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France

Capital city — Paris

+
Panorama

Health

Organisation of health care

Ministry in charge

Ministry of Health

Every prison facility has a health care unit

yes

Access to healthcare is assured in detention by a level 1 medical unit, an internal structure of the affiliate hospital, located in each institution. Services within the scope of general medicine and which do not require hospitalisation are provided there. The availability of medical equipment varies greatly between institutions and include a lack of X-ray or ophthalmology equipment or poor condition of sterilisation supplies. These units are often cramped and barely functional.

Access to medical units is uneven across facilities. On the whole, access to general medical care is satisfactory, although subject to the constraints of the institutions (activities on the same schedule, ongoing disciplinary procedures, etc.). There are serious shortcomings in specialised care, particularly ophthalmological and dental care, and care for chronic conditions. There are not enough specialist doctors. In certain situations, particularly in the disciplinary unit or in the event of medical extraction, the consultation conditions can be problematic. In particular, there is a lack of respect for medical confidentiality and the quality of care.

  • The Limoges remand centre could give regular medical follow-ups thanks to a healthcare unit available year-round. This unit would treat disorders that prisoners present upon arrival and those that emerge during incarceration. Almost all prisoners would have addiction problems requiring replacement therapy. Many specialists from the teaching hospital would work at the remand centre including general practitioners, ophthalmologists, gynaecologists, physiotherapists and gastroenterologists. Limoges prisoners could access to a great deal of care at the institution or outside it, if necessary. All services were able to treat disorders related to imprisonment conditions. The healthcare unit registered an average of 45 visits per day, which means about one third of the prison population was seeking treatment.

    i
    06/06/2022
    / France3

Different types of medical care are provided :

  • Level 1 care refers to doctor’s visits, external procedures and outpatient care. Medical units, formerly outpatient consultation and treatment units (unités de consultation et de soins ambulatoires (UCSA)), provide consultations and physical examinations pertaining to general practice that do not require hospitalisation. They are found in nearly all prisons and are served by general practitioners and nurses.
  • Level 2 care refers to short-term hospitalisation. This allows people to receive comprehensive, individualised, or intensive care and physical examinations during the day. Medical procedures are carried out in hospitals, with psychiatric care provided inside the prisons through the medical units.
  • Level 3 care refers to full hospitalisation. Medical care is provided in converted sections in the nearest hospitals (for urgent medical treatment and short-term stays). Long-term admissions (longer than 48 hours) go to specially secured hospital units (unités hospitalières sécurisées interrégionales (UHSI)). Psychiatric hospitalisation is available in specially adapted hospital units (unités hospitalières spécialement aménagées (UHSA)), with or without consent.

  • The French division of the International Prison Observatory (OIP-SF) published a report on access to specialised care in prison. It noted prisoners’ poor health was exacerbated by how complicated or impossible it is to access specialised care.

    i
    06/07/2022
    / OIP - SF

Access to health care

Health care is free

yes

All care related to illness or pregnancy is covered by the social security system, in the same conditions as on the outside and thus with the same rates of reimbursement. The patient remains responsible for certain health expenses that are not covered by health insurance.

A medical examination is performed upon admission

yes

A first medical visit must take place upon entry into detention in order to ensure continuity of care of those receiving treatment and to identify those who are carriers of contagious diseases or need urgent care. This examination allows for the detection of potential suicide risks and the future monitoring of immunisation status, addiction or mental health disorders.

A medical file is opened upon admission

yes

An epidemiological fact sheet is produced following the medical examination completed upon entry into detention and filed in the medical record.

Prisoners can access health care units after

a written request

Appointment requests are made in writing. Written requests create difficulties for people with low levels of literacy or those have not mastered the French language. The NGO Médecins du Monde tries to make appointment requests more accessible by offering a leaflet on which the inmate ticks boxes according to the treatment needed. Obtaining an appointment can take several months.

Medical examinations are carried out on a confidential basis

no

Physical health care

Preventative measures for epidemic and contagious diseases are implemented.
During the COVID-19 pandemic, the Controller-General for Places of Deprivation of Liberty requested a specific vaccination campaign for prisoners. She expressed particular concern about “the inevitable promiscuity in detention, the vulnerability of the prison population and the simplicity of the process as all patients [were] in one place”.
On 5 February 2021, the State Council stated that there was no need to register prisoners as a priority for the first phase of the vaccination. They believed that the risk of developing a severe form of COVID-19 did not appear to be higher for prisoners than for the average population.

  • The Controller-General of the places of deprivation of liberty (Contrôleure général des lieux de privation de liberté, CGLPL) expressed its concern about how few prisoners had received the first dose of the COVID-19 vaccine: 57% of incarcerated persons had been vaccinated, compared to 77% of the general population. The CGLPL further explained that the number of cases quadrupled during January.

    i
    13/01/2022
    / CGLPL

Mental health care

-

  • Attention deficit disorder and attention deficit hyperactivity disorder have been highly misunderstood neurodevelopmental disorders. A 2015 Cambridge University study based on diagnostic clinical interviews found that one in four prisoners suffered from this type of disorder. This is ten times higher than the general adult population. The study authors recommend prisoner-specific “multimodal treatment,” which would involve psychoeducation groups, and short behavioural and cognitive therapies to teach them how to better manage the intensity of their emotions. Jérôme Bachellier, a psychiatrist in the prison healthcare unit (unité sanitaire en milieu pénitentiaire, USMP) explained that “the prison lacks trained staff who can recognise the disorder.” The medical staff could use training, but “it always comes down to the question of human capacity and time.”

    i
    Le Monde