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Balse J. [Isolation and restraint in psychiatry: practice and feedback from professional experiences]. REVUE DE L'INFIRMIERE 2023; 72:20-22. [PMID: 37364970 DOI: 10.1016/j.revinf.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
A psychiatric nurse since 2013, who became a clinical psychologist in 2022, I have had the opportunity, on numerous occasions, to use isolation and therapeutic restraint as part of my nursing practice, mainly in a closed psychiatric admissions service. These therapeutic tools, specific to psychiatry, are used in a very specific theoretical and legislative framework. Their use always leads to reflection, both individually and as a team. Indeed, their use must remain the last therapeutic bulwark to be used because it can be experienced with difficulty or even in a traumatic way by the patient, which can damage the relationship of trust with the carers. Thus, it is important that this practice be supervised and discussed with the patient and the team in order to be as appropriate as possible.
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Affiliation(s)
- Julie Balse
- Centre hospitalier Charles-Perrens, 121 rue de la Bechade, 33000 Bordeaux, France.
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2
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Neyme P, Brulin-Solignac D, De Jésus A, Bouchard JP. [Isolation and restraint in units for difficult patients and in psychiatric intensive care units]. REVUE DE L'INFIRMIERE 2023; 72:23-25. [PMID: 37364971 DOI: 10.1016/j.revinf.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures.
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Affiliation(s)
- Pierre Neyme
- Unité pour malades difficiles (UMD) Louis-Crocq, Fondation du Bon Sauveur d'Alby, 81000 Albi, France
| | - Diane Brulin-Solignac
- Unité pour malades difficiles (UMD), Pôle de psychiatrie médico-légale (PPML), Centre hospitalier de Cadillac, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, Centre hospitalier de Cadillac, 33410 Cadillac, France
| | - Arnaud De Jésus
- Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, Centre hospitalier de Cadillac, 33410 Cadillac, France; Centre hospitalier du Pays d'Eygurande (CHPE), La Cellette, 19340 Monestier-Merlines, France
| | - Jean-Pierre Bouchard
- Unité pour malades difficiles (UMD), Pôle de psychiatrie médico-légale (PPML), Centre hospitalier de Cadillac, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, Centre hospitalier de Cadillac, 33410 Cadillac, France; Psychologie-Criminologie-Victimologie (PCV), 33000 Bordeaux, France; Statistics and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape, Bellville, 7535 Cape-Town, South Africa.
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3
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Moncany AH, Blanchet M, Duchêne L, Malinowski C, de Ranchin R. [Psychiatric care in specially equipped hospital units]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:40-44. [PMID: 36681505 DOI: 10.1016/j.soin.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The specially equipped hospital units (UHSA) receive detainees in the region (men, women, minors) requiring full psychiatric hospitalization, either in free care or in care by decision of the State representative. They are located on the site of hospitals, but a penitentiary enclosure allows for the control of the entry and exit of patients, as well as the security of the perimeter. To date, nine UHSAs are in operation in France.
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Affiliation(s)
- Anne-Hélène Moncany
- Unité hospitalière spécialement aménagée (UHSA), Pôle de Psychiatrie et conduites addictives en milieu pénitentiaire, Centre hospitalier Gérard-Marchant, 134 route d'Espagne, 31057 Toulouse, France.
| | - Mariannick Blanchet
- Unité hospitalière spécialement aménagée (UHSA), Pôle de Psychiatrie et conduites addictives en milieu pénitentiaire, Centre hospitalier Gérard-Marchant, 134 route d'Espagne, 31057 Toulouse, France
| | - Lucile Duchêne
- Unité hospitalière spécialement aménagée (UHSA), Pôle de Psychiatrie et conduites addictives en milieu pénitentiaire, Centre hospitalier Gérard-Marchant, 134 route d'Espagne, 31057 Toulouse, France
| | - Christophe Malinowski
- Unité hospitalière spécialement aménagée (UHSA), Pôle de Psychiatrie et conduites addictives en milieu pénitentiaire, Centre hospitalier Gérard-Marchant, 134 route d'Espagne, 31057 Toulouse, France
| | - Raphaëlle de Ranchin
- Unité hospitalière spécialement aménagée (UHSA), Pôle de Psychiatrie et conduites addictives en milieu pénitentiaire, Centre hospitalier Gérard-Marchant, 134 route d'Espagne, 31057 Toulouse, France
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Brun P, Cano JP, Moncany AH. [Health needs and organization of care in prison]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:16-20. [PMID: 36681499 DOI: 10.1016/j.soin.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prison population in France is mostly composed of young but aging men, in relatively good health but vulnerable. In order to ensure optimal health care for this population, several levels of health care organization - somatic and psychiatric - have been set up since 1994. The different structures created since then allow incarcerated patients to benefit from care adapted to their particular conditions.
