Reportage. “I killed someone. ” The visitor hasn’t asked for anything, has only known him for ten seconds, and now José (the first name has been changed), 34, hair slicked back, delivers this confession eye to eye. “We were in the car. He insulted my father, he insulted my mother, I pulled out a knife, I stuck it there, he says, index finger pointed at the heart. I didn’t want to do that, I regretted it a lot. “
Neutral gaze, neutral tone, no apparent emotion: the effects of his mental illness, and medication to stabilize him. With the same look, the same tone, the same absence of emotions, José says that he likes to crumble his rusks in his milk in the morning, and that he is delighted that his mother comes to visit him the next day and brings him Madeleines.
“You are not a judge, nor a prison supervisor. Here, there are only caregivers ”, says Fabienne, head of department.
José is one of the 51 patients of the unit for difficult patients (UMD) of Montfavet, in Avignon (Vaucluse). Behind the fence delimiting the courtyard of its building, you can see the 5-meter-high enclosure wall, impassable, which gives the place an air of prison. The ubiquitous white coats are a reminder that this is a hospital. “It’s not a place of punishment, it’s a place of care. You are not a judge, nor a prison supervisor. Here, there are only caregivers ”, explains Fabienne, head of department (the staff wished to remain anonymous), who underlines the absence of bars on the windows and CCTV cameras in the corridors.
Montfavet was the second UMD opened in France, in 1947. Doctor Henri Colin, who had created the first in 1910, in Villejuif (Val-de-Marne), had imagined this structure for “The repeat offenders of the asylums who are the terror of other patients and cause the despair of doctors”. These closed and isolated places are the psychiatric equivalent of an intensive care unit, a last resort for the most serious cases. “The end of the funnel”, summarizes Lylian, nurse team leader.
Three types of patients
Montfavet and the nine other French UMDs welcome three types of patients: the mentally ill who have become unmanageable in general psychiatry; the inmates “In a state of insanity” (Article D 398 of the Code of Criminal Procedure), who suffered mental breakdown in prison; criminals who have not been imprisoned, or even tried, often because they have been declared criminally irresponsible “Due to a mental disorder” (article 122-1 of the penal code).
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