Les directives anticipées psychiatriques (DAP) : propositions pour un modèle en France

Abstract

ObjectivesPsychiatric advance directives (PAD) are written documents which are used for patients to notify in advance their preferences for psychiatric treatment for a future situation of relapse when they are unable to give their consent. It contains his or her treatment preferences for any future psychiatric emergency, when he or she may be too unwell to express clear views. The hypothesis is that such active involvement by the patient in the process of crisis planning will increase the likelihood of averting major relapse and the need for compulsory detention. Materials and methodsThis article reviews the current state of knowledge on use of PAD and then explains the propositions for developing a new model of PAD in France. ResultsMany studies show a real interest for PAD, regarding user's autonomy, therapeutic alliance and diminution of coercion. PAD may contain information about medication, symptoms, non pharmaceutical demands, name of a proxy decision maker. Different types of PAD exist, depending on the number of stakeholders involved in their completion. Despite a lot of promises, implementation of PAD remains difficult. We define the Plan SOS as a new model of PAD, inspired by the Joint Crisis Plan. It's based on the completion with the user, his medical team, his family and the presence of a facilitator, of an advance care planning. ConclusionPlan SOS is so far a research intervention and a current study is taking place to explore effect of Plans SOS on number of hospitalisations, clinical state, and therapeutic alliance.