Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.10.002
Mélanie Lesueur , Dominique Dandelot , Patrick Le Bihan
Unités hospitalières spécialement aménagées (UHSA) are recent French structures offering psychiatric care to incarcerated persons. UHSA are part of a broader history and context of the interweaving of care and justice. This article proposes a contextual reading of the care processes within the UHSA in which we work. By following a spatio-temporal axis, we have avenues for reading the experience and psychopathological expression of the disorders of incarcerated people. The crushing of space and time seems to us particularly prevalent in the prison environment and sometimes requires other solutions. Hospitalization in a UHSA is now one of them, and some patients return here regularly. UHSA, in terms of space, time and relationships, takes charge of patients and accompanies them in a different way from the prison world. By starting from the ways of entry into care, with or without consent, we can read the ways of being hospitalized and of appropriating care. Our hypothesis is that this place allows an exit or an additional confinement in the hospital environment.
{"title":"UHSA : une nouvelle logique de l’espace de soin au milieu du carcéral ?","authors":"Mélanie Lesueur , Dominique Dandelot , Patrick Le Bihan","doi":"10.1016/j.amp.2023.10.002","DOIUrl":"10.1016/j.amp.2023.10.002","url":null,"abstract":"<div><p><em>Unités hospitalières spécialement aménagées</em> (UHSA) are recent French structures offering psychiatric care to incarcerated persons. UHSA are part of a broader history and context of the interweaving of care and justice. This article proposes a contextual reading of the care processes within the UHSA in which we work. By following a spatio-temporal axis, we have avenues for reading the experience and psychopathological expression of the disorders of incarcerated people. The crushing of space and time seems to us particularly prevalent in the prison environment and sometimes requires other solutions. Hospitalization in a UHSA is now one of them, and some patients return here regularly. UHSA, in terms of space, time and relationships, takes charge of patients and accompanies them in a different way from the prison world. By starting from the ways of entry into care, with or without consent, we can read the ways of being hospitalized and of appropriating care. Our hypothesis is that this place allows an exit or an additional confinement in the hospital environment.</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139294446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.12.006
Émilie Telle , Thierry H. Pham , Audrey Vicenzutto
This narrative literature review aims to articulate the interests and issues in investigating the potential links between the mental health of police officers and the use of force they may deploy during the course of their interventions. The first two sections delineate the definitions of the core concepts of police psychological health and the use of force, as well as their specific issues. The third addresses the issues underlying the study of potential relationships between these two fields. Due to the nature of their profession, police officers are at increased risk of developing mental health problems, which can be clinically significant and lead to several conditions known as common mental disorders (e.g., depression, post-traumatic stress, anxiety, burnout, substance abuse, suicidal ideation). Their etiology among police officers is related to three main risk factors: organizational, operational, and individual. Organizational and operational factors are considered to have a direct impact on the development of common mental disorders, while individual factors are more indirect. They are mostly related to the ability to manage stress or reinforce the effect of direct factors. While there is a voluminous amount of literature on the topic of risk factors relating to post-traumatic stress or burnout, there is a lack of evidence concerning depression, anxiety, suicidal ideation, or substance abuse among police officers. The mental health of police officers can have consequences on the missions they must carry out, including those involving the use of force. This concept is still relatively complex to define as it depends on both the legal framework and the policies and management practices within the police institution. The most widely accepted use-of-force theoretical model is the force continuum articulating escalation versus de-escalation of force and the degree of the officer's force and the offender's resistance. The identification of risk factors influencing the use of force is currently based on a non-consensual literature, although the key domains are relatively well established: officer, offender, encounter, and community characteristics. However, there is still little consensus as to the characteristics that constitute these domains, particularly regarding community, organizational, and individual characteristics. Only a few studies focus on the link between burnout and use of force. In this context, the intersection between organizational and work psychology and forensic psychology is of great interest, particularly in the development of a structured, empirical approach based on the modeling of risk factors.
