Évaluation psychiatrique et hospitalisation contrainte d'urgence. Analyse rétrospective de dossiers

Objectives: Psychiatric cares sometimes lead to coercive measures for the patient. Emergency procedures are initiated by the competent Public Prosecutor who can decide to hospitalize patient under constraint on the basis of a medical certificate. This procedure raises questions at different levels. The present study included several objectives: (1) investigation of the profile of the patients; (2) practical application of this type of procedure; (3) evaluation of the criteria related to the decision-making process leading to forced hospitalization. Method: This study was conducted in a Medical-Psycho-Social emergency unit in Belgium. This is a retrospective search, conducted on the basis of file analyses. Were included all patients who experienced emergency psychiatric assessment at the request of the magistrate. The following information were collected: date and time of admission, date of birth, sex, sector, diagnosis, use of therapeutic isolation, outcome of the evaluation, type of support, and the sex of the evaluators. These data were analyzed through descriptive and inferential statistical analyses. Results: Two hundreds and thirty-eight 238 persons were admitted in the emergency unit at the request of a magistrate. The average age is 39.99 years (59.66% men) and 62.18% of patients are registered in their hospital sector, while 34.87% of admissions are made outside the sector. Psychiatric night care is activated in 34.03% of cases, while 28.15% of psychiatric assessment requests arrive in the morning and 37.39% in the afternoon. The service receives between 4 and 5 requests from the magistrate per week. While 15.96% of them are referred on weekends, 84.04% are sent to the service on weekdays. Regarding the main diagnosis, 42.43% show a psychotic disorder, 13.44% a (hypo) manic episode, 10.50% an abuse of substance, 9.66% of behavioral disorders, 7.56% a personality disorder, 5.88% an adjustment disorder, 5.05% a depressive disorder and 3.36% a mental retardation. Therapeutic isolation is used in 34.87% of situations. In 55.04% of the cases, the procedure was stopped, while 43.69% lead to hospitalization under constraint. If the procedure is stopped, another follow-up is proposed: 22.38% of in-house ambulatory follow-up, 16.41% of outpatient follow-up, 14.17% with a mobile unit, 9.70% of in-house hospitalization, 9.70% of judicial follow-up, 8.95% of care by a medical service, 5.22% of network referral, and 2.23% of social follow-up. Patients whose assessment leads to hospitalization under constraint are significantly older than those whose procedure is stopped. The sex of the patient does not influence the outcome of the assessment. The decision to hospitalize under constraint is not influenced by the time of admission or the sex of the evaluator. However, the results demonstrate a significant link between therapeutic isolation and the decision to hospitalize under constraint. Patients spending the night in the emergency room are more often hospitalized under constraint. In addition, the main diagnosis posed is significantly related to the outcome of the psychiatric evaluation. The majority of people diagnosed with psychotic disorders and (hypo) manic episodes are hospitalized under constraint, while people met for substance abuse, behavioral disorders and adjustment disorders are not. A very small proportion of patients with personality disorder, depressive disorder or mental retardation are forced into hospital. Conclusion: This study provides detailed descriptions of the patients involved in the emergency procedure and its practical application, as well as the identification of factors related to forced hospitalization. This work allows an inventory of the urgent procedure (psychiatric assessment and forced hospitalization) and improves the understanding of psychiatric procedures and practices. © 2018 Elsevier Masson SAS