Mental health care in French correctional facilities during the Covid-19 pandemic
Mental health care in French correctional facilities during the Covid-19 pandemic
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DOI：
10.1016/j.encep.2020.05.002
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发表时间：
2020-06-01
影响因子：
2.7
通讯作者：
Thomas, P.
中科院分区：
文献类型：
--
作者：
Fovet, T.;Lancelevee, C.;Thomas, P.
目标。-新冠肺炎大流行对目前全世界被监禁的1,100万人的影响是许多人关注的主题。监狱和监狱里挤满了患有许多既往疾病的人，增加了并发症的风险。被拘留者获得医疗服务的机会已经有限，过度拥挤构成了大规模传染的威胁。除了危机对健康的影响外，监狱条件的收紧令人担忧。2020年3月16日，在法国，封锁措施伴随着针对监狱的具体规定：所有设施都暂停了探视、小组活动和外部干预。已经释放了1万多名囚犯，以减少监狱人口和病毒传播的风险。这些调整对法国监狱的医疗保健系统产生了重大影响。本文的目的是描述新冠肺炎疫情背景下法国监狱服刑人员三级精神护理的重组情况，了解关押措施和提前释放对服刑人员心理健康的影响。-这项工作是基于2020年4月在法国对在42个囚犯门诊病房和9个专门为囚犯服务的全日制住院精神病病房(UHSA，代表“Unites Hatealies Specialement Arnenages”，可翻译为“特殊设备医院单位”)工作的精神科保健提供者进行的一项调查。并对新冠肺炎疫情期间服刑人员心理保健系统的国际文献进行了综述。-在法国监狱监禁期间，新冠肺炎疫情得到了相当大的控制，但监禁措施对监狱人口的影响很大。为囚犯提供的三级精神护理实施了具体措施，以确保护理的连续性，在冠状病毒封锁期间支持被拘留者，并防止感染蔓延。其中最重要的是：将医疗咨询限制在严重和紧急情况下，设立“隔离病房”，取消自愿的精神病住院治疗，加强预防卫生措施和医务人员改组。长期监禁会对被拘留者的心理健康造成影响。目前，精神卫生工作者面临着多种临床情况，例如强制戒断药物和药物(与精神活性物质供应困难有关)、焦虑症状(出于对自己及其亲属福祉的担忧)以及患有严重精神疾病的患者的失代偿。提前出狱也可能会引发一些问题。最近从监狱释放的人被确认为自杀和吸毒过量死亡的高风险人群。缺乏时间在监狱内的卫生服务和外部的卫生结构之间提供必要的联系可能会产生严重的后果，强调众所周知的“监狱旋转门”效应。-法国监狱和监狱目前实行的封锁措施表明，对囚犯的精神护理和对普通民众的精神护理之间存在差距。鉴于监狱人口的高度脆弱性，公共卫生当局应该更多地关注监狱的卫生保健。(C)2020年L的首页，巴黎。
Objective. - The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners.Methods. - This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unites hospitalieres specialement arnenagees", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed.Results. - The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect.Discussion. - The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons. (C) 2020 L'Encephale, Paris.