Unit for difficult patients

The units for difficult patients ( UMD ) are hospital services psychiatric specialized in the treatment of the mentally ills presenting a major dangerous state.

There exist four UMD in France:

These units accommodate a total of approximately 450 patients including 40 women (in Villejuif and Montfavet). A fifth interregional UMD (for the Brittany, the Country of the Loire and the Basse-Normandie) is envisaged with Plouguernével.

A study of Oster and coll (cf Senninger quoted will infra ) bearing on a sample of 448 patients gives the distributions of the patients according to the psychiatric diagnosis:

Roles of the structure

The role of the UMD is exerted at various levels and is articulated within an elaborate therapeutic framework in multi-field team, under the authority of a hospital Psychiatre:

Role containing

The patients find reference marks fixed being able to channel to them Agressivité in this universe of “prison” pace with rules of procedure defined by the decree of October 14th, 1986. The patients hospitalized in UMD are it, under the mode of the hospitalization of office by order of the prefect. A token payment in the form of a placement in closed circle of type UMD can constitute a training of the limits and fall under a therapeutic step. The UMD must also know to assume a catch in specific charge with respect to the dangerosity.

A Infirmier of the UMD of Cadillac declared in the Point of September 26th, 1998 (article “Prison; The nave of insane”): “ If you approach without paying attention and that you burst their bubble, they jump you above to be defended because they feel attacked, even if you tighten the hand to them to say hello. With time, one knows when one can approach and for which distance it is necessary to remain of a patient who is too afraid. ”

Therapeutic role

The UMD must constitute a catch in concentrated loading at difficult moments and acute. This catch of load is concretized with the daily newspaper by various actions of care, carried out in multi-field team and more particularly marked on the level of the function nurse: individual assumption of responsibility and group, activities Sport ives, Ergothérapie, left therapeutic outside while keeping in mind the need a Re-socialization without rupture with time and reality.

The UMD accommodate:

  • of “medico-legal” declared penally irresponsible pursuant to article 122-1 of the Penal code (or of its old article 64)
  • of the patients who present major disorders of the behavior that cannot control any more the current means of monitoring and care of the units of sector in hospital of general psychiatry. They are “disturbing” patients of traditional psychiatric services, placed in hospitalization of office (HO) by stopped prefectoral
  • of the condemned prisoners (pursuant to the D398 article of the Criminal procedure code)

Texts

  • the decree No 86-602 of March 14th, 1986 relating to the fight against the mental diseases and the organization of the psychiatric sectorization lays out: “does not form part of the sectors defined in the article the 1st units for difficult patients, with interregional vocation, established in a specialized hospital and who ensure the full-time hospitalization of the patients presenting for others a danger such as the care, the monitoring and measurements of safety necessary can be implemented only in one specific unit.
    the operation of these units is given under the conditions fixed by the provisions of the article L. 328 of the public health code. ”

The decree of March 14th, 1986 was repealed by the decree as a Council of State n° 2005-840 of July 20th, 2005 relative to the sixth part (regulations) of the public health code and its article 1st from now on is codified with article R. 3221-6 of the known as code, which returns to the article L. 3222-3 with regard to the operation of these units.

The admission in UMD is governed by:

  • the decree of October 14th, 1986 relating to the standard rules of procedure of the units for difficult patients:
article 1: The patients concerned with a unit for difficult patients must present for others a danger such as they require adapted intensive therapeutic protocols and particular measures of safety, implemented in a unit especially organized for this purpose. these patients must in all the case belong to the provisions of the articles L 343 with L 349 of the public health code relating to the placements of office, and present, moreover, a state dangerous major, some or imminent, incompatible with their maintenance in a unit of hospitalization entitled to receive patients concerned with chapter III of title IV of this same code.
  • the, relative one in particular to the hospitalization of office.

  • the article D 398 of the Criminal procedure code: are transferred in service from psychiatry the responsible individuals penally who present mental disorders to connotation of dangerosity in the course of imprisonment and which cannot be neat in regional médico-psychological service (SMPR).

  • article 122-1 CPC which has that “the person who was reached, at the time of the facts, a mental health disorder or neuropsychic having abolished its understanding or the control of its acts”. A person profiting from a Non-lieu because of her state of psychic failure at the time them done can be subjected to an care obligation in closed circle. This care will be exempted in the structures of UMD to ensure the combination between care and safety.

The exit of the patient of UMD answers the medical and administrative criteria envisaged by the stopped of October 14th 1986. The transfer in a unit of care concerned with a psychiatric sector of origin of the patient is recommended by the commission of medical monitoring (CSM, replacing the medical commissions of the exits) made up doctors psychiatrists. The CSM once examines the case of each patient hospitalized in UMD every six month. The CSM then decides return of the patient in his units of hospitalization of origin or a prolongation of the stay in six months UMD.

Security issues

  • In 2004, two patients (condemned, one for assassination, the other for steerings, and hospitalized pursuant to the article D398 CP) are flee of the UMD of Montfavet, while threatening looking after them with a factitious gun manufactured in modeling clay. One of both will go returned then to the police force, the other will be stopped one year later. They were in part of the UMD intended for patients less dangerous than the others, which are surrounded by walls and ditches.

  • In April 2005, a patient has tent to flee of Henri-Hake, but it was quickly taken again outside the hospital. It would have succeeded in fracturing with naked hands a door or a French window, before crossing with the assistance of an accomplice the grid of the UMD then the wall of the hospital. The report/ratio of the regional office of hospitalization of Ile-de-France would give a report on a not very solid choice of construction materials (according to the department head, Doctor Christian Kottler, one neglected the security for budgetary reasons, by building for example PVC doors instead of preserving openings in Aluminum), as owing to the fact that the whole of the personnel of the hospital has the key giving access to the UMD.

See too

External bonds

  • “Voyage at the end of the madness”, the Express train of the 1/31/2005, Delphine Saubaber

  • the Unit for Difficult Patients of Cadillac (the Gironde), Dr. Patrick Bihan
  • Interview of a person in charge of the UMD Henri Hake, Synapse , May 2003, N° 195
  • “Henri-Hake: can the daily misery of a psychiatric unit”, Caroline Constant, Humanity , November 18th, 1998
  • '' a space of opening in a Unit for Difficult Patient '', memory of François Salvi, Training institute in Ergothérapie of Rennes
  • “Which be the place of the psychiatric care male nurse in medium of constraint? ”, Philippe GIRARDON, Memory IFSI Montfavet
  • Reports/ratios of the visit in France (in particular in Montfavet) of the European Committee for the prevention of torture and the sorrows or inhuman treatments or degrading in 1991 and 1996
  • One of the escaped prisoners of Montfavet went

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