[Characteristics of patients who received an indication of involuntary admission, with or without the involvement of a third party, in a Parisian psychiatric emergency unit].
Caractérisation d’une population de patients hospitalisés sous contrainte en ASPDT/u et ASPPI à partir d’un service d’urgence psychiatrique parisien.
Adult
Commitment of Mentally Ill
/ legislation & jurisprudence
Dangerous Behavior
Emergency Services, Psychiatric
/ legislation & jurisprudence
Female
Humans
Involuntary Commitment
/ legislation & jurisprudence
Male
Mental Competency
/ legislation & jurisprudence
Mental Disorders
/ diagnosis
Middle Aged
Mood Disorders
/ diagnosis
Paris
Patient Readmission
/ legislation & jurisprudence
Psychotic Disorders
/ diagnosis
Referral and Consultation
/ legislation & jurisprudence
Young Adult
Commitment of mentally ill
French mental health law
Hospitalisation psychiatrique sans consentement
Involuntary treatment procedures
Loi du 5 juillet 2011
Patient's rights in mental health
Santé mentale et droit
Soins psychiatriques en péril imminent
Soins psychiatriques à la demande d’un tiers
Journal
L'Encephale
ISSN: 0013-7006
Titre abrégé: Encephale
Pays: France
ID NLM: 7505643
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
26
11
2018
revised:
23
04
2019
accepted:
06
05
2019
pubmed:
20
8
2019
medline:
16
4
2020
entrez:
19
8
2019
Statut:
ppublish
Résumé
The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party. An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016. One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder. Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.
Sections du résumé
BACKGROUND
BACKGROUND
The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party.
METHODS
METHODS
An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016.
RESULTS
RESULTS
One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder.
CONCLUSION
CONCLUSIONS
Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.
Identifiants
pubmed: 31421813
pii: S0013-7006(19)30207-6
doi: 10.1016/j.encep.2019.05.005
pii:
doi:
Types de publication
Journal Article
Langues
fre
Sous-ensembles de citation
IM
Pagination
405-412Informations de copyright
Copyright © 2019 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.