Gérald Darmanin had pointed out a “psychiatric failure”. Almost a month after the attack committed in Paris by Armand Rajabpour-Miyandoab on December 2, which left one dead and two injured near the Eiffel Tower, the emotion has subsided, and the controversy has faded. But, among psychiatrists, the direct attack by the Minister of the Interior concerning the psychiatric follow-up of the radicalized young man has not been forgotten. Implicitly, it is the question of constraint and the “confinement of the mad” which has been, once again, released into the public debate by the Minister of the Interior. And he is not the first, doctors remind us.
Most news stories involving people under psychiatric care are widely commented on. The quintuple homicide of Meaux (Seine-et-Marne), committed on December 25 by a 33-year-old man who had already been hospitalized, was no exception, the mayor of the city, Jean-François Copé (Les Républicains, LR), denouncing the insufficient “cooperation between medical services, social and legal services” and one “taboo around psychiatric issues”.
Faced with this political challenge, psychiatrists put forward the same observation, going against the prevailing discourse: we have never had so many forced hospitalizations, that is to say, decisions on care without consent for patients suffering from psychiatric pathologies.
At other times, we spoke of internments, compulsory or voluntary placements, or even compulsory or forced hospitalizations. Since two laws (in 2011 and 2013) which established the regime still in force, this care given without the consent of the patient, an exception in medicine, can intervene at the request of the prefect in the event of a disturbance to public order, the request of a third party, or in the event of “imminent danger”, when it is impossible to find a loved one. In each case, a certain number of psychiatrist certificates must attest to a mental state justifying the impossibility of giving consent and the necessity of care.
These two laws also allow professionals to provide this care without consent on an outpatient basis, and no longer only in hospitalization, within the framework of “care programs”.
“Significant increase” in France
According to the latest official figures, the trend is beyond doubt. “A significant increase in the use of this care is noted between 2012 and 2021”can we read in a note from the Institute for Research and Documentation in Health Economics (Irdes) dating from June 2022, which notes a “inflection” since 2015.
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