Médecins du Monde: Jail diversion program in Marseilles

About 72,000 people are held in prisons in France. Among them, 21% suffer from psychotic disorders and 7% from schizophrenia. 7% also declared themselves homeless at the time of their incarceration and 14% declared they did not have a real housing or accommodation solution when being released. In addition, 61% of those released from prison following an imprisonment sentence are sentenced again within 5 years.

Recent studies tend to show that the homeless population suffering from severe mental illness and facing justice are very likely to experience a street - prison - hospital “revolving door” phenomenon generating recurring costs for the justice and the health systems.

Terms of the bond

  • Status: Deal structuring with aim to launch in 2020

  • Countries: France

  • Target population: homeless people suffering from severe mental illness and referred for immediate trial

  • Selected impact metrics: average re-incarceration rate and state spending

  • Duration: 63 months (5.25 years)

  • Amount: about €6.3M

  • Expected return: up to 4% IRR

  • Outcome funders: French ministries of Health, Justice, Social Economy, Housing and Research

  • Investors: institutional investors and foundations

  • Service provider: Médecins du Monde

The project

Inspired by the Mental Health Courts launched in the US and Canada and by “Un Chez Soi d’Abord” program in France, the “AiLSi” project is an initiative lead by Médecins du Monde and aiming to offer a jail diversion programme in Marseille based on an innovative holistic approach, enabled by collaboration between the judicial and health sectors and backed by research through a randomized control test.

KOIS is leading the structuring of the Social Impact Bond (SIB) to finance the AiLSi project for a period of 5 years.

The target beneficiaries will be identified in jails just before immediate trial and wiill be offered, in agreement with the local judge, an alternative to imprisonment. Each beneficiary will be hosted in a personal flat following the “housing first” methodology and will receive intensive outpatient care for a period of 24 months.

The aim of the programme is to reduce the re-incarceration rate of the target population in comparison to a control group. The actual spending in terms of health and prison will also be measured and compared between the two groups. The number of people included in the programme and the number of new flats rented to the target beneficiaries will be measured as process indicators. Finally a full research lead by an evaluator will be published after the end of the programme.

"Initally, we were not sure if a Social Impact Bond was the appropriate tool. However, we realized that the impact measurement logic intimately linked to SIBs made a lot of sense for this project. In addition, we were surprised to see that the mechanism enabled us, for the first time ever, to speak on a coordinated to more than one ministry at the same time… in this case they are five!"

Dr Thomas Bosetti, Médecins du Monde Marseilles

The expected impact

  • 100 people suffering from severe mental illness and accessing housing first and outpatient care while avoiding imprisonment

  • First research on this specfic issue in France, realized through a randomized control test and aiming to test if the solution is adequate

  • If successful, spreading of the approach in France with the support of the Administration

Sources: Observatoire international des prisons; Prévention de la récidive et individualisation des peines, chiffres clés, 2014; Camille Allaria 2019 : L’incarcération des personnes sans logement et en grande difficulté psychique dans les procédures de comparution immédiate

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