La prise en charge psychiatrique des mineurs incarcérés constitue un enjeu majeur de santé publique et un défi pour la psychiatrie infanto-juvénile. En effet, ces adolescents présentent une prévalence plus élevée de troubles psychiques que la population générale, et voient leur état mental fragilisé par la détention. Les modalités de soins psychiatriques en milieu carcéral restent peu étudiées dans la littérature scientifique. Cet article a pour but d’explorer les dispositifs de soins psychiatriques dans les établissements pénitentiaires pour mineurs (EPM) et les quartiers pour mineurs (QM) en France, en évaluant leur efficacité, leurs limites, les défis rencontrés, et en proposant des pistes d’amélioration.

L’objectif principal de cette étude est d’identifier les modalités et les méthodes de prise en charge psychiatrique, les ressources disponibles, ainsi que les défis rencontrés par les professionnels de santé dans ce contexte spécifique. L’objectif secondaire est de réaliser un état des lieux des diagnostics cliniques, et des traitements prescrits auprès de cette population.

Une étude descriptive, observationnelle et multicentrique a été menée via un questionnaire diffusé aux professionnels de santé exerçant dans les établissements pénitentiaires pour mineurs et les quartiers pour mineurs en France. Ce questionnaire a permis de collecter des données quantitatives et qualitatives.

L’étude révèle des pratiques hétérogènes selon les établissements, tant en termes d’organisation que de moyens humains et matériels. L’évaluation psychiatrique à l’arrivée n’est pas systématique, et son contenu varie largement. Le suivi psychiatrique repose principalement sur des consultations individuelles, dans la moitié des établissements sur des thérapies de groupe, et rarement sur des entretiens familiaux. Peu d’établissements disposent d’accès à un dispositif de soins gradués et on note des difficultés à l’accès aux hospitalisations. La coordination entre les intervenants médicaux et judiciaires pour préparer les relais de soins à la sortie de détention est jugée difficile voire insuffisante dans une partie des réponses. L’étude met également en lumière une prévalence élevée de troubles psychiatriques parmi les mineurs incarcérés, en particulier les troubles du comportement, les troubles anxio-dépressifs, et les troubles liés au stress et troubles somatoformes et de l’adaptation. Les problématiques addictologiques sont très présentes également.

Les résultats soulignent les disparités géographiques, et la nécessité urgente d’améliorer la prise en charge psychiatrique des mineurs détenus en France. Des axes d’amélioration sont identifiés, tels que l’augmentation des ressources humaines, la systématisation des évaluations psychiatriques à l’entrée, la diversification des prises en charge non médicamenteuses, et une meilleure préparation des relais de soins à la sortie de détention en collaborant mieux avec les différentes instances.

Cette thèse met en évidence les insuffisances dans la prise en charge psychiatrique des mineurs incarcérés et propose des recommandations pour améliorer la qualité des soins et favoriser l’insertion sociale des jeunes détenus.

The psychiatric care of incarcerated minors represents a major public health issue and a critical challenge for child and adolescent psychiatry. Adolescents placed in detention exhibit a considerably higher prevalence of mental disorders than their peers in the general population. The prison environment, marked by isolation, loss of freedom, and often pre-existing psychosocial difficulties, tends to exacerbate their mental health issues. Psychiatric care modalities within juvenile detention facilities remain under-studied in scientific literature. In France, minors may be detained either in Establishments for Incarcerated Minors (EPM) or in Juvenile Wards (QM) within adult prisons. Despite representing less than 1% of the total prison population, these young detainees constitute a particularly vulnerable group. This study aims to explore psychiatric care systems within juvenile penitentiary institutions and juvenile wards in France, evaluating their effectiveness, limitations, encountered challenges, and suggesting areas for improvement.

The primary objective of this study is to identify psychiatric care modalities and methods, available resources, and challenges faced by healthcare professionals in this specific context. The secondary objective is to document the clinical diagnoses and the prescribed treatments among this population.

A descriptive, observational, and multicenter study was conducted through a comprehensive questionnaire distributed to healthcare professionals working in EPMs and QMs across metropolitan France and overseas territories. The questionnaire included 37 items covering organizational characteristics, clinical practices, coordination mechanisms, and perceived needs. Data collection occurred between November 2024 and February 2025 through both digital and paper formats, followed by reminder calls to increase participation. Thirty out of fifty eligible facilities (a 60% response rate) completed the survey, providing a representative overview of national practices. Both quantitative and qualitative analyses were performed, including descriptive statistics and thematic analysis of open-ended responses.

