Notre travail a pour but d’étudier le devenir des sujets considérés comme irresponsables sur le plan pénal en raison d’une abolition du discernement au titre de l’article 122-1 alinéa 1 du Code pénal et de mettre en évidence un lien entre leur pathologie, leur infraction et leur prise en charge.

Cette étude observationnelle et rétrospective a recueilli auprès d’un expert psychiatre exerçant auprès de la cour d’appel de Rennes l’ensemble des expertises de 2015 à 2019 ayant conclu à l’abolition du discernement. Les Agences Régionales de Santé de la région ouest de la France ont été sollicitées afin d’obtenir les éléments concernant le devenir de ces sujets depuis leur examen expertal. Nous avons étudié les caractéristiques médico-psycho-criminologiques, les pathologies retrouvées, les infractions commises et les conclusions de l’expert concernant la responsabilisation ou l’irresponsabilisation pénale conduisant à la nécessité d’une orientation sanitaire ou judiciaire.

Nous avons pu obtenir des informations concernant 58 sujets sur les 103 recueillis initialement. Au total, 19,42 % des sujets étaient en hospitalisation complète, 18,45 % en Programme de Soins et 17,48 % avaient bénéficié d’une levée de leur mesure. Les sujets souffraient d’un trouble psychotique dans 75,73 %. Pour une même infraction, cette population psychotique était plus souvent hospitalisée que les sujets non psychotiques (31,32 %) et parmi les sujets psychotiques, ils étaient également plus souvent hospitalisés en cas de crime (atteinte aux personnes ou crimes sexuels) commis que de délit (31,83 %).

Notre hypothèse de départ a été confirmée par les tendances que nous avons pu dégager : les sujets considérés comme irresponsables sur le plan pénal ont tendance à rester hospitalisés, notamment lorsqu’ils sont psychotiques et qu’ils ont commis un crime.

Article 122-1 of the French Penal Code regulates the status of non-criminally responsible (NCR) subjects due to an abolition of their judgment. Although little epidemiological data are available regarding the application of article 122-1, the French judicial literature reports a 0.2 to 0.5% rate of non-conviction due to psychiatric reasons. More recent studies report a higher rate, around 5%. The goal of our study was to determine the future of subjects considered to be NCR due to the abolition of their judgment, following article 122-1 §1 of the French Penal Code and to highlight a link between their pathology, their offenses and their management.

This is a retrospective chart review, that included all the forensic assessments that took place between 2015 and 2019, of an expert psychiatrist, practicing at the Rennes Court of Appeal, and that resulted in a judgment of non-criminal responsibility. Information was retrieved from the Regional Health Agencies of the western region of France about the evolution of these subjects since their examination by the expert. Medico-psycho-criminological data was gathered, including the psychiatric profile, the committed offenses and the expert's conclusions regarding criminal accountability or non-criminal responsibility as well as the need for referral to the medical care or judicial system.

58 of the 103 initially identified charts were retained. Our sample consisted mainly of single men with no children, lacking professional qualifications but mostly employed. A majority of them had a positive psychiatric history, a history of substance use but no criminal history or childhood trauma. The ages ranged from 17 to 82 years, the mean age being 41 years (SD=16 years). When the psychiatric expertise identified an abolition of judgment and non-criminally responsibility, 51.46% (95% CI: [41.40-61.43]) of the subjects were referred to in-patient psychiatric treatment. In 2020, 19,42% of subjects were hospitalized in a psychiatric unit, 18,45% were on compulsory outpatient treatment and 17,48% were no longer on compulsory treatment. Psychotic disorders were identified in 75,73% of the sample. For the same offense, this psychotic sub-population was more often hospitalized than the non-psychotic sub-population. Additionally, psychotic subjects were more often hospitalized in the event of a crime (injury to persons or sexual crimes) than of misdemeanor (31,83%).

While we expected an overwhelming majority of hospital management following the recognition of the non-criminal responsibility, our study does not highlight a predominant outcome. Nonetheless, our initial hypothesis was confirmed by the trends we were able to identify: subjects considered to be non-criminally responsible tend to stay hospitalized, especially when they are psychotic and have committed a crime.