Orsat M, Auffret E, Brunetière C, Decamps-Mini D, Canet J, Olié J-P, Richard-Devantoy S
Centre hospitalier spécialisé de la Sarthe, pôle 1-6 de psychiatrie adulte, secteur 6, 20, avenue du 19-Mars 1962, 72703 Allonnes cedex, France.
Centre hospitalier Guillaume-Régnier, pôle hospitalo-universitaire, 108, avenue du Général-Leclerc, 35703 Rennes, France.
Encephale. 2015 Oct;41(5):420-8. doi: 10.1016/j.encep.2015.03.003. Epub 2015 May 12.
In France, there are two main types of court-ordered treatment (COT) as far as mental health is concerned: obligations of treatment and injunctions of treatment. Obligations of treatment date back from 1958 whereas the law implementing injunctions of treatment is fairly recent as it was passed in 1998. Obligations and injunctions of treatment are two different types of COT that differ in terms of proceedings (obligations of treatment require no preliminary forensic psychiatric assessment; as for injunctions of treatment, they require the appointment of a coordinating medical doctor) and that are applied for different offences. However, both are psychiatric commitment procedures connecting the judicial, medical and social fields and their overall numbers have been on the rise. These common psychiatric practices have seldom been assessed and no review of the literature on the subject has ever been published. Better knowledge of such forensic practices is essential to their improvement and even to adjust the legal framework of these measures that are enjoying a boom. The purpose of this literature review is to define the prevalence of COT as well as the sociodemographic, criminal and psychiatric characteristics of those concerned by such measures.
A review of the French medical literature on COT was carried out using Science Direct up to December 2013. The results of seven studies were included and analysed. This was completed with a review of the articles listed in social sciences and law databases (Cairn and Dalloz).
It has become increasingly frequent to rely on psychiatric teams to implement COT while at the same time public mental health services have to face a surge in activity with restricted financial means. Obligations of treatment are far more common (about 20,000 court orders a year) than injunctions of treatment (about 4000 measures are currently being enforced). However the latter have showed an increase of 506% over the 2000 decade. Both measures mainly concern men (83-99%) who are rather low on the social scale. In about half of these men, no mental disorder was found, however the prevalence of personality disorders ranged from 22 to 65% while that of psychotic disorders was low. Injunctions of treatment concerned sex offenders (90% of cases) whereas obligations of treatment concern non-sexual abusers (40-70%) rather than sex offenders (20-30%).
Psychiatric research on COT is still thin on the ground and its methodology does not allow rigorous evaluation though the use of such measures is growing. When confronted with people who have not sought any care or treatment, healthcare professionals are at a loss. In France, training in forensic psychiatry is inadequate and specialised healthcare (particularly for sex offenders) need improving to reach the level of those found in many other European countries. The purpose of psychiatric treatment differs from that of lawmakers whose aim is to prevent recidivism. However, better treatment consistency requires setting up partnerships between justice, health and social services. To improve connections, there are various avenues of work such as, for instance, the creation of coordinating medical doctors for injunctions of treatment in France or European experiments using a multidisciplinary approach to prevent recidivism in sex offenders. The framework of such a partnership remains to be created as it is part and parcel of COT but has not been provided for in the law. Healthcare jurisdictions as defined in the 2009 French National Health Law might provide an appropriate framework for mental health and law professionals to collaborate.
在法国，就心理健康而言，有两种主要的法庭强制治疗（COT）类型：治疗义务和治疗禁令。治疗义务可追溯到1958年，而实施治疗禁令的法律相对较新，于1998年通过。治疗义务和治疗禁令是两种不同类型的法庭强制治疗，在程序方面有所不同（治疗义务无需初步法医精神病学评估；至于治疗禁令，则需要指定一名协调医生），并且适用于不同的犯罪行为。然而，两者都是连接司法、医疗和社会领域的精神病学强制程序，其总数一直在上升。这些常见的精神病学实践很少得到评估，关于该主题的文献综述也从未发表过。更好地了解此类法医实践对于改进它们甚至调整这些正在蓬勃发展的措施的法律框架至关重要。这篇文献综述的目的是确定法庭强制治疗的患病率以及受此类措施影响者的社会人口统计学、犯罪和精神病学特征。
截至2013年12月，使用科学Direct对法国关于法庭强制治疗的医学文献进行了综述。纳入并分析了七项研究的结果。同时对社会科学和法律数据库（Cairn和Dalloz）中列出的文章进行了综述。
越来越频繁地依赖精神科团队来实施法庭强制治疗，与此同时，公共心理健康服务不得不面对活动激增但资金有限的情况。治疗义务比治疗禁令更为常见（每年约20000份法庭命令），而治疗禁令（目前约有4000项措施正在执行）。然而，在2000年至2010年期间，后者增长了506%。这两种措施主要涉及社会地位较低的男性（83% - 99%）。在这些男性中，约一半未发现精神障碍，然而人格障碍的患病率在22%至65%之间，而精神障碍的患病率较低。治疗禁令涉及性犯罪者（90%的案例），而治疗义务涉及非性侵犯者（40% - 70%）而非性犯罪者（20% - 30%）。
关于法庭强制治疗的精神病学研究仍然很少，其方法虽然此类措施的使用在增加，但不允许进行严格评估。当面对未寻求任何护理或治疗的人时，医疗保健专业人员不知所措。在法国，法医精神病学培训不足，专门的医疗保健（特别是针对性犯罪者）需要改进，以达到许多其他欧洲国家的水平。精神病学治疗的目的与立法者的目的不同，后者旨在防止累犯。然而，更好的治疗一致性需要在司法、卫生和社会服务之间建立伙伴关系。为了改善联系，有各种工作途径，例如，在法国为治疗禁令设立协调医生，或欧洲采用多学科方法预防性犯罪者累犯的实验。这种伙伴关系的框架仍有待创建，因为它是法庭强制治疗的重要组成部分，但法律中未作规定。2009年法国国家卫生法中定义的医疗保健管辖权可能为心理健康和法律专业人员合作提供一个适当的框架。