{"title":"Troubles mentaux courants et usage de la force dans la police : intérêts et enjeux","authors":"Émilie Telle , Thierry H. Pham , Audrey Vicenzutto","doi":"10.1016/j.amp.2023.12.006","DOIUrl":"10.1016/j.amp.2023.12.006","url":null,"abstract":"<div><p>This narrative literature review aims to articulate the interests and issues in investigating the potential links between the mental health of police officers and the use of force they may deploy during the course of their interventions. The first two sections delineate the definitions of the core concepts of police psychological health and the use of force, as well as their specific issues. The third addresses the issues underlying the study of potential relationships between these two fields. Due to the nature of their profession, police officers are at increased risk of developing mental health problems, which can be clinically significant and lead to several conditions known as common mental disorders (e.g., depression, post-traumatic stress, anxiety, burnout, substance abuse, suicidal ideation). Their etiology among police officers is related to three main risk factors: organizational, operational, and individual. Organizational and operational factors are considered to have a direct impact on the development of common mental disorders, while individual factors are more indirect. They are mostly related to the ability to manage stress or reinforce the effect of direct factors. While there is a voluminous amount of literature on the topic of risk factors relating to post-traumatic stress or burnout, there is a lack of evidence concerning depression, anxiety, suicidal ideation, or substance abuse among police officers. The mental health of police officers can have consequences on the missions they must carry out, including those involving the use of force. This concept is still relatively complex to define as it depends on both the legal framework and the policies and management practices within the police institution. The most widely accepted use-of-force theoretical model is the force continuum articulating escalation <em>versus</em> de-escalation of force and the degree of the officer's force and the offender's resistance. The identification of risk factors influencing the use of force is currently based on a non-consensual literature, although the key domains are relatively well established: officer, offender, encounter, and community characteristics. However, there is still little consensus as to the characteristics that constitute these domains, particularly regarding community, organizational, and individual characteristics. Only a few studies focus on the link between burnout and use of force. In this context, the intersection between organizational and work psychology and forensic psychology is of great interest, particularly in the development of a structured, empirical approach based on the modeling of risk factors.</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.12.008
Robert Courtois , Valérie Roy , Lorene Causse
The aim of this paper is to report on the current state of research into the perpetrators of intimate partner violence in France in relation to changes in public policy. In France, 22% of women aged 15–49 who are married or are in a relationship have been subjected to physical or sexual violence by their intimate partner. If we also take into account psychological violence, this figure rises to almost 60%. The fight against intimate partner violence has been gathering more and more impetus in France over the last ten years. The first Council of Europe Convention on preventing and combatting violence against women and domestic violence (Istanbul Convention) was adopted in 2011, and the first country-specific recommendations were made in 2015. Intimate partner violence became a major undertaking of the first five-year term (2017–2022) of the French President of the Republic. In September 2019, his government launched the “Grenelle” of fighting against intimate partner violence, which aimed to identify improvements in the implementation of previous initiatives and to transform professional practices. Included among the measures taken after the “Grenelle”, was the creation of Centers for perpetrators of intimate partner violence (“Centres de prise en charge des auteurs de violences conjugale”: CPCA), and their implementation in 2020–2021 marked a real turning point, at a time when the care of perpetrators had previously received little attention from public policy in France. Other measures will follow, notably those recently introduced in order to better deal with family violence in the courts. Evaluation of these policies shows that there is still considerable room for improvement, but there is currently momentum for further progress, with a clear desire displayed for public authorities to step up their efforts. The primary objective of the CPCA is to stop intimate partner violence and reoffending from happening again. However, they were set up without any standards having been established, e.g. in terms of theoretical references or intervention approaches, as is the case in other countries (United States, United Kingdom, Canada) where the adoption of standards of practice has been gradual over 20 or 30 years. The lack of systematic risk assessment procedures for intimate partner violence in France can also be noted. In the same vein, this work provides an overview of research into the perpetrators of intimate partner violence in France. It reports on national statistical and demographic surveys, and on research in sociology, law, prison administration and the medical-psychological field. Scientific research focusing on the perpetrators of intimate partner in France is rare in psychiatry and the humanities and social sciences. Finally, a research project entitled “A portrait of practices with perpetrators of intimate partner violence and their impact: a case study of 7 to 8 centers which take care of them” funded by the French Ministry for g
本文旨在结合公共政策的变化，报告法国对亲密伴侣施暴者的研究现状。在法国，15-49 岁的已婚或有伴侣的妇女中，有 22%遭受过亲密伴侣的身体暴力或性暴力。如果将心理暴力也计算在内，这一数字将上升到近 60%。近十年来，法国对亲密伴侣暴力的打击力度越来越大。2011 年，欧洲委员会通过了第一份《预防和打击暴力侵害妇女行为及家庭暴力公约》（《伊斯坦布尔公约》），并于 2015 年提出了第一份针对具体国家的建议。亲密伴侣间的暴力行为成为法国共和国总统第一个五年任期（2017-2022 年）的主要任务。2019 年 9 月，法国政府启动了打击亲密伴侣间暴力行为的 "格勒内勒 "计划，旨在确定以往举措实施过程中的改进之处，并转变专业做法。在 "格奈尔计划 "之后采取的措施中，包括建立亲密伴侣施暴者中心（"Centres de prise en charge des auteurs de violences conjugale"：CPCA），这些中心将于 2020-2021 年实施，这标志着一个真正的转折点，因为此前法国的公共政策很少关注施暴者的护理问题。随后还将采取其他措施，特别是最近为在法庭上更好地处理家庭暴力问题而采取的措施。对这些政策的评估表明，仍有相当大的改进余地，但目前有进一步取得进展的势头，公共当局显然希望加大努力。保护儿童和青少年法》的主要目标是制止亲密伴侣间的暴力行为和再次犯罪。然而，这些机构在成立之初并没有制定任何标准，例如理论参考或干预方法方面的标准，这与其他国家（美国、英国、加拿大）的情况一样，这些国家的实践标准是在二三十年间逐步采用的。在法国，亲密伴侣间的暴力行为缺乏系统的风险评估程序。同样，本著作概述了对法国亲密伴侣暴力施暴者的研究。报告涉及国家统计和人口调查，以及社会学、法学、监狱管理和医学心理学领域的研究。在法国，以亲密伴侣施暴者为重点的科学研究在精神病学和人文社会科学领域并不多见。最后，介绍了由法国性别平等、多样性和机会均等部资助（2023-2024 年）的一个研究项目，题为 "亲密伴侣施暴者的做法及其影响：对 7 至 8 个照顾亲密伴侣施暴者的中心的案例研究"。
