Utilization of Hospital-Level Mental Health Care Services for Inmates in France: A Transversal Study [2020]

Objectives:
No study has assessed utilization of hospital-level mental health care for French prisoners. In particular, the impact of unités hospitalières spécialement aménagées (UHSAs; “specially equipped hospital units”), the full-time inpatient psychiatric wards for inmates created in 2010, remains unknown. The aim of this study was to describe the overall patterns of psychiatric hospitalization for detained people in France during 2016.

Methods:
The study was conducted by using a national psychiatric hospital discharge database. The authors identified incarcerated people who were hospitalized in UHSAs, general psychiatric hospitals, maximum-security unités pour malades difficiles (UMDs; “units for difficult patients”), and day treatment hospitals for inmates known as services médico-psychologiques régionaux (SMPRs; “regional medical-psychological services”), from January 1 to December 31, 2016.

Results:
In 2016, 4,392 incarcerated patients (7,027 admissions) were hospitalized (92% males). Overall, 1,944 patients were hospitalized in UHSAs, 1,787 in general psychiatric hospitals, 97 in UMDs, and 1,465 in SMPRs. That year, 815 patients (19%) were admitted to at least two different facilities. The mean cumulative length of stay per patient was 86.7 days (95% confidence interval=80.1–93.3; median=27 days), with longer durations of stay in UMDs and SMPRs than in UHSAs and general psychiatric hospitals.

Conclusions:
Despite the recent creation of UHSAs, the hospitalization of inmates in general psychiatric hospitals remains frequent in France. Future research should consider the value of further developing UHSAs.

Thomas Fovet, M.D., Ph.D., Ali Amad, M.D., Ph.D., Mathilde Horn, M.D., Ph.D., Pierre Thomas, M.D., Ph.D., Christine Chan-Chee, M.D., M.P.H.
Psychiatric Services, 8 Apr 2020
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