Bernard J, Le Gal D, Brugallé J, Gohier B, Orsat M
Service de psychiatrie et addictologie, CHU d'Angers, 49100 Angers, France.
Service de psychiatrie et addictologie, CHU d'Angers, 49100 Angers, France.
Encephale. 2019 Sep;45(4):297-303. doi: 10.1016/j.encep.2019.01.004. Epub 2019 Apr 5.
The injunction to care (IC) is a new compulsory treatment created by the Act of June 17, 1998. Initially, this judicial tool concerned mainly sex offenders, but then the number of overall crimes requiring an IC began to dramatically rise. The judge can order this measure only if a psychiatric expertise has concluded to its potential opportunity. Then the convict must undergo a psychiatric follow-up after having served the sentence. The creation of a court-ordered treatment is based on the premise that many offenders are affected by psychiatric disorders. For the lawmaker, the aim is to lower the risk of recidivism.
The main purpose of this study is to assess the convicts concerned by the IC describing their sociodemographic characteristics, psychiatric diagnostics and criminal characteristics. The second purpose is to assess the efficiency of this measure regarding re-offending and specifically legal recidivism.
This is a retrospective and descriptive study concerning 119 subjects followed-up by two "coordinating doctors" in the department of Sarthe who could assess their psychiatric diagnostics and sociodemographic characteristics. They could also compare medical data with the judicial data for 78 of the subjects.
The population was composed of 117 men (98.3%) aged 45 years old on average. They had a job in 37% of cases (n=44) and were single in 56.3% of cases (n=67). According to the DSM-IV-TR, only 29 subjects (24.4%) had an axis I disorder and 37.8% of the population had a pathological personality trait (non DSM-IV-TR categorized disorder). Furthermore, 51.3% (n=61) of the subjects were addicted (mainly alcohol). The medical follow-up was carried out by a psychiatrist in 83.2% of cases (n=99). The average duration of follow-up was five years. Among the 78 subjects for whom there was access to juridical data, 13 (16.7%) had committed a new offense during follow-up. Among them, seven had recidivated six of whom were initially sentenced for sexual offense.
Most of the subjects in injunction to care had no axis I disorder but addictions and/or pathological personality traits. Nevertheless, the expert concluded the need of an IC. Personality and behavior disorders do not always require psychiatric care, and the management must be multidisciplinary. In France, the psychiatrist remains at the center of injunction to care measure. The addictology care is not developed whereas it is a population at risk and there is a lack of interactions between professionals (medical, social and judicial professionals). The IC is a measure that needs to be improved by means of better communication among the different professionals and a better global assessment of the subjects. Medical care must be a possible option but not a systematic treatment.
护理禁令（IC）是1998年6月17日法案创设的一种新的强制治疗方式。最初，这一司法手段主要针对性犯罪者，但随后需要实施护理禁令的犯罪总数开始急剧上升。只有在精神科专业评估认定其具有潜在可行性后，法官才能下达这一措施。随后，罪犯在服刑期满后必须接受精神科随访。创设法院指令性治疗的前提是许多罪犯患有精神疾病。对立法者而言，目的是降低再犯风险。
本研究的主要目的是评估受护理禁令影响的罪犯，描述他们的社会人口学特征、精神科诊断结果和犯罪特征。第二个目的是评估这一措施在预防再次犯罪尤其是法定再犯方面的效果。
这是一项回顾性描述性研究，涉及萨尔特省的119名受试者，由两名“协调医生”进行随访，他们能够评估受试者的精神科诊断结果和社会人口学特征。他们还可以将78名受试者的医疗数据与司法数据进行比较。
研究对象包括117名男性（98.3%），平均年龄45岁。37%（n = 44）的人有工作，56.3%（n = 67）的人单身。根据《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR），只有29名受试者（24.4%）患有轴I障碍，37.8%的研究对象具有病理性人格特质（非DSM-IV-TR分类的障碍）。此外，51.3%（n = 61）的受试者有成瘾问题（主要是酒精成瘾）。83.2%（n = 99）的病例由精神科医生进行医疗随访。平均随访时长为五年。在可获取司法数据的78名受试者中，13人（16.7%）在随访期间再次犯罪。其中，7人再次犯罪，6人最初因性犯罪被判刑。
大多数受护理禁令约束的受试者没有轴I障碍，但有成瘾问题和/或病理性人格特质。然而，专家认为仍有必要实施护理禁令。人格和行为障碍并非总是需要精神科护理，管理必须是多学科的。在法国，精神科医生仍是护理禁令措施的核心。成瘾护理尚未得到充分发展，而这是一个高危人群，专业人员（医疗、社会和司法专业人员）之间缺乏互动。护理禁令是一项需要通过不同专业人员之间更好的沟通以及对受试者进行更全面的评估来加以改进的措施。医疗护理可以是一种选择，但不应是系统性的治疗。