{"title":"État des lieux de la recherche en France concernant la prise en charge des auteurs de violences conjugales en lien avec l’évolution des politiques publiques","authors":"Robert Courtois , Valérie Roy , Lorene Causse","doi":"10.1016/j.amp.2023.12.008","DOIUrl":"10.1016/j.amp.2023.12.008","url":null,"abstract":"<div><p>The aim of this paper is to report on the current state of research into the perpetrators of intimate partner violence in France in relation to changes in public policy. In France, 22% of women aged 15–49 who are married or are in a relationship have been subjected to physical or sexual violence by their intimate partner. If we also take into account psychological violence, this figure rises to almost 60%. The fight against intimate partner violence has been gathering more and more impetus in France over the last ten years. The first Council of Europe Convention on preventing and combatting violence against women and domestic violence (Istanbul Convention) was adopted in 2011, and the first country-specific recommendations were made in 2015. Intimate partner violence became a major undertaking of the first five-year term (2017–2022) of the French President of the Republic. In September 2019, his government launched the “Grenelle” of fighting against intimate partner violence, which aimed to identify improvements in the implementation of previous initiatives and to transform professional practices. Included among the measures taken after the “Grenelle”, was the creation of Centers for perpetrators of intimate partner violence (“Centres de prise en charge des auteurs de violences conjugale”: CPCA), and their implementation in 2020–2021 marked a real turning point, at a time when the care of perpetrators had previously received little attention from public policy in France. Other measures will follow, notably those recently introduced in order to better deal with family violence in the courts. Evaluation of these policies shows that there is still considerable room for improvement, but there is currently momentum for further progress, with a clear desire displayed for public authorities to step up their efforts. The primary objective of the CPCA is to stop intimate partner violence and reoffending from happening again. However, they were set up without any standards having been established, e.g. in terms of theoretical references or intervention approaches, as is the case in other countries (United States, United Kingdom, Canada) where the adoption of standards of practice has been gradual over 20 or 30 years. The lack of systematic risk assessment procedures for intimate partner violence in France can also be noted. In the same vein, this work provides an overview of research into the perpetrators of intimate partner violence in France. It reports on national statistical and demographic surveys, and on research in sociology, law, prison administration and the medical-psychological field. Scientific research focusing on the perpetrators of intimate partner in France is rare in psychiatry and the humanities and social sciences. Finally, a research project entitled “A portrait of practices with perpetrators of intimate partner violence and their impact: a case study of 7 to 8 centers which take care of them” funded by the French Ministry for g","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.08.001
Edouard de Lassus Saint-Genies , Sophie Raymond , Marine Dalmont , Olivier Guillin , Jean-Pierre Bouchard , Ivan Gasman
The ten French psychiatry high security care units (Unité pour Malades Difficiles : UMD) are the only forensic institutions in the country to provide care for dangerous and/or difficult patients (homicide, acts of barbarity, sexual assault, cannibalism, pyromania…). They benefit from intensive care protocols and high security measures. In this first epidemiological multicentric descriptive study in French history including 418 violent and homicidal patients, medico-judiciary and social characteristics of the standard UMD patient are described. This standard patient is a young single man, with a criminal record and from an underprivileged background, suffering from treatment-resistant schizophrenia with strong delusional symptoms. He has a weak compliance to treatment, low insight, a history of drug abuse and is admitted for severe violence against others and in particular against caretakers or for homicidal act. The study's secondary goal is to revisit the risk factors of high violence described in medical literature and to reveal new ones (cultural uprooting, parental psychopathology, homelessness, perverse sadistic behavior, aggressive behavior a month prior the violent acting out, resistance to antipsychotic drugs, treatment discontinuation), particularly in the homicidal patient cohort. This study should enable clinicians to evaluate dangerousness and to offer better medical care and preventive measures against violence.
法国的十个高度戒备精神病护理单位（Unité pour Malades Difficiles : UMD）是法国唯一为危险和/或疑难病人（杀人、野蛮行为、性攻击、食人、嗜火狂......）提供护理的法医机构。这些机构得益于严密的护理规程和高度的安全措施。在这项法国历史上首次流行病学多中心描述性研究中，包括 418 名暴力和杀人患者，描述了标准 UMD 患者的医疗司法和社会特征。这名标准患者是一名年轻的单身男子，有犯罪记录，出身贫寒，患有难治性精神分裂症，并伴有强烈的妄想症状。他对治疗的依从性差，洞察力低，有药物滥用史，并因对他人，尤其是对看护人的严重暴力行为或杀人行为而入院。这项研究的第二个目标是重新审视医学文献中描述的高暴力风险因素，并揭示新的风险因素（文化背井离乡、父母精神病理学、无家可归、变态虐待狂行为、暴力行为发生前一个月的攻击性行为、对抗抑郁药物的抗药性、治疗中断），尤其是在杀人患者群体中。这项研究应能帮助临床医生评估患者的危险性，并提供更好的医疗护理和暴力预防措施。
{"title":"Étude nationale française du profil des patients hospitalisés en unité pour malades difficiles","authors":"Edouard de Lassus Saint-Genies , Sophie Raymond , Marine Dalmont , Olivier Guillin , Jean-Pierre Bouchard , Ivan Gasman","doi":"10.1016/j.amp.2023.08.001","DOIUrl":"10.1016/j.amp.2023.08.001","url":null,"abstract":"<div><p>The ten French psychiatry high security care units (Unité pour Malades Difficiles : UMD) are the only forensic institutions in the country to provide care for dangerous and/or difficult patients (homicide, acts of barbarity, sexual assault, cannibalism, pyromania…). They benefit from intensive care protocols and high security measures. In this first epidemiological multicentric descriptive study in French history including 418 violent and homicidal patients, medico-judiciary and social characteristics of the standard UMD patient are described. This standard patient is a young single man, with a criminal record and from an underprivileged background, suffering from treatment-resistant schizophrenia with strong delusional symptoms. He has a weak compliance to treatment, low insight, a history of drug abuse and is admitted for severe violence against others and in particular against caretakers or for homicidal act. The study's secondary goal is to revisit the risk factors of high violence described in medical literature and to reveal new ones (cultural uprooting, parental psychopathology, homelessness, perverse sadistic behavior, aggressive behavior a month prior the violent acting out, resistance to antipsychotic drugs, treatment discontinuation), particularly in the homicidal patient cohort. This study should enable clinicians to evaluate dangerousness and to offer better medical care and preventive measures against violence.