Soins intensifs à domicile : modèles internationaux et niveau de preuve

[Can intensive home care solve the problem of overcrowded psychiatric beds?]

The growing demand for psychiatric care raises questions about the place and value of alternatives to hospitalization. Community-based intensive care, such as home-based intensive care teams, are models that have been extensively studied and precisely described in international literature. They make it possible to avoid or shorten hospital stays, and have interesting variations for providing access to care in rural areas.

[Psychiatric emergencies and sense of urgency occurring upstream from health services: What should be done?]

The French psychiatric health system is not properly organized for managing the sense of urgency felt in critical situations that occur upstream from psychiatric health services, in "inappropriate" locations (e.g. home, street, work.), particularly for patients who are unwilling to cooperate and receive health care. Emergency services, police departments, or psychiatric teams - who should take charge? Families are distraught. The authors draw the line to propose a comprehensive and coherent model. Pressing emergencies require the intervention of emergency services, who may, when necessary, receive remote counsel from psychiatric health professionals. Other situations require a quick but delayed access to specialized care, including at-home care. With this comprehensive model, the authors address both a pre-hospital emergency occurring out of a dedicated sanitary place, as well as access to care for patients who are unwilling or partly unwilling to receive health care.