Terrorist attack in Yvelines

Two days after a terrorist attack in the Yvelines that killed one person and injured several others, including an 11-year-old child, the release of the main suspect, Kevin T., 39, from custody for psychiatric reasons raised questions. The lawyer for the victim's relatives expressed surprise at the decision, particularly since Kevin T.'s health was initially considered compatible with custody before a psychiatrist requested that he be placed under observation at the Psychiatric Infirmary of the Paris Prefecture of Police (I3P).

French law on psychiatric care

In France, the Public Health Code allows for provisional psychiatric care measures under certain conditions when a person presents an imminent danger to the safety of others. These measures are strictly regulated. Karine Jean, a hospital psychiatrist and expert at the Paris Court of Appeal, explained that if an arrested person does not seem mentally sound, mayors and the Paris police commissioner can impose provisional placement in SDRE (psychiatric care on the decision of a representative of the state) when it is not possible to conduct a psychiatric examination in an emergency.

Role of the I3P

The I3P receives people subject to this measure and is the only establishment in France that can do so. Its mission is to receive, in extreme urgency and temporarily, people with severe psychiatric disorders associated with an immediate danger to themselves or others, justified by the intervention of law enforcement and attested by a psychiatrist external to the Paris Prefecture of Police. The objective is to carry out a complementary psychiatric evaluation of the people sent to the I3P, for a maximum period of 48 hours.

Referral process to the I3P

The referral to the I3P is also regulated. The person arrested is first taken to the emergency room. In Paris, the usual circuit is the medical-judicial units of the Hôtel-Dieu. There is an interview with a psychiatrist. If the psychiatrist needs more time, when the situation is not clear, he signs a paper and hands it to the police, requesting a referral to the I3P for a complementary evaluation.

Care process at the I3P

Upon arrival at the I3P, the person is taken care of by a nursing team present seven days a week. The care process is the same, regardless of the facts attributed to the person, whether they have a terrorist character or not. The person is received, an inventory of their belongings is made, they are put in a pajama and placed in an isolation room to ensure their safety and that of others. An initial interview is organized upon admission with an on-site duty physician, present 24 hours a day.

Evaluation and next steps

After this initial interview, the person goes to a room "with treatment to calm them down." A new exchange is organized the next morning with a health professional, to which is added a clinical examination. Several conclusions can then be drawn. The psychiatrist can conclude that the psychiatric examination is completely normal. A person can sometimes be subject to toxic behavior disorders with, for example, delusional elements, things that are not clear at the emergency room. Finally, after 24 hours and sometimes a separation from toxic consumption, the person regains a normal state.

Post-evaluation procedures

In this case, the person leaves the service, which refers to the Mental Health Action Office in Paris, which in turn calls the police to know "whether the custody resumes or not." Some people can be arrested due to serious behavioral problems in the street, but without endangering anyone. In the case where the person presents real psychiatric disorders, especially "because they are known to a Paris psychiatric sector, they are in treatment interruption or sometimes in flight from a hospitalization measure, a hospitalization without consent can be pronounced."

Outcome of the I3P evaluation

According to the Paris Prefecture of Police, "at the end of the legal observation period," that is, 48 hours, "nearly one patient out of two is hospitalized without their consent in a specialized institution," subject to the availability of accommodation. In the case of the terrorist attack in Trappes, Kevin T.'s health was initially considered compatible with custody by a first doctor who met him. It was a psychiatric expert who, after examining him, requested that he be placed under observation at the I3P. The custody of Kevin T. was finally resumed on Monday, October 26, at 14:46, announced Olivier Christen, the anti-terrorism prosecutor of the Republic.

Clarification on psychiatric evaluation

Karine Jean also recalls that this psychiatric evaluation has "absolutely nothing to do" with the issues of the abolition and alteration of sanity. These questions are addressed in presentenciary expertise by a psychiatrist or several psychiatrists or a college of experts when there are disagreements. This has absolutely nothing to do with this initial observation period. From the moment the I3P referral form is signed by the commissioner, this means that the custody is lifted and we are preserving this precious time to listen to the person and gather initial elements to justify, for example, a provisional detention.