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Affiliation(s)
- Pierre Brun
- Unité hospitalière sécurisée interrégionale, Centre hospitalier universitaire de Bordeaux, Groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Unité médicale du centre de rétention administrative, Centre hospitalier universitaire de Bordeaux, Groupe hospitalier Saint-André, 1 rue Jean-Burguet, 33075 Bordeaux cedex, France.
| | - Jean-Philippe Cano
- Service médico-psychologique régional, Centre hospitalier Charles-Perrens, 121 rue de la Béchade, 33076 Bordeaux cedex, France
| | - Anne-Hélène Moncany
- Pôle de psychiatrie et conduites addictives en milieu pénitentiaire, Unité hospitalière spécialement aménagée, Centre hospitalier Gérard-Marchant, 134 route d'Espagne, 31100 Toulouse, France
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Brulin-Solignac D, De Jesus A, Bouchard JP. [Psychiatric intensive care units]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:37-39. [PMID: 36681504 DOI: 10.1016/j.soin.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The intensive psychiatric care units are intermediate health structures between the sector psychiatric services and the units for difficult patients. Prisoners can be treated there under article D. 398 of the Code of Criminal Procedure.
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Affiliation(s)
- Diane Brulin-Solignac
- Institut psycho-judiciaire et de psychopathologie (IPJP), Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France; Unité de soins intensif psychiatrique (Usip), Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Unité pour malades difficiles (UMD), Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France
| | - Arnaud De Jesus
- Institut psycho-judiciaire et de psychopathologie (IPJP), Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France; Centre hospitalier du Pays d'Eygurande, La Cellette, 19340 Monestier-Merlines, France
| | - Jean-Pierre Bouchard
- Institut psycho-judiciaire et de psychopathologie (IPJP), Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France; Unité de soins intensif psychiatrique (Usip), Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Unité pour malades difficiles (UMD), Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Psychologie-criminologie-victimologie, Cours de Gourgue, 33000 Bordeaux, France; Statistics and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape, Robert-Sobukwe road, Bellville, 7535 Cape-Town, South Africa.
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Arrive M, Cano JP, Thoumy N. [Regional medical-psychological services]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:31-33. [PMID: 36681502 DOI: 10.1016/j.soin.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The history of psychiatric care in prisons is relatively recent, and the regional medical-psychological services - initially called regional medical-psychological centers - were established in the different regions of France from 1977 onwards. Their main missions are the prevention and treatment of mental illnesses and addictions, as well as the organization of post-prison psychiatric care. Composed of multidisciplinary teams, they offer individual or group assessments and follow-up, as well as more specific care for certain penal populations.
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Affiliation(s)
- Maud Arrive
- Service médico-psychologique régional, Centre hospitalier Charles-Perrens, 121 rue de la Béchade, 33076 Bordeaux cedex, France
| | - Jean-Philippe Cano
- Service médico-psychologique régional, Centre hospitalier Charles-Perrens, 121 rue de la Béchade, 33076 Bordeaux cedex, France.
| | - Nicolas Thoumy
- Service médico-psychologique régional, Centre hospitalier Charles-Perrens, 121 rue de la Béchade, 33076 Bordeaux cedex, France
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[Units for difficult patients]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:34-36. [PMID: 36681503 DOI: 10.1016/j.soin.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The ten French units for difficult patients are secure psychiatric services which receive people suffering from mental pathologies who could have committed or have committed dangerous acts. Among the mental health structures presented in this dossier, the units for difficult patients are those which admit prisoners with psychological disorders and problems of dangerousness for the longest period of time. As fully-fledged care facilities, they offer intensive and multi-professional care.
