Hospitalisation en pédopsychiatrie : description et évolution d’une unité

RésuméLe secteur universitaire de psychiatrie de l’enfant et de l’adolescent du CHU de Brest dispose, au sein de l’unité nommée centre de soins pour enfants et adolescents, d’un service d’hospitalisation complète de 14 lits, service d’admission d’urgence qui accueille des mineurs de moins de 16 ans, le plus souvent en crise (crise individuelle et/ou familiale et/ou institutionnelle). Le service accueille tout type de pathologie, reste ouvert 24 h sur 24, toute l’année ; il fonctionne essentiellement avec des hospitalisations de courte durée et traite majoritairement des patients sans demande de soins. Après une description du service et de ses modalités de fonctionnement, les auteurs présentent leur activité sur les huit dernières années en s’appuyant sur des données chiffrées. L’évaluation de cette cohorte hospitalière (1225 admissions) sur plusieurs années leur a permis d’effectuer différents constats (explosion de la demande de soins, et ce, pour les deux sexes, rajeunissement des troubles, nouvelles demandes de soins avec augmentation des troubles externalisés, demandes de sevrage aux jeux vidéos on-line ou d’utilisation d’Internet, etc.) et de soulever différents questionnements, en particulier sur la phase de latence.

The university department of child and adolescent psychiatry of Brest Hospital (a medium size town of 200,000 inhabitants) has at disposal a 14 in-patient emergency care unit, where young people under 16, mostly in crisis (individual and/or family and/or institutional crisis) are admitted. This unit opens 24 h a day throughout the year, and patients with any type of pathology are admitted for a short stay, mainly with no demand for care. After a description of this unit with its modalities of functioning, the authors will report on its activity assessed from sets of data pertinent to the last 8 years. One thousand two hundred and twenty-five admittances were recorded over these 8 years. A very strong increase in the number of hospitalisation over the years (+201.4%) was also noticed. However, the sex-ratio remained quite alike with a majority of boys (55.3%), as well as the average stay duration (15.5 days in 2007). About the age at admittance, one should note that, after the relative stability observed in the first years, the average age has been decreasing regularly for the last 3 years to pass from 13.2 years for girls and 12.7 years for boys in 2005 to 12.6 years (girls) and 11.2 years (boys) in 2007. Despite a rise in the number of children under placement in this region (Finistère) between 2001 and 2006, the origin of the admittances has remained quite stable over 8 years: in 2007, 64.9% of the accepted children were living in their family, 24.6% in a foster care and 10.4% in a foster family. The evaluation of this hospitable cohort over several years allowed the authors to highlight various trends such as the explosion of the demand for medical care in both sexes, the rejuvenation of mental disorders, evolution in the motives for admittance with an important increase of psychomotor instability and externalised behavioural problems as well as the occurrence of new demands for care, e.g. the weaning of “on-line” video games or Internet. The growing expansion of NICT (new information and communication technologies) would invite them to appropriate them as tools in the meetings and to reconsider their restrictive position with respect to them. Finally, this rejuvenation of mental disorder(s), the occurrence of adolescent problems at an earlier age, together with their observation of the lengthening of the oedipian phase, whose elaboration seems more problematic than previously, have made them wonder about the contemporary characteristics of the phase of latency and the modalities of negotiation of this stage by their cohort of young people. These modifications have incited the authors to reconsider their offer of care and to propose alternatives to the hospitalisation through the recent development of a structure of home psychiatric-care. This new unit caused no arrest in the massive influx of the patients in complete hospitalisation, but it allowed them to optimise the care for some young people in complex situations through improvement of relationships with their various partners of the sanitary and socio-educational world (listening and support by the partners, exchanges of know-how in full awareness of complementarity, and work in the continuity during the stay at hospital [better prepared hospitalisation together with a better understanding of its interest by the child/teenager and the partners]).