Réhabilitation psychosociale en France

The concept of psychosocial rehabilitation and the various practices it involves appeared in North America in the eighties. In France the sectorization policy of mental health care included from the beginning such notions as readaptation and rehabilitation. However, it has been difficult to distinguish between general care for mental patients and rehabilitation as such. We shall, in this presentation, give a brief summary of the modern aspects of psychosocial rehabilitation and summarize how they have been developed in France over the last years.     

Secteurs psychiatriques et circuits de l'information en matière de précarité

The public service for mental health has been facing a conjuncture with necessary modifications to be made. In this context, we felt that it would be appropriate to carry out a survey in 2000, and then in 2002, on how much psychiatric districts know and are informed about access to general medical care and rehabilitation. Psychiatric staff seemed indeed to pay particular attention to those who may benefit from existing social systems and not only in connection to new legislations. According to our estimates, 19 % of patients under psychiatric care benefit from the Universal Medical Coverage (Couverture Médicale Universelle, CMU). The CMU was considered to be a good measure for patients by most medical and social partners polled. The latter emphasised the relevance of covering hospital fees and making access to general medical and dental care, which is otherwise often disregarded, easier. Moreover, districts themselves suffer from institutional “precariousness”. Tensions occur in the first place when, despite their willingness to deal with issues or problems, they are unable to do so.     

Potassium effect on Na+, K+-ATPase activity of cultured newborn rat astroblasts during differentiation

High K⁺ concentration effect on Na⁺, K⁺-ATPase activity of cultured newborn rat astroblasts has been studied in conditions under which astrocytic differentiation could have taken place. In 14-day-old cultures, no potassium effect could be found reflecting the undifferentiated state of these cultures. After dibutyryl-cyclic AMP treatment, which induces a morphological transformation suggesting a differentiation, no K⁺ effect appears but the specific enzyme activities are higher than in control cells reflecting the development of numerous cellular processes. After 28 days of cultivation — a cultivation period which closely corresponds to the time of astrocytic differentiation in vivo — Na⁺,K⁺-ATPase activity at 25 and 50 mM K⁺ concentrations are higher than at 10 mM, suggesting that an astrocytic differentiation has taken place in vitro.     

Psychiatrie de liaison en milieu pénitentiaire : organisation, moyens, psychopathologies et réponses thérapeutiques

The rise of the psychiatry practice in prison is recent. It corresponds to the setting places, since the law of January 18, 1994, of interventions by teams of sector psychiatry in the penal establishments, to supplement the action of the SMPR established two or three per region. The practice of psychiatry in prison must take account of a particular private clinic where acting out and psychopathology of deprivation dominates. The model of the consultation-liaison psychiatry such as it was developed in general care is completely appropriate to these working conditions. It allows not only one rewriting necessary of the psychiatric private clinic, but also a taking into account of the specific difficulties to this work environment (monitoring, insulation, risk of cleavage…). Lastly, an adaptation of the therapeutic assumption of responsibility is necessary not only according to pathologies present, but also according to the framework and to the limited duration of the assumptions of responsibility. The role of the maintenance of reception is of primary importance on this level.     

Psychiatrie et prison : toujours dans le champ de l'actualité

The relationship between psychiatry and prison is always in the field of the topicality in all the industrialized countries. All knew a psychiatric deinstitutionalization and a disengagement of social lodging, all know a rise of violence and often face there by the recourse to sorrows of detention often longer because of the development of the movement of “tolerance zero” aiming at repressing any delinquency, even minor. The increase often advanced in the number of the prisoners presenting of the mental disorders was studied little, apart from recent work. It can be put in connection with the located population more than one century ago by the French mental specialists, population of subjects which are not recognized irresponsible but present nevertheless mental disorders. In France, since 1994, health is carried out in prison by the teams of the hospitals. The Services Médico-Psychologiques Regional (SMPR) were consolidated. However, as much a many mental sick prisoners still do not have the care worthy of our republican company. Ten years after the law of January 18, any evaluation and any assessment is not carried out. However, it is a question well of thinking together the articulation of the care and the sorrow in our democratic company.     

From “ineducability” to “rare disabilities”. Evolution and emergence of political categories involved in shaping the French medico-social sector

In France, a notion is currently the focus of a number of political debates, that of “rare disabilities”, a notion that does not seem to be used, or to a limited extent, in other countries. The aim of this article is to return to the history of this notion in France: when and why did it appear? What issue and what population does this category designate? To set the issues related to “rare disabilities” in the context of the French disability policy, the first section of the article traces the development of the medico-social sector at the end of the 1940s, on the basis of the notion of educability, superseding that of incurability on one hand, and the categorization of the populations of disabled persons in terms of impairments on the other hand. The second part shows how in this context, the issue of children with several impairments emerges and how, under the impetus of parents and health professionals, distinctions are formed within the category of multiple disabilities between “multihandicap”, “plurihandicap” and “polyhandicap”. The third section traces the appearance of the term “rare disabilites” in the context of a political decentralization in 1986, the construction of a new political and administrative category and the fluctuations of its definition, which currently falls short of the challenges raised by this complex form of disability. The fourth section shows how this new category became from 1998 on, a performative and pragmatic category leading to the creation of specific and original modes of care that challenge the traditional institutional approach of disability in a context of reform of the French disability policy. The article is based on an exploratory research that has consisted in an analysis of grey literature (legal texts, associations and working groups reports) concerning the notion of “rare disabilities”.     

Les maisons des adolescents (MDA) : une menace pour les secteurs ?

The author describes the principle of the houses of the teenagers. Then, he compares the missions of the houses of the teenagers with those of the psychiatric childhood sector. In the current context of reorganization of the system of care, he describes the tensions created by the dynamics of the houses of the teenagers, then underlines the interest of the coexistence and the narrow collaboration of these two devices.     

De l’image à la mise en scène,quelle place la médiation artistique donne-t-elle au sujet adolescent ?

The houses of the teenagers, despite a precise specification, earn to enroll in the history of a pre-existing experience. That of Saint-Denis, born in a context of psychiatry sector, has benefited from it to better exceed. The example of the pinhole workshop tries to show the interest of artistic mediation in the care of the teenagers and how a faced with other partners work enriches and is developed.