Violence psychiatric patients became unmanageable

The violence of patients with mental disorders has become difficult to manage, while the violence has always been part of the world of psychiatry, found the participants in a symposium on "security concerns in psychiatry."
Violence can lead to murder
The speakers of the conference, organized by the National Psychiatric Association presidents and vice presidents of medical boards establishment of hospital and the International Centre for Criminal and Penal Sciences (CPSIC) centers have agreed to say that the events violence had increased but the extreme violence of a patient, leading to a murderous act, as Pau (Pyrénées-Atlantiques), Saint-Venant (Pas-de-Calais) and Saint-Maur-des-Fosses (Val- de-Marne), is rare.

"Violence is a complex issue that puts us in trouble and we must not make otherworldliness, it seems there are problems from time to time," said Jean-Charles Pascal, president of the French Federation Psychiatry.

From a general point of view, the French company is facing an increase in attacks on people, while France was known for a balance of damage to property, said Jacques Genthial, former director of the Central Judicial Police. Between 1993 and 2003, crimes against persons increased by 113% (from about 153,000 to nearly 326,000 acts acts).

About 300 people are reported each year because of irresponsible abolition of discernment when criminal acts and escape punishment, a fairly stable figure, said Dr. Jean-Louis Senon (CHS Henri Laborit of Poitiers).

The Association of Directors of institutions managing areas of mental health (ADESM) tried to assess in a short survey the extent of violence in the service, said its president Bernard Raynal.

"On 8 sectors, two weeks during the day, there were 41 interventions reinforcement primarily on admission units, on patients in hospital under stress, including isolation room. 5 Each operation mobilizes male caregivers, between 10 and 30 minutes. "

The President of the Federation of Associations of patients FNAP Psy, Claude Finkelstein noted that the first violence by a patient is violence against himself.

"If there is an area where violence is expressed, it is in psychiatry. A psychiatric patient is milk on the fire. But if there is violence in our lives at some point, we remain the Wrong People, "she added, to counter the stigmatization of patients.

Lack of time caregivers
The problem of management of violence emerged in the discussions and seminars in psychiatry before the double murder of Pau, in December 2004. A report by the Clery-Melin mission "Acting the roots of violence," published in March 2003, had raised the issue and Psychiatric Association CME had undertaken a process of reflection with CPSIC, which includes judges, lawyers Police and gendarmes.

Sessions on the management of violence are usually part of training programs for nurses and nursing assistants.

But psychiatrists and nurses have agreed to conclude that the terms of their labor favored the emergence of violence, primarily because of lack of time.

Alain Pidolle, president of the Psychiatric Association of CME, said that the work meeting, coordination decreased significantly. "Whose fault is that? On the increase in the active file, which is a consequence of the reduction in length of stay. There are more people who come by, come and go faster, to make way for the next. The time exchanges, transmission, passages set to discuss the case is no longer there. "

"It became the slaughter" slice there.

The members of patients, "the end of the tunnel" La-Roche-sur-Yon (Vendée), showing a video, supported this, stressing the importance of contact with nurses and human contact in general.

However, the lack of personal service results in a lack of time to develop this dialogue. "Everyone is in its path" and communication is of lower quality, sorry John, permanent association.

Beyond this time problem, psychiatric nurses also point to the problem of nursing education and the transmission of knowledge between generations of caregivers.

"Before, in front of an agitated patient, there was a security cordon around him are doing. Now it encloses," lamented Hélary Annie, nurse CH Charcot Caudan (Morbihan). "Why has it changed? Nurses are more trained in psychiatric care. We do not know how," she said.

Families against violence
But the problem lies not in the hospital, as evidenced by the case of Pau, noted Jean Canneva, president of the National Union of friends and families of mentally ill (UNAFAM). Romain Dupuy's mother had tried unsuccessfully to warn about his condition but did not find a solution for the treatment.

"Now 95% of patients are in town and it is the families who have to deal with and manage violence. Only 5% are in the hospital, although for the most severe cases. Violence is present every day families must learn to manage. "

"The difficulty is to find a family who to call when she sees signs that announce the violence There are three signs that lead to sure on a drama. Isolates the person she stopped her medication and it consumes drugs. Three factors were present in Pau. "

But it is difficult to call someone before it is passed something. "If we call saying he is angry, it is not enough. Often must wait until something happens, then it would be before."

And Jean Canneva branded patient support default, returned to their home faster with medications, although assets.

"The lack of support is a factor in violence. When you can not support it because of involuntary admissions, it is monstrous."

Support in the city, provided by external structures of hospitals is failing in a crisis. Psychiatrists and families face the problem of transporting the patient who does not want to be treated to the hospital.

"The Department of Psychiatry has no mobile team.'s Samu not want to do and no more police," late Bernard Raynal.