</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90381734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jury duty, as exceptional as it is, is not without consequences for mental health. Indeed, during this assignment, randomly selected citizens are called on to judge people accused of criminal acts, to decide on their guilt and, if necessary, on their sentence. Thus, in court trials, the juror's voice will count just as that of the professional judges who sit with them. However, this enormous responsibility and the imperative aspect of jury duty can cause significant stress, especially when we consider that very often, jurors only have a limited knowledge of the judicial system. Also, being exposed to various types of evidence and to serious facts can be trying. Finally, the various obligations jurors have to meet can accentuate the difficulty of this duty, for example, the fact that, because the procedure is subject to sanctions, the jurors cannot discuss the case with others and must respect the secrecy of deliberations, even after the judgment has been rendered. For all these reasons, and also sometimes because of pre-existing individual vulnerabilities, the jury duty experience can lead to a variety of psychological difficulties, difficulties that are still not sufficiently taken into account. Although several forms of care are emerging today, such treatments remain varied and unequally available throughout the country. This article has multiple purposes. First, it aims to enumerate the possible consequences of jury duty on mental health, then, to present an inventory of what is actually available in terms of care in France. Finally, this inventory leads us to the possible intervention in several stages which could be made available to jurors, thereby offering a comprehensive and generalized support. A review of French and international literature was carried out, highlighting the main consequences of jury duty on mental health and the emergence of care systems, particularly in North America and France. Several studies stress the impact of jury duty on mental health, particularly in terms of stress, anxiety disorder and/or post-traumatic symptomatology. While support systems have emerged particularly in Canada, some have also gradually begun to be put in place in France, but they differ from one area to another, and they are not systematically made available. Some of them focus exclusively on post-trial support, while others also offer an upstream prevention phase. Finally, in terms of evaluation, the effectiveness of those interventions is estimated only by the participant's satisfaction, without any systematization or assurance of the real effectiveness of these interventions. Considering the available data in the literature and the various existing support systems, a proposal for a system of generalized support to jurors has been put forth in order to argue in favor of the adoption of this type of care. Indeed, in addition to a post-trial intervention, it seems important to plan for a phase of pre-trial prevention and the presentati
{"title":"Les conséquences du rôle de juré d’assises sur la santé mentale : état des lieux et préconisations","authors":"Sarah-Salomé Durand , Sixtine Guillaud , Célia Marquilly , Elisa Vivien , Massil Benbouriche","doi":"10.1016/j.amp.2023.05.010","DOIUrl":"10.1016/j.amp.2023.05.010","url":null,"abstract":"<div><p>Jury duty, as exceptional as it is, is not without consequences for mental health. Indeed, during this assignment, randomly selected citizens are called on to judge people accused of criminal acts, to decide on their guilt and, if necessary, on their sentence. Thus, in court trials, the juror's voice will count just as that of the professional judges who sit with them. However, this enormous responsibility and the imperative aspect of jury duty can cause significant stress, especially when we consider that very often, jurors only have a limited knowledge of the judicial system. Also, being exposed to various types of evidence and to serious facts can be trying. Finally, the various obligations jurors have to meet can accentuate the difficulty of this duty, for example, the fact that, because the procedure is subject to sanctions, the jurors cannot discuss the case with others and must respect the secrecy of deliberations, even after the judgment has been rendered. For all these reasons, and also sometimes because of pre-existing individual vulnerabilities, the jury duty experience can lead to a variety of psychological difficulties, difficulties that are still not sufficiently taken into account. Although several forms of care are emerging today, such treatments remain varied and unequally available throughout the country. This article has multiple purposes. First, it aims to enumerate the possible consequences of jury duty on mental health, then, to present an inventory of what is actually available in terms of care in France. Finally, this inventory leads us to the possible intervention in several stages which could be made available to jurors, thereby offering a comprehensive and generalized support. A review of French and international literature was carried out, highlighting the main consequences of jury duty on mental health and the emergence of care systems, particularly in North America and France. Several studies stress the impact of jury duty on mental health, particularly in terms of stress, anxiety disorder and/or post-traumatic symptomatology. While support systems have emerged particularly in Canada, some have also gradually begun to be put in place in France, but they differ from one area to another, and they are not systematically made available. Some of them focus exclusively on post-trial support, while others also offer an upstream prevention phase. Finally, in terms of evaluation, the effectiveness of those interventions is estimated only by the participant's satisfaction, without any systematization or assurance of the real effectiveness of these interventions. Considering the available data in the literature and the various existing support systems, a proposal for a system of generalized support to jurors has been put forth in order to argue in favor of the adoption of this type of care. Indeed, in addition to a post-trial intervention, it seems important to plan for a phase of pre-trial prevention and the presentati","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135484445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.12.002
Emma Rouchy , Mathieu Garcia , Patrick Le Bihan , Grégory Michel
In this article, we explore the links between adverse childhood experiences (ACEs) and the commission of certain types of homicide(s): infanticide, filicide, uxoricide, matricide, patricide, parricide, fratricide, aviolicide, double homicide, mass killings, serial murders, and so on. The patient files of 423 male perpetrators of homicide(s) hospitalized in a French secure forensic psychiatric unit between 1963 and 2020 were examined. A thematic collection grid was specially designed to reconstruct the traumatogenic trajectories of the subjects concerned, and to thereby determine the presence or absence of different forms of ACE (physical, emotional, and sexual violence, physical and emotional neglect, exposure to domestic abuse and conjugal violence, etc.). After calculating prevalence data, multiple correspondence analyses (MCA) were performed, in order to identify patterns of association linking specific ACEs to the types of homicide investigated. Projection of the results within a multidimensional space will enable us to visualize the main associations that may be established for clinical and preventive purposes. Agglomerative hierarchical clustering (AHC) is then used to group individuals into distinct latent classes, based on the similarities and dissimilarities of the homicidal criminals studied. The profiles outlined are then discussed, as are the particularly high rates of ACEs found – especially in comparison with data obtained from other studies (carried out in general, prison or forensic populations). Finally, we suggest a few avenues for future research.
