Penser la formation des familles et de l’entourage d’une personne atteinte de schizophrénie

RésuméLe déplacement des soins de l’hôpital vers la cité a considérablement modifié le regard porté sur les familles ; la maison familiale est aujourd’hui le principal recours pour l’accueil du patient. Face à ce changement radical de la conception de l’entourage des patients en psychiatrie, plusieurs équipes soignantes ont conçu des programmes de formation pour permettre aux familles de tenir une fonction d’aidant et de favoriser l’accueil du patient au domicile. Parallèlement, les familles rassemblées en associations ont développé des dispositifs pour transmettre à d’autres familles leur expérience. Cet article propose une réflexion basée sur une comparaison entre des programmes de formation de l’entourage conçus par les soignants et des programmes conçus par les familles. Il s’agit de comprendre pourquoi ils se sont développés simultanément, de mettre en évidence leurs différences et leurs points de convergence afin de mieux comprendre les besoins réels des familles.

Shifting care from hospitals to the community has significantly changed the perception on families. The family home is now the primary means of hosting patients. Given this radical change in psychiatric care approach, training programs dedicated to the patient's entourage have developed. We question the large number of these programs and we aim to analyze whether there are important variations from one to another. It is about detecting differences but also convergence points between these programs in order to understand and better address the specific needs and difficulties encountered by families of persons with psychiatric disorders. In this article, we will take the profile of the designers of these programs as a variable. We will compare two training programs designed by professional caregivers and two other training programs designed within family associations by families themselves, who therefore are both designers and recipients of these programs. We will see how the designer profile has an impact on training goals, on the substance but also on how this information is passed, as well as on the assessment criteria of these trainings. In addition, we will see that the very concept of “entourage” and “family” varies according to the nature and function of the designer. Secondly, we will see how this comparative approach helps us to better understand the impact of changes in psychiatric care on families and to detect new arising questions such as: “Are entourage members intended to become care assistants?”, “Should family carers be professionalized?”, “Should the family home be considered as a place of care?”, “How to define the patient's family?”, “Who are the people concerned by the changes in caring and hence by these trainings?” This original comparative approach allows us to take into account the complexity of these changes and to detect how strong their impact can be on the schizophrenic person's entourage. It raises the question of training to other stakeholders, including in the social and medical-social sectors, since families cannot handle by themselves the shifting of care to the community.