Une loi folle peut-elle être un mal nécessaire ?

Abstract

The Social Security Financing Act of 14.12.2020, in Article 84, establishes a control of isolation and restraints (measures) in health facilities providing psychiatric care without consent by the liberty and custody judges. From now, isolation and restraints only affect hospitalized patients without consent. The restraints must be limited up to 6h, and the isolation up to 12h. Exceptionally, they may exceed this period with an obligation to inform the judge of the freedom and the people listed in Article L 3211-12 of the CSP, i.e. the patient and his relatives. The application of this law poses practical problems: (1) the 12-hour time for isolation can include the patient's wake-up call. The twice daily medical visit probably requires to double the number of carers in some hospitals; (2) the failure to comply with medical confidentiality, as there exists now communication to third parties, without informing the patient/against the patient's advice. Many of the motions emphasize the need for the hospital administration to be involved in the transmission of documents. ObjectivesThe aim of our paper is to assess the impact (of the application) of such law on the decrease in the number of isolation cases in one specialized/psychiatric hospital. Our objective is to quantify/verify/assess the potential decrease in the number of isolation cases brought by (the application of) such a law in one specialized/psychiatric hospital. Material and methodsAt the hospital Valvert, we have 4 pavilions of 24-bed for the 4 sectors (hence 96 beds per sector), with two isolation rooms (for each sector). To assess the impact of the law, we compare the occupation time of the isolation rooms (relative to the number of patients) at two different periods: one period from January the 1st to March the 15th, 2020 (before the enforcement of the law), the other from January the 1st to March the 15th, 2021 (after the enforcement). ResultsOur results show a net decrease in the occupation time of the isolation rooms. Moreover, the number of isolation cases has decreased. Over the 2021 period, the occupation time of isolation rooms is 110 days and 10hours, while the capacity of the hospital is 592 days for this period. The average occupation rate of the rooms is 1.5 out of 8 in 2021, half of the occupation rate in 2020 (3 out of 8). ConclusionThe 2016 and the 2020 laws are rather symptomatic of the confusion between politics, legal and administrative. Even if isolation and restraints would go against patients’ rights, should we necessarily ban them? The risk is that after the ban comes the segregation and that means that our open services and hospitals should be closed. One of the solutions to avoid segregation could be to strengthen the capacity of the constitutional institution, including psychiatric follow-up of patients in the hands of justice. We are experiencing the paradox of our modern society with an unparalleled degree of security and increasingly at-risk living…For sure, risk zero in psychiatry is an utopic goal.