{"title":"Antécédents d’adversité et types d’homicide : une étude menée en Unité pour Malades Difficiles","authors":"Emma Rouchy , Mathieu Garcia , Patrick Le Bihan , Grégory Michel","doi":"10.1016/j.amp.2023.12.002","DOIUrl":"10.1016/j.amp.2023.12.002","url":null,"abstract":"<div><p>In this article, we explore the links between adverse childhood experiences (ACEs) and the commission of certain types of homicide(s): infanticide, filicide, uxoricide, matricide, patricide, parricide, fratricide, aviolicide, double homicide, mass killings, serial murders, and so on. The patient files of 423 male perpetrators of homicide(s) hospitalized in a French secure forensic psychiatric unit between 1963 and 2020 were examined. A thematic collection grid was specially designed to reconstruct the traumatogenic trajectories of the subjects concerned, and to thereby determine the presence or absence of different forms of ACE (physical, emotional, and sexual violence, physical and emotional neglect, exposure to domestic abuse and conjugal violence, etc.). After calculating prevalence data, multiple correspondence analyses (MCA) were performed, in order to identify patterns of association linking specific ACEs to the types of homicide investigated. Projection of the results within a multidimensional space will enable us to visualize the main associations that may be established for clinical and preventive purposes. Agglomerative hierarchical clustering (AHC) is then used to group individuals into distinct latent classes, based on the similarities and dissimilarities of the homicidal criminals studied. The profiles outlined are then discussed, as are the particularly high rates of ACEs found – especially in comparison with data obtained from other studies (carried out in general, prison or forensic populations). Finally, we suggest a few avenues for future research.</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139391650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.10.001
Tiffanie Muller , Julien Luc , Jokthan Guivarch
Objectives
A specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison.
Methods
This study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as “SAS” in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled.
Results
Sixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients’ entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care.
Conclusions
Currently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrat
目标 正如有关这一主题的主要流行病学研究所示，囚犯这一特殊人群尤其受到精神健康问题的影响。这一研究结果促使法国监狱管理部门考虑各种因素，以改善囚犯的精神状态，减少他们今后重新犯罪的机会。在这些因素中，与家人和朋友保持联系是最重要的，也是监狱管理部门目前的首要任务。我们希望了解在监狱从事精神科门诊工作的专业人员对这一问题的认识程度，尤其是那些为病人出狱做准备的人员。本研究的主要目的是探讨家人和朋友目前在病人护理中以及在支持病人出狱的系统中所扮演的角色。 本研究是一项前瞻性、多中心的定性研究，采用半结构化访谈的方式，对在出狱支持机构（在法国被称为 "SAS"）工作的医务人员进行研究。所包括的 SAS 机构在访谈时已经存在并运行了至少一年。访谈一直进行到所有数据汇总为止。结果表明，在大多数情况下，监狱的精神科门诊治疗期间不与病人的家人和朋友联系。这与护理人员在访谈中反复提到的家人和朋友形成了鲜明对比。对于绝大多数人来说，病人的亲朋好友被认为是病人重新融入社会的支柱，因此护理人员希望在他们的工作中更多地融入病人的亲朋好友。据几位受访者称，病人的亲近者对精神障碍的发展和复发、对监禁经历和行为都有影响。护理人员认为，让家人和朋友参与进来对病人及其亲人都有很多好处。另一方面，研究表明，这种融合治疗也有局限性，特别是在监狱机构、护理人员和患者本身方面。这项研究提供了一些要素，证实了特别辅助系统是一个有利于将家人和朋友纳入精神病治疗实践的结构这一观点。最后，研究结果强调了将家人和朋友纳入这种释放前护理的一些创新想法。结论目前，在法国监狱中，尤其是在 SAS 内部，很少将家人和朋友纳入病人的精神科门诊护理中。本研究对这些做法的未来发展提出了建议，并就这一主题提出了一些非常有趣的观点。通过采取本研究中提出的具体步骤，可以将家人和朋友融入到护理工作中，从而提供最佳护理和全面的病人管理。
{"title":"L’entourage et la prise en charge psychiatrique ambulatoire en milieu pénitentiaire : enquête menée auprès des structures d’accompagnement vers la sortie implantées en France","authors":"Tiffanie Muller , Julien Luc , Jokthan Guivarch","doi":"10.1016/j.amp.2023.10.001","DOIUrl":"10.1016/j.amp.2023.10.001","url":null,"abstract":"<div><h3>Objectives</h3><p>A specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison.</p></div><div><h3>Methods</h3><p>This study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as “SAS” in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled.</p></div><div><h3>Results</h3><p>Sixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients’ entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care.</p></div><div><h3>Conclusions</h3><p>Currently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrat","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135921941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.12.007
Caroline Benouamer , Émilie Telle , Luca A. Tiberi , Thierry H. Pham
Cet article articule deux études sur les facteurs de protection et de désistance parmi les Auteurs d’Infraction à Caractère Sexuel (AICS). La première étude est une revue systématique de la littérature scientifique portant sur la validité prédictive de la Structured Assessment of PROtective Factors (SAPROF) pour cette population. Les résultats soutiennent une grande variabilité de la validité prédictive de la SAPROF. Ce constat fait écho aux limites inhérentes à l’état actuel des connaissances concernant les facteurs protecteurs. L’amélioration de la SAPROF ne peut alors être envisagée que conjointement à un éclaircissement concernant la nature, l’effet et la conceptualisation des facteurs protecteurs. La seconde étude examine les facteurs de désistance identifiés à travers les discours de six AICS libérés. Les principaux résultats indiquent une prédominance des facteurs positifs liés à la désistance, en particulier des relations interpersonnelles positives (externes) et les transformations cognitives, surtout les processus de réflexion liés aux infractions (internes). Les facteurs externes positifs sont marqués par un recouvrement conceptuel important avec les facteurs protecteurs, tandis que la majorité des facteurs négatifs correspondent à ce qui est communément reconnu comme des facteurs de risque. La complémentarité des résultats de ces études est discutée, jetant les bases de recherches futures nécessaires à la clarification conceptuelle et opérationnelle de ces facteurs.
