Le processus d’initiation des soins psychiatriques sans consentement en Savoie : description épidémiologique et analyse des décisions de mainlevée du juge des libertés et de la détention lors du contrôle systématique au douzième jour

Abstract : On July 5th 2011, a new mental health law regarding involuntary psychiatric commitment was issued. It introduced systematic judiciary control, outpatient commitment, and "imminent peril involuntary commitment". This monocentric descriptive study, which was carried out in the psychiatric hospital of Savoie between 2011 and 2016, describes the initiation process of psychiatric involuntary commitment, the proportion of and the reasons behind releases ordered after the systematic audience with the judge on the 12th day, and identifies the medical reactions to these releases. The comprehension of the release orders was evaluated by two independent doctors. There was no increase in the number of involuntary commitments, but the "imminent peril involuntary commitment" represented over 40% of these commitments. Over the period of the study 2081 systematic audiences took place, among which 79(3.8%) releases were ordered. In 47 cases (59.5%), the clinical indication of involuntary psychiatric commitment was questioned; in 20 cases (25.3%), it was due to a lack of form; and in 12 cases (15.2%), a combination of the two situations was found. 73.4% of the judges decisions were understood by the medical staff, with a moderate concordance of opinions between the two doctors (Cohen's kappa = 0.59). 11 problematic decisions were identified. This study highlights the importance of the judge-psychiatrist dialogue, identifies new inherent problems created by this new medicolegal device, and suggests some lines of thought and improvements.
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Master Thesis
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Pierre Aussedat. Le processus d’initiation des soins psychiatriques sans consentement en Savoie : description épidémiologique et analyse des décisions de mainlevée du juge des libertés et de la détention lors du contrôle systématique au douzième jour. Médecine humaine et pathologie. 2017. ⟨dumas-02169358⟩

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