Findings revealed striking heterogeneity in psychiatric care practices across French juvenile detention facilities. Although 86% of responding institutions had a dedicated psychiatric team, the composition of these teams varied widely. Some facilities lacked essential professionals, such as child psychiatrists or addiction specialists, and some facilities did not have dedicated consultation spaces for mental healthcare. Psychiatric evaluation at entry was systematic in 83% of establishments, typically occurring within the first three days of detention. However, the professional conducting the assessment differed (psychiatrist, psychologist, or nurse), and the evaluation content depended on the facilities. Ongoing psychiatric follow-up was primarily based on individual consultations, generally occurring weekly or biweekly. Nearly 40% of the respondents did not propose a systematic reevaluation of the minors that were not followed. Group therapies and therapeutic workshops were offered in more than half of institutions, while family interviews were reported in only one out of four facilities, revealing a limited involvement of parents or guardians. Preventive or health-promotion programs were present in one-third of the sites. Regarding clinical profiles, behavioral disorders were the most frequently reported (81%), followed by anxiety and stress-related disorders (63%), substance-use disorders (44%), and mood disorders (31%). Most respondents estimated that more than 60% of minors used tobacco before incarceration, and over 40% consumed cannabis. Pharmacological treatment initiation during detention was relatively rare. When prescribed, anxiolytics and hypnotics were the most common, followed by antipsychotics and antidepressants. Access to hospitalization remained limited and complex. The majority of emergency transfers occurred to adult psychiatric wards or specialized prison hospital units ( UHSA ), while pediatric psychiatric wards were rarely mobilized. Several professionals cited barriers such as lack of available beds, administrative constraints linked to the detainee status, and limited collaboration with external hospital services. Coordination between the various actors (medical, social, and judicial) was described as insufficient. Families were rarely contacted, and communication with community healthcare providers or probation services was often weak. Only 60% of institutions reported organizing a continuity-of-care plan for release, and in more than half of cases, this preparation began less than two weeks before the expected release date. Both healthcare and judicial constraints were identified as major barriers to effective follow-up.

This national survey highlights the disparities and shortcomings in psychiatric care for incarcerated minors in France. The variability in human resources and infrastructure creates unequal access to quality care depending on the region. Despite some positive elements (such as the presence of dedicated mental health teams and early psychiatric evaluations) the system remains fragmented. The limited frequency of re-evaluations and the absence of standardized screening tools may lead to under-detection of emerging disorders, including suicidal ideation or adjustment disorders. Moreover, the lack of structured family involvement and the weak collaboration with external services hinder the continuity of care. Professionals also reported systemic difficulties such as staff shortages, the absence of pediatric psychiatric expertise, and institutional constraints that limit time and space for care. Many underlined the risk of “over-psychiatrization” of behavioral problems that may have primarily social or educational origins, emphasizing the need for multidisciplinary approaches rather than purely medicalized responses. The study further underscores the near invisibility of female minors in detention. Their confinement—often within adult women's units—raises significant ethical and practical concerns regarding isolation and access to age-appropriate care. Based on the data collected, several avenues for improvement emerge. For human resources, recruit more child psychiatrists and addiction specialists, provide targeted training for all staff working with adolescents. For the facilities, ensure dedicated and confidential spaces for psychiatric consultations and therapeutic activities. For clinical practices, systematize initial and periodic psychiatric assessments, integrate validated screening tools for suicide and substance-use risk, and expand group and family therapies. For the coordination, enhance inter-institutional communication between psychiatric teams, the Youth Judicial Protection Service (PJJ), and community health providers to guarantee continuity of care while preserving the doctor-patient confidentiality. And for the aftercare, strengthen post-release support by establishing structured referral networks and pre-release planning, including post-detention psychiatric consultations.

This study offers a rare, nationwide perspective on the psychiatric management of incarcerated minors in France. It reveals persistent inequalities in access to care, a shortage of specialized staff, and insufficient coordination among institutions. Despite the commitment of healthcare professionals, psychiatric care for young detainees remains inconsistent and under-resourced. To achieve parity of care between detained and non-detained adolescents, we must invest in dedicated resources, standardized procedures, and long-term intersectoral cooperation. Improving mental healthcare within juvenile detention is not only a medical priority but also a societal and ethical imperative, essential for reducing recidivism and supporting the reintegration of these vulnerable young people.