Forensic literature has revealed a plethora of risk assessment tools, emphasizing the factors that can lead to a greater risk of recidivism among sexual offenders. Thus, the assessment and treatment of individuals who have offended have gradually evolved to the point where professionals no longer ask what doesn’t work (Nothing works) but what does work (What works) for them. From this perspective of positivist forensic psychology, the inclusion of so-called positive factors such as protective or desistance factors is an important issue. A strengths-based approach to risk assessment encourages a more balanced assessment by including factors that mediate, moderate, or even cancel out this risk, specifically protective factors. Despite a strong interest in them, there are many conceptual shortcomings that hinder their widespread use. The existence of these factors is still assumed. While the importance of their integration in assessment has been established, their lack of validity hinders it. Hence, the Structured Assessment of PROtective Factors (SAPROF) has been developed to measure exclusively protective factors. The SAPROF assesses internal factors (e.g., intelligence, secure attachment, etc.), motivational factors (e.g., work, leisure activities, etc.), and external factors (e.g., social network, positive interpersonal relationships, etc.). An additional version for Individuals who have Committed Sexua
{"title":"Facteurs de protection et facteurs de désistance chez les auteurs d’infraction à caractère sexuel : articulation et clarification","authors":"Caroline Benouamer , Émilie Telle , Luca A. Tiberi , Thierry H. Pham","doi":"10.1016/j.amp.2023.12.007","DOIUrl":"10.1016/j.amp.2023.12.007","url":null,"abstract":"<div><p>Cet article articule deux études sur les facteurs de protection et de désistance parmi les Auteurs d’Infraction à Caractère Sexuel (AICS). La première étude est une revue systématique de la littérature scientifique portant sur la validité prédictive de la <em>Structured Assessment of PROtective Factors</em> (SAPROF) pour cette population. Les résultats soutiennent une grande variabilité de la validité prédictive de la SAPROF. Ce constat fait écho aux limites inhérentes à l’état actuel des connaissances concernant les facteurs protecteurs. L’amélioration de la SAPROF ne peut alors être envisagée que conjointement à un éclaircissement concernant la nature, l’effet et la conceptualisation des facteurs protecteurs. La seconde étude examine les facteurs de désistance identifiés à travers les discours de six AICS libérés. Les principaux résultats indiquent une prédominance des facteurs positifs liés à la désistance, en particulier des relations interpersonnelles positives (externes) et les transformations cognitives, surtout les processus de réflexion liés aux infractions (internes). Les facteurs externes positifs sont marqués par un recouvrement conceptuel important avec les facteurs protecteurs, tandis que la majorité des facteurs négatifs correspondent à ce qui est communément reconnu comme des facteurs de risque. La complémentarité des résultats de ces études est discutée, jetant les bases de recherches futures nécessaires à la clarification conceptuelle et opérationnelle de ces facteurs.</p></div><div><p>Forensic literature has revealed a plethora of risk assessment tools, emphasizing the factors that can lead to a greater risk of recidivism among sexual offenders. Thus, the assessment and treatment of individuals who have offended have gradually evolved to the point where professionals no longer ask what doesn’t work (<em>Nothing works</em>) but what does work (<em>What works</em>) for them. From this perspective of positivist forensic psychology, the inclusion of so-called <em>positive</em> factors such as protective or desistance factors is an important issue. A strengths-based approach to risk assessment encourages a more balanced assessment by including factors that mediate, moderate, or even cancel out this risk, specifically protective factors. Despite a strong interest in them, there are many conceptual shortcomings that hinder their widespread use. The existence of these factors is still assumed. While the importance of their integration in assessment has been established, their lack of validity hinders it. Hence, the <em>Structured Assessment of PROtective Factors</em> (SAPROF) has been developed to measure exclusively protective factors. The SAPROF assesses internal factors (e.g., intelligence, secure attachment, etc.), motivational factors (e.g., work, leisure activities, etc.), and external factors (e.g., social network, positive interpersonal relationships, etc.). An additional version for Individuals who have Committed Sexua","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.08.007
Julien Da Costa , Mathilde Coulanges , Tristan Renard , Trevor O’Neill Walsh , Julie Malaterre , Lucille Moutet , Maxime Védère , Anne-Hélène Moncany
Objectives
Since the enactment of the French law of 4 March 2002, patients’ rights have been the subject of constant legislative evolution and particular attention from many independent administrative authorities. In psychiatry, these have led to numerous legal reforms over the years. Moreover, psychiatry is a medical specialty with abundant, long-standing and more than ever topical interactions with the judicial system (psychiatric care without consent, isolation and restraint, court-ordered care, psychiatric care in prisons, treatment of perpetrators of sexual violence, judicial expertise or the question of lack of criminal responsibility due to a mental disorder). In response to the many legal questions asked by medical and paramedical teams, and to the growing interest in research in forensic psychiatry, a unit called EPL (Espace de Psychiatrie Légale) was created, composed of a multidisciplinary team, based in the department of Haute-Garonne, France. In order to adjust its scope of intervention, a questionnaire was distributed to mental health professionals to assess their training needs in forensic psychiatry. In this article, we aim to present and discuss the results of this survey.
