L’isolement cellulaire des détenus associé au risque de récidive violente et non violente : une revue systématique et méta-analyse

La récidive en communauté est associée à de lourdes conséquences financières et une atteinte à la santé publique. L’isolement cellulaire (IC) est une pratique adoptée pour répondre aux comportements perturbateurs en milieu carcéral, sans indications quant à l’impact sur la récidive. Environ 7% des détenus nord-américains sont logés en IC et plusieurs vivront une détérioration psychologique. De plus, la littérature ne démontre pas une réduction de l’inconduite suite à l’IC, mettant en doute la possibilité d’un changement comportemental. Clarifier l’effet de l’IC sur la récidive permettrait d’informer les débats récents autour de son rendement coût-efficacité et d’évaluer les risques de victimisation associés. Une revue systématique et une méta-analyse ont donc été menées afin d’élucider l’impact de l’IC sur la récidive. Des modèles à effets mixtes ont été employés pour quantifier l’association entre l’IC et la réarrestation, réincarcération ou récidive violente. Des sous-analyses ont permis d’évaluer le risque de récidive associé à différentes formes d’IC, la durée d’exposition et le temps écoulé entre la sortie d’IC et la libération. Notre article a démontré une association modérée entre l’IC et l’augmentation de la récidive, laquelle résistait au contrôle de facteurs confondants. L’IC était associé à l’augmentation des trois formes de récidive. De surcroît, une plus longue et récente exposition augmentait davantage ce risque. Ainsi, ce mémoire contribue à démontrer que l’IC ne présente pas de retombées comportementales pouvant contrebalancer ses coûts opérationnels ou sur la santé mentale des détenus. Plusieurs initiatives sont proposées pour faciliter la réintégration des détenus exposés à l’IC.Recidivism amongst releasees bears heavy consequences for society in terms of financial costs and public health strain. Placing inmates in solitary confinement (SC) was adopted as a solution for disordered behaviors in prison, without indication as to its impacts on recidivism. Approximately 7% of North American inmates are housed in SC, many of whom will suffer psychological deterioration. Moreover, studies dispute that SC can reduce institutional misconduct, casting doubt on its potential for inspiring behavioral change. To clarify the effects of SC on recidivism would inform recent debates around its cost effectiveness and the evaluation of associated victimization risks. Therefore, a systematic review and meta-analysis were conducted to clarify the impact of SC on recidivism. Random-effects meta-analyses were carried out to quantify the association between SC and rearrest, reincarceration, and violent reoffense. Additional sub-analyses allowed to characterize recidivism risk following different forms of SC, lengthier periods of exposure, and shorter transition time between release from SC and to the community. Our article showed a moderate association between SC and increased recidivism, which remained robust to confounders. SC was associated with an increase in all forms of recidivism. Finally, longer and more recent exposure to SC upon release both further increased recidivism risk. This memoir thus provides further evidence that SC does not present significant benefits that could outweigh its associated mental health and financial costs. Finally, multiple initiatives are discussed in the context that they could facilitate community reentry for inmates exposed to SC

Facteurs déterminants de l’attitude des professionnels en santé mentale envers le rétablissement - une revue de littérature

Objective: The attitudes of mental health professionals towards consumers’ recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. Methods: A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. Results: From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals’ pessimistic attitudes towards recovery. Conclusions: This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers

The burden for clinical services of persons with an intellectual disability or mental disorder convicted of criminal offences: A birth cohort study of 14,605 persons followed to age 64

Intellectual disability (ID), schizophrenia spectrum disorder (SSD), bipolar disorder (BD), substance use disorder (SUD), and other mental disorders (OMDs) are associated with increased risks of criminality relative to sex-matched individuals without these conditions (NOIDMD). To resource psychiatric, addiction, and social services so as to provide effective treatments, further information is needed about the size of sub-groups convicted of crimes, recidivism, timing of offending, antecedents, and correlates. Stigma of persons with mental disorders could potentially be dramatically reduced if violence was prevented. A birth cohort of 14,605 persons was followed to age 64 using data from Swedish national health, criminal, and social registers. Percentages of group members convicted of violence differed significantly: males NOIDMD, 7.3%, ID 29.2%, SSD 38.6%, BD 30.7%; SUD 44.0%, and OMD 19.3%; females NOIDMD 0.8%, ID 7.7%, SSD 11.2%, BD 2.4%, SD 17.0%, and OMD 2.1%. Violent recidivism was high. Most violent offenders in the diagnostic groups were also convicted of non-violent crimes. Prior to first diagnosis, convictions (violent or non-violent) had been acquired by over 90% of the male offenders and two-thirds of the female offenders. Physical victimization, adult comorbid SUD, childhood conduct problems, and adolescent substance misuse were each associated with increased risks of offending. Sub-groups of cohort members with ID or mental disorders were convicted of violent and non-violent crimes to age 64 suggesting the need for treatment of primary disorders and for antisocial/aggressive behavior. Many patients engaging in violence could be identified at first contact with clinical services.</p