Soins-études en psychiatrie : historique, définition et évaluation

Abstract

Since 1956, and thanks to a better prognosis of tuberculosis, the Fondation Santé des Etudiants de France (FSEF i.e.: Students Health French Foundation) converted its sanatoriums into “soins-études” (“care and studies”) institutions to allow students with psychiatric disorders to continue their studies while receiving care. These therapeutic residential care centers were designed as open psychiatric institutions to avoid social withdrawal and possible iatrogenic effects. The specificity of these therapeutic residential facilities is the presence of national education teachers who enable high school and university students to continue or resume their schooling. The objectives of this collaboration between caregivers and teachers are the recovery and autonomy of young people. All admissions in French therapeutic residential care are based on medical indication of continuation of psychiatric hospital care. The FSEF's authors described the care as integrating “treatment through environment”: the institutional psychotherapy allowing multiple vectors of transference, different forms of identifications, and alternative social relations. The studies are coordinated with the therapeutic program and are considered as one of the therapeutic mediations allowing the young person to strengthen his resources and skills. They participate in resocialisation and empowerment of hospitalized young people. MethodWe conducted a systematic review of the literature to collect quantitative studies evaluating FSEF French therapeutic residential care in psychiatry since the opening of the first service in 1956. ResultsWe found 11 quantitative studies carried out in the FSEF therapeutic residential care. Young people in therapeutic residential programs are most often between the ages of 16 and 22, which corresponds to the schooling opportunities in most FSEF institutions. The evolution of the gender ratio observed in favor of girls corresponds to observed gender ratio in the population of French high school students. Young people in French therapeutic residential care generally have chronic disorders. Their previous care pathway has often been long and scarred by one or more suicide attempts. Length of stay in therapeutic residential care was more than six months on average. Depending on the severity of the disorders presented in the samples, the young people who leave the therapeutic residential care were considered to be improved in 44% to 63% of cases. A majority of young people had a school activity during the hospitalization and after discharge. The young people who did not return to school established an alternative training project. Almost two thirds of them were also clinically improved and had established a training project more than 5 years after discharge. PerspectiveThe contribution of therapeutic residential care seems very interesting for adolescent and young adult with chronic mental disorders.