Methods
We used a self-assessment survey designed by the multidisciplinary team of the EPL and which was filled out online by the respondents. The target population was all the professionals working in mental health facilities, members of the FERREPSY Occitanie research federation. The questionnaire consisted of several sections relating to the respondents, the typology of patients under their care, the professionals’ daily practice, and training in and knowledge of forensic psychiatry. We included some open-ended questions on the situations encountered that may have presented difficulties and on the impact of legislative changes on the daily practice of professionals. All responses were analyzed anonymously.
Results
From 05/05/21 to 17/07/21, 155 professionals responded. Most of them were psychiatrists (32.3%), healthcare managers (20.6%) or nurses (18.7%). The majority were women (78.7%) and had been working in Haute-Garonne for more than 5 years (74.2%). 56.1% of the professionals worked in outpatient units, 37.4% in inpatient wards and 74.8% in adult psychiatry. This questionnaire revealed a strong need for training in forensic psychiatry. Indeed, 94.8% of respondents wanted to receive training in forensic psychiatry, which contrasts with the number of people who had already received training in this area (15.5% in initial training, 32.3% in continuing education). The results highlighted that the most common forensic situations encountered in daily clinical practice concerned areas where professionals considered their knowledge to be insufficient. In addition, the self-assessment scales used were able to highlight specific training topics that should be developed.
{"title":"La formation des professionnels en psychiatrie légale : résultats d’une enquête en Occitanie","authors":"Julien Da Costa , Mathilde Coulanges , Tristan Renard , Trevor O’Neill Walsh , Julie Malaterre , Lucille Moutet , Maxime Védère , Anne-Hélène Moncany","doi":"10.1016/j.amp.2023.08.007","DOIUrl":"10.1016/j.amp.2023.08.007","url":null,"abstract":"<div><h3>Objectives</h3><p>Since the enactment of the French law of 4 March 2002, patients’ rights have been the subject of constant legislative evolution and particular attention from many independent administrative authorities. In psychiatry, these have led to numerous legal reforms over the years. Moreover, psychiatry is a medical specialty with abundant, long-standing and more than ever topical interactions with the judicial system (psychiatric care without consent, isolation and restraint, court-ordered care, psychiatric care in prisons, treatment of perpetrators of sexual violence, judicial expertise or the question of lack of criminal responsibility due to a mental disorder). In response to the many legal questions asked by medical and paramedical teams, and to the growing interest in research in forensic psychiatry, a unit called EPL (Espace de Psychiatrie Légale) was created, composed of a multidisciplinary team, based in the department of Haute-Garonne, France. In order to adjust its scope of intervention, a questionnaire was distributed to mental health professionals to assess their training needs in forensic psychiatry. In this article, we aim to present and discuss the results of this survey.</p></div><div><h3>Methods</h3><p>We used a self-assessment survey designed by the multidisciplinary team of the EPL and which was filled out online by the respondents. The target population was all the professionals working in mental health facilities, members of the FERREPSY Occitanie research federation. The questionnaire consisted of several sections relating to the respondents, the typology of patients under their care, the professionals’ daily practice, and training in and knowledge of forensic psychiatry. We included some open-ended questions on the situations encountered that may have presented difficulties and on the impact of legislative changes on the daily practice of professionals. All responses were analyzed anonymously.</p></div><div><h3>Results</h3><p>From 05/05/21 to 17/07/21, 155 professionals responded. Most of them were psychiatrists (32.3%), healthcare managers (20.6%) or nurses (18.7%). The majority were women (78.7%) and had been working in Haute-Garonne for more than 5 years (74.2%). 56.1% of the professionals worked in outpatient units, 37.4% in inpatient wards and 74.8% in adult psychiatry. This questionnaire revealed a strong need for training in forensic psychiatry. Indeed, 94.8% of respondents wanted to receive training in forensic psychiatry, which contrasts with the number of people who had already received training in this area (15.5% in initial training, 32.3% in continuing education). The results highlighted that the most common forensic situations encountered in daily clinical practice concerned areas where professionals considered their knowledge to be insufficient. In addition, the self-assessment scales used were able to highlight specific training topics that should be developed.</p></div><div><h3>Conclusion","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135921940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.amp.2023.09.014
Simon Bertin , Mathias Wohl , Philippe Fossati , Cédric Lemogne
Objectives
In French forensic medical units, medical doctors are requested to assess the functional impact of violence on its victims and to determine a total incapacity for work (ITT). Specific to French criminal law, with significant consequences in the judicial field, this practice is highly heterogeneous with considerable differences depending on the center and the assessor. The objective of this qualitative study was to describe the assessment methods of practitioners in the forensic medical unit at the Hôtel-Dieu Hospital in Paris, where both forensic practitioners and psychiatrists contribute to the evaluation of total incapacity for work.
