État des lieux et horizon du soin psychique des blessés de guerre

Abstract

ObjectivesThe changing nature of armed conflicts lead the defence community to confront new challenges. Deployed in either internal or external missions, soldiers are subjects to many constraints which test their mental and physical limits, and are exposed to unsafe situations which can become potentially traumatic. This psychological impact is a constant concern for Army's Health Service as well as for Commandment. Mental health specialists’ intervention in military environment had to adapt to soldiers and battle group's needs in accordance with the evolution of conflicts themselves. Patients or materials and methodsLessons learned from armed conflicts participated in structuring of medical and psychological support, forming part of a continuum before, during and after the mission. In that context, battlefield psychiatric care's doctrine has been developed around the following founding principles: immediacy, proximity, simplicity, expectative, and non-obligation to return to battle. Classically, immediate phase is time for first aid, which is the only possible on the full forward war zone. Then, when fighting time is over and soldiers are in a secure space, the defusing, literally “psychological shock treatment”, engages in first dialogue after an experience which can be assimilated to a subjective disaster. This dialogue can re-establish a link of humanity with persons whose world perception might have been devastated. À few days after the potentially traumatic event, the post-immediate phase urges the caregivers in identifying disorders to provide a more structured care. It's the time of medico-psychological debriefing which can be either individual or collective. Beyond this phase, care is organized according to a coherent healthcare system, from the operational theatre to mainland, based on a network of mental health actors. ResultsIn this way, psychiatrists on mission provide an approachable and receptive presence which allows soldiers to express their pain in an individual or collective address, and therefore permit engagement on battlefield. The main risk for soldiers is to be injured, whether physically or psychologically, and justify a constant attention from health-care providers towards them. ConclusionsIndeed, we can see that battle wound has an influence on relationships between an individual and his environment which highlights one of the main challenges in mental healthcare, that in addition to the identification of postraumatic suffering involves in therapeutic continuity of the relationship with individual. Finally, consistency of care is organized around a multidisciplinary which requires an institutional work of rehabilitation fully participating in supporting injured persons.