Les mécanismes de défense d’une équipe soignante d’une unité d’hospitalisation sécurisée pour les détenus

RésuméLa nouveauté du dispositif d’hospitalisation des détenus, UHSI (unité d’hospitalisation sécurisée interrégionale) réactualise les questions relatives à la prise en charge sanitaire des détenus dans son articulation avec les aspects sécuritaires. Afin de repérer le positionnement subjectif et professionnel des soignants d’une unité d’hospitalisation sécurisée, nous avons conduit des entretiens qui ont permis de réaliser une analyse thématique et clinique (repérage des mécanismes de défense). Les résultats apportent une lecture clinique des conflits que les soignants rencontrent dans l’articulation de leur pratique de soin avec les exigences sécuritaires et dans leurs relations avec les détenus hospitalisés. Des préconisations sont proposées afin d’améliorer chez les soignants la collaboration avec le personnel pénitentiaire et la relation qu’ils développent avec les détenus hospitalisés.

The latest hospital admission device aimed at inmates (the special forensic hospital units [UHSI]) updates the issues relating to the security aspects of the inmates’ medical care. Since 1994, medical care of inmates is under responsibility of hospitalize personals. The main objective of this article is to analyse the consequences of the new way of inmate's hospitalization. Literature shows some difficulties when sanitary exigencies must be articulated with security interests: limitation in relation between nurses and inmates, conflicts between medical and penitentiary staff… In order to spot the subjective and professional positioning of a UHSI's medical team, we led some interviews, which enabled to carry on a thematic and clinical analysis (location research of the defence mechanisms). We proceeded first to the descriptive and thematic analysis of the data obtained according to the aspects developed during the interviews. Then we conducted a clinical analysis to identify the defensive level (DSM IV) used by caregivers according to the different dimensions of care at the UHSI. The systematic tracking of defence mechanisms in the caregivers’ speech was then ordered by the dimensions of care. The outcomes are a clinical reading of the conflicts the medical team meets when medical care has both to cope with security requirements and to deal with the hospitalized inmates. Carers mobilized significantly more adaptive mechanisms of high-level and significantly less mechanisms of minor level of distortion of the image for the professional organizational dimensions. While mention of the elements relating to prisoners (clinical dimensions) increases the use of mechanisms of the level of disavowal and significantly reduces the use of high-level adaptive mechanisms. The elements analyzed encourage us to believe that caregivers make a defensive regression when the relationship with the detainee is evoked. If the structural and organizational aspects (professional practices) are the subjects of tailored strategies, the clinical dimensions (representation of the detainee, the relationship to detainee and experience in hospital by the detainee) foster among the caregivers the use of mechanisms very close to division. Moreover, caregivers demonstrate an important empathy in respect of detainees in hospital, especially compared to the experiences of safety rules and transfer to the prison staff the aggressiveness generated by the frustrations linked to security constraints. Some recommendations are made in order to improve among the medical team the collaboration with the prison service staff as well as to develop the relation with those inmates. It is necessary to support professionals with a vulnerable population and potentially dangerous. First, training in psychopathology provides an opportunity for caregivers to liberate and develop their affects on the care of this population. This work will contribute to building a professional practice based on greater ownership of the special care to detainees. Then, in the form of an analysis group practice, support would improve collaboration with the team prison by an exchange around representations of detainees hospitalized and missions of UHSI. The creation of a space dedicated to groups of health care and prison improve mutual recognition of different identities and their characteristics.