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[Court-ordered treatment: Analysing a complex practise through a literature review].

M Orsat1, E Auffret2, C Brunetière3

  • 1Centre hospitalier spécialisé de la Sarthe, pôle 1-6 de psychiatrie adulte, secteur 6, 20, avenue du 19-Mars 1962, 72703 Allonnes cedex, France.

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Summary

Court-ordered treatment (COT) in France is increasing, primarily affecting men with personality disorders. Better collaboration between justice, health, and social services is needed to improve care and prevent recidivism.

Keywords:
Criminal lawEpidemiologyForensic psychiatryInjonction de soinsObligation de soinsPsychiatrie légaleReviewRevue de la littératureSoins pénalement ordonnés

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Area of Science:

  • Forensic Psychiatry
  • Legal Medicine
  • Public Health Policy

Background:

  • Court-ordered treatment (COT) in France includes obligations and injunctions, with increasing numbers and rising use of psychiatric teams.
  • These measures connect judicial, medical, and social sectors, yet have been inadequately assessed.
  • Understanding these forensic practices is crucial for improvement and potential legal framework adjustments.

Purpose of the Study:

  • To review the literature on court-ordered treatment (COT) in France.
  • To determine the prevalence of COT and characterize individuals undergoing these measures sociodemographically, criminally, and psychiatrically.

Main Methods:

  • A literature review of French medical publications on COT was conducted using Science Direct up to December 2013.
  • Seven studies were analyzed, supplemented by a review of social sciences and law databases (Cairn, Dalloz).

Main Results:

  • Obligations of treatment are more common (approx. 20,000/year) than injunctions (approx. 4,000 currently enforced), though injunctions saw a 506% increase in the 2000s.
  • Both measures predominantly affect men (83-99%) from lower socioeconomic backgrounds, with about half showing no mental disorder.
  • Personality disorders were prevalent (22-65%), while psychotic disorders were less common. Injunctions targeted sex offenders (90%), whereas obligations focused on non-sexual abusers (40-70%).

Conclusions:

  • Psychiatric research on COT is limited, hindering rigorous evaluation despite its growing use.
  • Inadequate forensic psychiatry training and specialized care (especially for sex offenders) in France require improvement.
  • Enhanced collaboration between justice, health, and social services is essential for treatment consistency and recidivism prevention, potentially utilizing healthcare jurisdictions as a framework.