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Abstract
The practice of care in a psychiatric service, whether outpatient or inpatient, appears more than ever to be a personal commitment. How can we conceive it despite the difficulties of the profession, which make new professionals hesitate to join it? There is now open talk of a "crisis in psychiatry", of professionals leaving the profession. However, many observers and caregivers manage to give meaning to this demanding profession, at the crossroads between disciplines and institutions. The activity is constantly evolving, shaped as much by the advent of multiple theoretical frameworks as by societal movements. The number of people using this discipline, which is now also called "mental health" care, is constantly increasing, while at the same time all the players are struggling to recruit professionals. However, patients who have become users can testify to the quality of the caregivers.
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Affiliation(s)
- Arnaud De Jésus
- Centre hospitalier du Pays d'Eygurande (CHPE), La Cellette, 19340 Monestier-Merlines, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Sophie Narvaez
- Centre hospitalier du Pays d'Eygurande (CHPE), La Cellette, 19340 Monestier-Merlines, France
| | - Jean-Pierre Bouchard
- Institut psycho-judiciaire et de psychopathologie (IPJP), Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France; Unité pour malades difficiles, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Statistics and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape, Robert-Sobukwe road, Bellville, 7535 Cape-Town, South Africa.
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Barbey P, Guiresse G, Brulin-Solignac D, Bouchard JP. [Management of patients with addictions in units for difficult patients]. REVUE DE L'INFIRMIERE 2022; 71:37-39. [PMID: 36150838 DOI: 10.1016/j.revinf.2022.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Addictive co-morbidities, which are increasingly frequent, are an additional risk factor for some of these patients to commit dangerous acts. Psychiatric and psychological care for pathological perpetrators of such violence can be provided under certain conditions in units for difficult patients, with addiction treatment if necessary.
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Affiliation(s)
- Pauline Barbey
- Unité pour malades difficiles (UMD), pôle de psychiatrie médico-légale, centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Gabrielle Guiresse
- Unité pour malades difficiles (UMD), pôle de psychiatrie médico-légale, centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Diane Brulin-Solignac
- Unité pour malades difficiles (UMD), pôle de psychiatrie médico-légale, centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Jean-Pierre Bouchard
- Unité pour malades difficiles (UMD), pôle de psychiatrie médico-légale, centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France; Statistics and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape, Robert-Sobukwe road, Bellville, 7535 Cape Town, South Africa.
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Nolla-Vilella F, Fleury L, Sadras-Neret A, Laborde E, Bouchard JP. [Social care for patients hospitalised in units for difficult patients]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:13-16. [PMID: 35995493 DOI: 10.1016/j.soin.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The units for difficult patients are secure psychiatric wards that receive mentally ill people who could have committed or have committed dangerous acts. As part of the overall care of these patients, the treatment of their social problems by social workers plays an essential role. These interventions provide the psychosocial benefits necessary for the stabilisation and evolution of these subjects.
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Affiliation(s)
- Françoise Nolla-Vilella
- Unité pour malades difficiles, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Unité de soins intensifs psychiatriques, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie, Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Laura Fleury
- Unité pour malades difficiles, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie, Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Amandine Sadras-Neret
- Unité pour malades difficiles, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie, Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Elsa Laborde
- Unité pour malades difficiles, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Unité hospitalière spécialement aménagée, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie, Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France
| | - Jean-Pierre Bouchard
- Unité pour malades difficiles, Pôle de psychiatrie médico-légale, Centre hospitalier de Cadillac, 10 avenue Joseph-Caussil, 33410 Cadillac, France; Institut psycho-judiciaire et de psychopathologie, Centre hospitalier de Cadillac, 89 rue Cazeaux-Cazalet, 33410 Cadillac, France; Statistics and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe road, Bellville, 7535 Cape Town, South Africa.
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