L'entourage et la prise en charge psychiatrique ambulatoire en milieu pénitentiaire : enquête menée auprès des structures d'accompagnement vers la sortie implantées en France.

Plusieurs études épidémiologiques témoignent des problématiques de santé mentale chez les personnes incarcérées. En France, le Plan Psychiatrie et Santé Mentale de 2011 à 2015 considère l'entourage du malade comme ressource essentielle à la fois pour l'évaluation, l'accompagnement et le rétablissement du patient. Cette étude a pour objectif principal d'analyser la place actuelle de l'entourage des patients dans les prises en charge psychiatriques en prison et plus particulièrement au sein des Structures d'Accompagnement vers la Sortie de prison. Il s'agit d'une étude qualitative multicentrique menée auprès de 16 professionnels de santé travaillant dans les quatre Structures d'Accompagnement vers la Sortie de effectives au moment de la réalisation de l'enquête. Actuellement, l'entourage reste peu associé au parcours de soins psychiatrique ambulatoire du patient en milieu pénitentiaire. On observe une absence de tout contact avec les proches dans la majorité des cas. Ce résultat contraste avec la volonté des professionnels de santé d'intégrer les proches dans leurs pratiques car les soignants considèrent l'entourage comme un pilier essentiel pour le rétablissement du patient. Il existe de nombreux bénéfices à intégrer l'entourage au parcours de soins du patient incarcéré mais aussi des limites à cette intégration. Les Structures d'Accompagnement vers la Sortie apparaissent comme des structures propices à l'inclusion des proches dans les pratiques des professionnels. L'intégration de l'entourage dans les prises en charge peut être mise en place par la réalisation d'actions concrètes, établies dans cette étude, afin de proposer une offre de soins optimale et une prise en charge globale du patient. A specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison. This study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as "SAS" in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled. Sixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients' entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care. Currently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrating family and friends into care can be achieved by taking the concrete steps set out in this study, in order to provide optimum care and overall patient management. [ABSTRACT FROM AUTHOR]