Le devenir des soins psychiatriques sans consentement : suivi à deux mois de 510 cas

Abstract

IntroductionThe French Mental Health Act was reformed by the law of July 5th 2011, adding new and useful tools in the therapeutic management of the mentally ill, such as the possibility of involuntary admission to a psychiatric ward in case of an “imminent danger” and involuntary psychiatric treatment in outpatient settings. In France, these measures concern over 100,000 hospital stays a year. We wished to test the hypothesis that there is no statistical distinction between groups of patients with different types of admission orders. Material and methodsWe designed an observational, retrospective, single-centre study. Inclusions in the sample concerned all adults (aged 18 or above) involuntarily admitted to the specialised psychiatric centre of the Sarthe county between November 1st 2013 and October 31st 2014. A single follow-up took place 60 days after the admission order had been pronounced and included data extracted from administrative and medical files. ResultsFor the purpose of the study, each new admission was treated as a new “case”. Thus, 510 cases have been included in the main sample: 342 admitted upon a third persons’ application (67.1%), 115 for imminent danger (22.5%) and 53 upon the state's representative decision (10.4%). Follow-up data showed the average duration of involuntary treatment to be significantly higher between the first two groups, 31.8 vs. 26.1 days respectively (p = 0.03). The state's representative group shared distinct clinical characteristics (p≤0.05) in terms of sex-ratio, initial application setting, length of involuntary treatment and hospital stay, as well as diagnosis, history of suicide attempt, rate of judicial hearings and care programming upon discharge from hospital. DiscussionOur initial hypothesis was rejected. The type of measure was indeed significantly associated with different outcomes 60days after admission. As was the case in other recent studies, the “imminent danger” group made up a significant part of the sample, highlighting its usefulness in emergency settings. This subgroup benefited from shorter hospital stays and had a significant tendency to see their admission order revoked at an earlier stage than in the case of a third party's application. This suggests that the incapacity to consent to treatment is less likely to last in the “imminent danger” group, although overall clinical characteristics are shared with the “third party” sub-sample. On the contrary, the combined “state's representative decision” group differed significantly from the rest of the sample on clinical grounds, especially a higher prevalence of psychotic disorders and a lower one for mood disorders. This could contribute to the higher rate of outpatient care programmes. ConclusionOur study points out some of the differences involving admission groups in psychiatric centers and is coherent with previous findings. However, given its single-centre approach and the notorious disparity of clinical practices over the national territory, it would be useful to include larger, nationwide samples, in order to assess the new Health Act's impact and to guide future public health decisions.