France: prisons and mental health

Prison Insider. What can you say about the treatment of prisoners with mental heath issues, now that you are about to complete your mandate?¶

Adeline Hazan. The problem gets worse as the years go by. Many prisoners suffer from mental illness. The first challenge is that of poor definition and the scope of these illnesses. The last epidemiological study was done in 2007. I feel there is an urgent need for a survey to help accurately define the scope of mental illness in prison. I was told by the Minister of Justice that it would happen in the coming months. I think we are still seeing more or less the same numbers we did in 2007.

About 70% of prisoners suffer from at least one mental or psychological disorder and about 25% suffer from a severe psychotic disorder. This is major and should be urgently be reviewed.

Identification prior to conviction must be improved. One of the reasons we have a high number of prisoners suffering from mental illness is because imprisonment can cause or worsen disorders. The inability to properly identify this at the time of conviction amplifies the phenomenon. Immediate appearance absolutely hinders the identification of those who are affected. The Taubira law of 15 August 2014 anticipated significant improvement in the treatment of people suffering from mental illness. It accounted for a reduction by one third of the sentence assigned to those suffering from impaired judgment. However, as this disability is not always detected at the time of immediate appearance, or even during any other form of judgement, and since the judges are not really aware of this measure, the people appearing in court do not benefit from it. A better identification and the application of this disposition of 15 August 2014 could help prevent the imprisonment of people suffering from mental illnesses.

Whether the illness was triggered by imprisonment or it existed already, it is poorly noted. Prison staff are not trained to detect these diseases. When the illnesses or disorders are identified, the treatment procedure for mental health is not efficient enough. The establishment of regional medical psychological services (SMPR) and specially equipped hospital units (UHSA) should improve the situation. In reality, we can see that SMPR is indeed regional, as indicated by its name. It cannot claim to fully cover the needs of a region. The nine existing UHSA are recent (2010) and certainly not sufficient. The second phase of construction will begin soon. It should have begun a long time ago.

Treatment and care are usually satisfactory with UHSA, but the big problem is the lack of follow-ups when the patient returns to prison. The specific treatment is over.

The benefit of the UHSA stay is quickly destroyed when the detainee returns to prison with insufficient treatment, a lack of psychiatrists, and little attention given to prisoners’ needs and illnesses.

Some Units for Difficult Diseases (UMD) work well. They have more staff for each prisoner. This is shown by the fact that prisoners do not want to return to prison. The scheme is quite strict, but their treatment is more sophisticated in terms of psychiatry. On the other hand, they cannot fully exercise their rights to family visits and access to tobacco, for example. Contrary to this, some prefer to leave the UMD facility due to these minimal rights.

PI. What recommendations do you give to the relevant authorities (prisons or medical facilities)? Do you feel like you are being heard?¶

AH. I feel heard, in the sense that we now share similar concerns. Parliament members are interested in this issue. A work group has come up with proposals and reflections about psychiatric treatment in prisons. For the Minister of Justice, it is also about being aware of this poor treatment. However, actions are still not enough. At the political and administrative level, it is still about raising awareness and the similarities in concerns, but not implementing solutions.

One of my proposals for the Justice Programming and Reform Act, published in March 2019, aimed at changing an expedited immediate appearance procedure, particularly for a certain number of offences. In any case, the government or legislator’s orientation, has mostly been different.

PI. Are you aware of any systems or treatments in other countries that seem more appropriate and would help promote best practices?¶

AH. The concept of imprisonment in northern countries, and of course, for mental healthcare is more open. Italy completely closed its psychiatric hospitals all at once and opened centres called REMS (Residenza per l’esecuzione delle misure di sicurezza) where prisoners are treated. This could be interesting and perhaps inspire France.

But we must not fail to notice that experiments are being carried out in different parts of France. Especially in Marseille,where psychiatrists are focusing on the treatment of people in police custody. They meet these people, identify those with mental illness and work very briefly with them during their detention, to establish a project with them. This is in a bid to be able to propose a therapeutic home, a residence with follow-ups, etc., at the time of their immediate appearance. It is quite commendable. These local experiments are good to follow, but in my view, they are not supported enough by public authorities.

The government is not against this initiative in Marseille. The slow rate of administrative procedures makes it difficult to formalise and spread this type of experiment.