France: dealing with helplessness

Philippe Nivière. A 2017 study ¹ reminds us that one in seven prisoners worldwide suffers from psychiatric disorders. Other assessments place this proportion at a much higher level. Thus, Professor Frederic Rouillon ² deduced from an epidemiological study, carried out between July 2003 and September 2004, the presence of psychotic disorders in 21.4% of prisoners in metropolitan France, including 7.3% with schizophrenia and 7.3% with chronic psychosis. Several ministers cited the figure of 30%, also mentioned by the CGT prison staff union in recent years.

Our association develops training for its members. It thought that in order to not be passive when faced with what the mentally ill go through in prison, it had to share its experience with those who now “accompany” many of these people.

While saying loud and clear that the mentally ill have no place in prison, we were able to provide basic training to the supervisors and counsellors of the SPIP (penitentiary integration and probation services) and hence a little humanity to the lives of these inmates who are unhappier than most.

We signed a multi-year agreement with the Department of Prison Administration at the end of 2018 in order to collaborate on the subject of support and integration of ill and/or mentally disabled people in the hands of the law. Our association is expected to provide assistance in the areas of awareness raising, information or training on the specifics of mental illnesses, as well as the recommended actions and attitudes to facilitate contact with these people.

Around 40 days of training for supervisors, SPIP and social workers for penitentiary facilities in western Normandy are scheduled as part of this agreement. This began in 2019 with four ‘test’ days and will carry on over the next few years.

PN. We knew that the need to better understand mental disorders was important for administration staff. Our biggest surprise was to see the analogy between the questions of staff and those of families faced with the mental illness of one of their relatives:
• How do we “admit” the disease is there? Too many families deny the suffering of their loved one: “he’s lazy and would be better off if he worked” or “it’s a teenager problem, he’ll get over it!” For supervisors, the question is to know whether the person is truly ill or just trying to deceive people… This outdated representation is still very much alive in some.
• How do we deal with the disease, act, position ourselves? A feeling of helplessness takes over the environment of the sick person; we want to be able to help and protect them…

There’s something disturbing about mental illness when you’re faced with it.

• How can they be heard by psychiatry services? Medical confidentiality is such that it’s difficult for information to circulate from the care world to those around it.
• What support solutions exist beyond the prison walls?

We’ve met people who want to do their job to the best of their ability, to understand the difficulties encountered by psychiatric patients.

Six hours certainly isn’t enough to cover everything… The morning is reserved for generalities on mental illness (schizophrenia, bipolarity, borderline disorder and severe and resistant depression) and mental disability. In the afternoon, we focus on coping mechanisms and red flags. We aim to change the way mental illness is portrayed and not to provide “turnkey” solutions, which is impossible, but avenues that trainees can take to improve their professional practices.

PN. Although it’s difficult to observe changes in professional practices at the moment, the training course evaluations conducted by the training department of the Caen prison administration show that this training is well suited to staff needs. The first four days in 2019 made it possible to fine-tune the programme; this will continue in the years that follow.

We know that training, given not by healthcare professionals but by volunteers confronted with the mental illness of a loved one, is particularly appreciated by trainees.

Our way of approaching this problem in a global manner and not from a strictly medical point of view makes it possible to fuel exchanges and bring out all the difficulties felt in the exercise of their functions.