Attachement des patients psychiatriques en situation d’exclusion sociale : une étude pilote en équipe mobile psychiatrie précarité à Paris

Abstract

ObjectivesThe mission in Mobile Psychiatry Precariousness Team is to access and maintain psychiatric care for patients experiencing social exclusion. Professionals are faced with some difficulties to carry out their work. Homeless people have four times more psychiatric disorders than observed in the general population; they have difficulty accessing care, and most of them have experience serious childhood trauma. For these reasons, integrating attachment theory seems to help improving the care of these patients. The objective of this study is therefore to evaluate the attachment styles of a population of patients met in Mobile Psychiatry Precariousness Team in Paris. Materials and methodsNon migrants adults were recruited in patients met in Mobile Psychiatry Precariousness Team, in a situation of precariousness and social exclusion, between December 2018 and July 2019. A questionnaire was completed with socio-demographic data; psychiatric diagnosis were noted; and attachment style was evaluated with the self-administered questionnaire Relationship Style Questionnaire - Revised Codage. Descriptive analyzes were carried out for socio-demographic data, psychiatric disorder, and attachment styles. Means and standard deviations for the four categories of attachment (secure, preoccupied, avoidant, disorganized) were calculated, as well as the prevalence of each attachment style. Each patient could be classified in secure or insecure. Only patients with a higher score at one of the four categories can be classified in one of them. ResultsEighteen patients (8 women, 10 men), aged 28 to 65, were included. Eleven patients had several psychiatric diseases. Three patients were classified as secure, and 15 as insecure. Eleven patients could be classified in 4 categories: 7 were avoidant and 4 were preoccupied. Therefore, the rate of insecure attachment reached 83% in this sample, with a predominance of the avoidant style for 39% of the subjects. ConclusionsThe high rate of insecure attachment in this population may lead caregivers in Mobile Psychiatry Precariousness Teams to build a working alliance with these patients, in order to stand as a Secure base for them, as a first step to a durable entry into psychic care. The authors underline the relevance of attachment-informed therapy in this population. Finally, the Mobile Psychiatry Precariousness Team, as an outreach structure of care could or should take the lead for this population. Further studies are needed to test these hypotheses.