Isolement et contention : trois syndicats de psychiatres publics dénoncent l’entrée en vigueur de la loi sans concertation ni accompagnement (Coline Garré, Le Quotidien du Médecin)
L’Intersyndicale de la défense de la psychiatrie publique (IDEPP), le Syndicat des psychiatres d’exercice public (SPEP) et le Syndicat des psychiatres des hôpitaux (SPH) alertent, dans un communiqué commun, sur la « très grande désorganisation et une confusion sans précédent »que devrait entraîner l’entrée en vigueur des nouvelles modalités de l’isolement et de la contention en psychiatrie. Alors que les décrets ne sont pas parus, les mesures d’accompagnement des équipes et établissements se font attendre.
L’article 84 de la loi de financement de la sécurité sociale pour 2021 précise en effet l‘encadrement de l’isolement et de la contention en psychiatrie, en soins sans consentement. Il introduit des durées maximales pour ces mesures, en s’appuyant sur les recommandations de la Haute Autorité de santé : 12 heures pour l’isolement, 6 heures pour la contention, chacune renouvelable dans la limite de 48 heures pour la première, 24 heures pour la seconde. Il prévoit aussi que le médecin puisse dépasser ces limites, dans certaines conditions et avec l’obligation d’en informer le Juge des libertés et de la détention (JLD).
Le mécontentement des psychiatres se cristallise autour de deux points. Un décret en Conseil d’État devrait préciser les modalités de saisine du JLD et un plan d’accompagnement doté de 15 millions d’euros doit permettre d’accompagner les établissements dans la mise en œuvre de la réforme (formation des équipes, investissement immobilier, etc.).
Absence de moyens humains et logistiques, selon les syndicats
Sans remettre en cause le bien-fondé de l’objectif de la loi, à savoir limiter ces pratiques de dernier recours, les syndicats déplorent « l’absence totale d’encadrement de la mise en œuvre de cette loi », avec pour conséquence, « de graves désordres institutionnels », selon les Drs Norbert Skurnik (IDEPP), Michel Triantafyllou (SPEP) et Marc Bétrémieux (SPH). « Où sont les moyens annoncés (personnels, financement) pour accompagner à la hauteur de l’enjeu, ce nouveau choc institutionnel ? Où se situent la qualité des soins et la sécurité des usagers quand on nous demande d’appliquer de nouvelles mesures pourvoyeuses d’une multitude de documents obligatoires selon un rythme déconnecté de la réalité ? », demandent-ils.
Ils regrettent aussi le manque de concertation préalable avec les organisations syndicales de la psychiatrie publique, y lisant un certain « mépris du gouvernement » pour la discipline.
« L’application de cette loi dans des conditions non préparées risque d’avoir des conséquences graves et sans précédent tant sur le plan médico-légal qu’organisationnel et qui seront extrêmement dommageables pour les patients, leurs proches et les professionnels dans leur ensemble », alertent-ils.
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References:
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