La continuité des soins pour les militaires atteints de syndrome de stress post-traumatique : projet d'un centre de référence interministériel

Nine hundred cases of post-traumatic stress disorder syndrome (PTSD) have been identified these last ten years within the French army corps (2013). This pathology described since Antiquity, was the object of famous works by military psychiatrists (Barrois, Crocq, Lebigot). The various armed conflicts of the last years saw the fighters suffering from psychic wounds further to the fights. For their treatment, a psychic trauma plan builds a way to military care starting from the battle zone. This consideration of the PTSD by the Ministry of Defense is essential in the process of acceptance of the wound by the soldier and in his (her) process of reconstruction. Indeed it gives a sign of gratitude and solidarity to the wounded person. But, this global treatment can be partially or totally interrupted if the subject leaves the army or if he or she wishes to quit and his family wants him to quit the military institution, fearing an unfavorable valuation of his aptitude. In this case, the soldier and his family can be made a break by symptoms which can appear years after the initial trauma, not knowing towards which healthcare professional they can be addressed. Policemen, firemen, diplomats, customs officers, staff of the NGO can, during their functions, be exposed to a traumatic event. The current event demonstrates unfortunately that the exposure in the trauma can take place as much on the national territory as abroad, and thus concern a very important number of people belonging to very different circles. The civil offer of care is heterogeneous and not always visible for a not warned public. Every ministerial structure develops its own model of care. Yet the “Livre blanc” (White book) 2013 on the Defense and the National Security recommends a solidarity and a commitment for all the military and civil staffs who make a commitment in the service of the State. The treatment of PTSD becomes de facto interministerial, and both a civil and a military matter. In fact, managing crises requires multidisciplinary competences. Therefore, an interministerial PTSD reference Center under the guidance of the Ministry of Defense would be a very well structured and adapted response to the issue, with an territorial implantation of military and civil specialized professionals well knowing incidences of maintaining in the army or reinserting in the civil word. This center would be federative of an innovative approach to assure the continuity of treatments. It would allow to develop a common doctrine on the psychic trauma from the exchanges of experts.