L’évaluation de l’aide humaine en psychiatrie : un enjeu de la réparation du dommage psychique

Abstract

According to the Dintilhac nomenclature, human assistance is determined after consolidation as are the expenses related to third party permanent assistance to help the disabled victim carry out administrative procedures and more generally different aspects of daily life. In situations of post-traumatic mental disability, the evaluation of the need for a third party must allow for compensation, not only for daily living, but also in term of safety needs, the restoration of dignity and to make up for the loss of autonomy. The difficulty of assessing the need for a third party in case of disabling psychiatric symptoms is correlated to the initial difficulty of identifying and establishing the after-effects attributed to the traumatic event. It is also related to the absence of precise indicative scales for psychiatric disorders. The psychiatric pathologies that can be developed following a trauma are diverse. There is of course post-traumatic stress disorder, but it is also possible to find other anxiety disorders, as well as reactionary mood disorders. It is also necessary to take into account the decompensation of preexisting disorders. The quality of the expertise, whatever the diagnosis, is to evaluate the victim's needs in the most accurate way possible and taking into account daily discomfort. Indeed, the intensity of the symptoms can lead to a significant loss of autonomy for the victim. This can be due on the one hand to the disabling psychiatric symptomatology but can also be related to the consumption of psychotropic treatments. It is also important to anticipate the need for a third party during leave if hospitalization in psychiatric ward was necessary. Another element to take into account is the potentially fluctuating nature of psychiatric symptoms in the post-consolidation period. It may therefore be appropriate to assess the need for a third party on the basis of the most recent pre-consolidation fluctuations and to consider the possibility of a worsening of the situation post-consolidation. In the context of psychiatric symptoms, in the vast majority of cases, the need for a third party is that of assistance or support. Assessing the current or future need for a third party in the case of disabling psychiatric symptoms resulting from a traumatic event is complex, especially when the victim benefits from significant family or health support. Indeed, this support may mask certain difficulties or, on the contrary, prevent the mobilization of certain existing capacities. The purpose of this article is to propose a grid to help assess the need for a third party in the case of disabling psychiatric symptoms. Different entries to be rated from A to C evaluate personal safety management, participation in social life, travel, personal maintenance as well as the management of treatments, budget and administrative procedures. In association with these entries, a number of hours are suggested and practical examples are shown. It seems necessary to help the experts in the evaluation of these needs and to standardize this evaluation as much as possible. Victims of mental disabilities need medical treatment and care but also daily life aids and support. To compensate for psychological damage, whatever the permanent functional deficit defined, evaluating the needs for human assistance requires a precise and individual quantification needs in the victim's social, family and environmental context.