Materials and methods
Semi-structured individual interviews were conducted with four forensic medical practitioners and four psychiatrists. The questionnaire addressed the evaluation methods and tools, the impact of the kinds of violence and their possible chronicity, as well as the rationale for a dual-evaluation by both a forensic practitioner and a psychiatrist.
Results
In the absence of consensual tools, practitioners tend to take into account the judicial consequences of their assessment of total incapacity for work, while striving to establish an internal coherence between a fact, an injury and its functional repercussions. The osteoarticular system is given as a model, with determined durations of bone healing, while the field of psychotraumatology lacks a similar data set and requires the practitioners to aim to relate the traumatic impact on the daily consequences reported by patients. Forensic practitioners and psychiatrists differ in the extent to which they take into account the plaintiffs’ grievances and the assessment of chronic violence cases. The former tend to determine an incapacity for work based on a clinical lesion, either assessed during their own clinical exam or reported in a former medical certificate, while the latter establish an incapacity for work grounded in the functional consequences reported by patients, especially in cases of psychotraumatic symptoms (sleep disorders, avoidance symptoms, and social interaction limitations, for example) following a physical or sexual assault. A dual-assessment is seen as an efficient way to ensure that the psychological impact of violence is taken into account. However the question arises of the systematic recourse to a psychiatrist or another professional trained in the field of psychotraumatology. The assessment and the clinical symptoms are specific and require appropriate training. Medical certificates are also considered to be judicial material with a broader implication than the sole determination of total incapacity for work. In reporting griefs and the circumstances of the events which have an impact on the clinical situation of the patient, the practitioners also provide qualitative data that a judge may take into account.
{"title":"Raisonnement médico-légal dans la détermination de l’incapacité totale de travail : une étude qualitative à l’unité médico-judiciaire de l’Hôtel-Dieu de Paris","authors":"Simon Bertin , Mathias Wohl , Philippe Fossati , Cédric Lemogne","doi":"10.1016/j.amp.2023.09.014","DOIUrl":"10.1016/j.amp.2023.09.014","url":null,"abstract":"<div><h3>Objectives</h3><p>In French forensic medical units, medical doctors are requested to assess the functional impact of violence on its victims and to determine a total incapacity for work (ITT). Specific to French criminal law, with significant consequences in the judicial field, this practice is highly heterogeneous with considerable differences depending on the center and the assessor. The objective of this qualitative study was to describe the assessment methods of practitioners in the forensic medical unit at the Hôtel-Dieu Hospital in Paris, where both forensic practitioners and psychiatrists contribute to the evaluation of total incapacity for work.</p></div><div><h3>Materials and methods</h3><p>Semi-structured individual interviews were conducted with four forensic medical practitioners and four psychiatrists. The questionnaire addressed the evaluation methods and tools, the impact of the kinds of violence and their possible chronicity, as well as the rationale for a dual-evaluation by both a forensic practitioner and a psychiatrist.</p></div><div><h3>Results</h3><p>In the absence of consensual tools, practitioners tend to take into account the judicial consequences of their assessment of total incapacity for work, while striving to establish an internal coherence between a fact, an injury and its functional repercussions. The osteoarticular system is given as a model, with determined durations of bone healing, while the field of psychotraumatology lacks a similar data set and requires the practitioners to aim to relate the traumatic impact on the daily consequences reported by patients. Forensic practitioners and psychiatrists differ in the extent to which they take into account the plaintiffs’ grievances and the assessment of chronic violence cases. The former tend to determine an incapacity for work based on a clinical lesion, either assessed during their own clinical exam or reported in a former medical certificate, while the latter establish an incapacity for work grounded in the functional consequences reported by patients, especially in cases of psychotraumatic symptoms (sleep disorders, avoidance symptoms, and social interaction limitations, for example) following a physical or sexual assault. A dual-assessment is seen as an efficient way to ensure that the psychological impact of violence is taken into account. However the question arises of the systematic recourse to a psychiatrist or another professional trained in the field of psychotraumatology. The assessment and the clinical symptoms are specific and require appropriate training. Medical certificates are also considered to be judicial material with a broader implication than the sole determination of total incapacity for work. In reporting griefs and the circumstances of the events which have an impact on the clinical situation of the patient, the practitioners also provide qualitative data that a judge may take into account.</p></div><div><h3>Conclusions</h3><p>This ","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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