinary and on the ground, with the help of anthropologists, sociologists, historians or still imams.

‘Then a great misfortune befell them’: the laws of war on surrender and the killing of prisoners on the battlefield in the Hundred Years War

ABSTRACTThe Battle of Agincourt has been seen as glorious feat of arms for the English, and for Henry V in particular. However, for many historians, Henry’s conduct was marred by his order for the killing of French prisoners, which has been characterised by some as a war crime. This paper examines how common were such massacres of prisoners, and whether such attitudes were shared by contemporaries. It has usually been considered that the ethics of chivalry and the laws of war forbade the deliberate killing of prisoners; how then could such conduct be justified?

‘Barbarity more suited to Savages’: British soldiers’ views of Spanish and Portuguese violence during the Peninsular War, 1808–1814

This article explores British soldiers’ reactions to the violence that Iberian soldiers, guerrillas and civilians perpetrated against wounded French soldiers and prisoners of war during the Peninsular War. Whilst they saw this violence as retaliatory, and sympathized with the suffering of the occupied, British soldiers were shocked, disturbed and outraged, often leading them to self-identify with their very enemy — the French. On one level, this violence was seen as a fundamental violation of customary rules of war. Yet further, in British minds it revealed a deeper Iberian culture of violence and way of war, which set the Iberian peoples apart from ‘civilized’ nations.

Les Alsaciens-Lorrains dans la Grande Guerre by Jean-Noël Grandhomme and Francis Grandhomme

Les Alsaciens-Lorrains dans la Grande Guerre, by Jean-Noel Grandhomme and Francis Grandhomme. Strasbourg, La Nuee Bleue, 2013. 464 pp. 22,00 [euro] (cloth). It is high time: with Les Alsaciens-Lorrains dans la Grande Guerre, Jean-Noel and Francis Grandhomme contribute an important study of Alltagsgeschichte of Alsace-Lorraine between 1914 and 1918. This book--the most extensive work on this topic so far--is based on meticulous research in numerous German and French archives and enriched with about 250, partly unedited, photographs. The book is organized into seven sections. Following the battle front in detail, the authors remind us in the first chapter that in August 1914, Alsace-Lorraine immediately became an important battleground, allowing the French to temporarily regain Sarrebourg, Mulhouse, and Colmar. The front was then quasi-stabilized in September until the end of the war, with a German occupied zone (the Reichsland) and a French presence maintained around Thann, Masevaux, and Dannemarie. However, Alsace-Lorraine continued to be marked by the presence of the war. Analyzing the situation of Alsace-Lorrainers in opposing armies, in the second and third chapters the authors give a detailed account of the daily lives of these soldiers, breaking with myths and taboos that are still commonly accepted. We learn for example that while in 1914, some 3,000 men left the Reichsland to enlist in the French army, most Alsace-Lorrainers fit for military service joined the German army without almost any concerns: 250,000 in the first weeks, 380,000 in total. The image of the malgre nous that developed in the 1920s must therefore be revised as an anachronism. On the basis of multiple testimonies, the authors also question any physical or moral maltreatment in the ranks as a general German politic against Alsace-Lorrainers. In fact, and contrary to what happened in WWII, many of them made careers in the military (99). Alsace-Lorrainers have served not only on all the fronts of the German and French army, aviation and marine, Alsatian emigrants also fought in American and Canadian troops. The experience of the 17,650 Alsace-Lorrainers who fought on the Allied side was, however, quite different from their compatriots. Many, like the descendants of optants (those who chose to leave German-occupied Alsace-Lorraine to preserve their French heritage) from 1872, were raised in the cult of the lost provinces. The clash of their divergent memories appeared in the post-war years. The fourth chapter is the most interesting one. While describing in detail everyday life under German rule, the authors reaffirm what others have said, including vexations and police arbitrariness, but are also careful to take a more reflective and balanced view based on what can be confirmed. In fact, 3,000 to 4,000 individuals in total were arrested or expelled by the Germans during its occupation (257). But this chapter also looks at the French zone, where hundreds, accused of germanophilia, were evacuated and put into French prisons. Obviously, the ongoing harassments in the Reichsland were pain beni for French propaganda, which did not stop underlying the unanimous sentiment of hatred amongst the indigenous population against the German intruders. Meanwhile, however, numerous Alsace-Lorraine family photographs collected by the authors show German soldiers as being part of the decor (273). …

Prevalence of traumatic brain injury and epilepsy among prisoners in France: Results of the Fleury TBI study

Objective: The first aim of this study was to estimate the prevalence of TBI and epilepsy in a French prison population and to study variables known to be associated with TBI. The second aim was to compare prisoners with and without a history of TBI.Participants: All offenders (females, males and juveniles) admitted consecutively to Fleury-Mérogis prison over a period of 3 months were included in the study.Design: During the admission procedure, offenders were interviewed by healthcare staff using a self-reported questionnaire.Results: In all, 1221 prisoners were included. The rates of TBI and epilepsy were high, with a prevalence of 30.6% and 5.9%, respectively. Psychiatric care, anxiolytic and antidepressant treatment, use of alcohol and cannabis were all significantly higher among offenders with a history of TBI. Moreover, the number of times in custody and the total time spent in jail over the preceding 5 years were significantly higher among offenders with a history of TBI.Conclusions: These results provide further evidence that specific measures need to be developed such as, first of all, screening for TBI upon arrival in prison.