Hospitalisation psychiatrique des adolescents dans le canton de Vaud: une étude sur les modalités d'admission, les filières de soins, le rôle et le vécu de l'hospitalisation

Abstract

The development of practices and clinical and psychopathological knowledge concerning adolescence has affirmed the place and necessity of pedopsychiatric hospital treatments for certain adolescents. Nevertheless, it is mainly the pressure linked to the increase in severe pathologies and behavioural disorders (the prevalence of psychiatric disorders is evaluated to be about 5% in the adolescent population) and the difficulties encountered by the hospital staff who are confronted with the relational and psychological behavioural particularities inevitable at that age that have acutely raised questions about the reception of adolescents in psychiatry and the specific training of multidisciplinary hospital teams. Still, one should not ignore the hospital realities: in times of crisis, in times of emergency, in times of soothing, the demands for care are not that easily organised. The psychiatric hospitalisation of an adolescent constitutes a very specific modality of care. Fortunately occurring in only a few cases, it mostly happens in an emergency, during a crisis - sometimes violence and acute symptomatic expressions are involved - and can lead to an overwhelming of the adolescent's usual environment. It is the sign of failure, a wound, reaching an impasse, sometimes a rejection by the family. At the same time psychiatric hospitalisation can also provide the adolescent with a frame of care, be a haven that is expected to be strong enough and sufficiently organised, to address and calm the often invading violence and intensity of the disorder's symptoms. However, psychiatric hospitalisation is always complex and there has to be a merging of opposites: to be a place of rupture while still assuring a continuity, to assure security without oppression, to respect freedom in relation to effort, to permit regression while at the same time offering means of reconstruction, to shelter the patient and impose the rules of common living. If emergency and hospitalisation are often the modalities of encounter between adolescents and psychiatry, they also constitute opportunities that shouldn't be missed. Most of the time the problem for these adolescents is their difficulty in expressing their needs as much as their difficulty to accept help, even more so if psychiatric. After a short review of certain questions recently treated in the scientific literature, we explain and discuss the results of our study on psychiatric hospitalisation of adolescents (admissions, paths of care, role and subjective experience) in Lausanne (Vaud). This study was realised in the Adolescent Psychiatric Hospitalisation Unit (UHPA) of the University Service for Child and Adolescent Psychiatry (SUPEA) in 1998/99. Our results cover 66 adolescents, age 13 to 18. We compared two groups: patients admitted on an imposed mode and patients admitted on a voluntary basis. The diagnoses and the clinical scales confirm the clinical severity and acuteness of the disorders presented (more marked for the group of patients admitted on an imposed mode). Our group of patients is also characterised by the burden of adverse life events. In half the cases social adaptation is poor, significantly worse for the patients admitted on an imposed mode. The hospitalisation (an average of 24 days) notably improves the most acute manifestations.