A psychiatric hospital in Val-d’Oise has just been denounced for “illegal confinement practices” of patients yet “hospitalized in free care”, reports Le Monde on June 19. In his “recommendations” published at Official newspaper Friday, June 19, the Controller General of Places of Deprivation of Liberty (CGLPL) warns of “serious violations of the fundamental rights of hospitalized persons” who have been there observed during the health crisis due to Covid-19. To better understand the situation of psychiatric hospitals during the confinement period, Nicolas Meton, psychiatrist in charge of a 15-bed unit at the Paul Guiraud hospital in Villejuif (94), tells how the reception units were reorganized at the peak of the epidemic.
Government recommendations difficult to apply
Psychiatry, a great oversight of the Covid crisis? In any case, this is the message sent through a forum signed by a hundred doctors at the beginning of April, in the midst of the epidemic peak. Their observation: forgotten patients, degraded care with confinement, disrupted care with the closure of day hospitals, the cessation of outpatient activity, hasty exits to free up beds.
The psychiatric hospital thus paid the price for instructions that were difficult to apply, a lack of equipment and nursing staff. “We were recommended to reduce patient visits to the CMP (psychological medical center, editor’s note) as much as possible in order to limit the risk of contamination in the waiting rooms. At the same time new support requests were still running. We have therefore favored teleconsultations for the least serious patients and still see urgent situations and new patients face-to-face.“says Nicolas Meton.
In anticipation of an influx of patients requiring hospitalization, “we rushed the outings of the less physically fragile by arranging so that they were obviously not alone at home“, continues the psychiatrist, who explains the implementation of close monitoring by teleconsultation in order to ensure the stabilization of the mental disorder despite early discharge from the hospital. But certain pathologies, intense delusional episodes, did not allow it. No. As well as patients who have attempted suicide or even bipolar patients going through an acute phase.
Bunkerization of units and individual quarantine: an absolute necessity
In this context, the hospital continues to operate, but a reorganization quickly becomes necessary. “We had to review everything: stop going back and forth between services, close certain ambulatory structures such as day hospitals or social reintegration support structures, put fragile or elderly staff on telework” explains Nicolas Meton. The patients are distributed, the doctors assigned to a single unit to limit as much as possible the possible circulation of the virus between the services. “We crossed our fingers so as not to all fall ill at the same time, especially since we were only half of the workforce of psychiatrists“. And there was this measure, necessary: the temporary quarantine.
“You should know that in the psychiatric hospital, there are few single rooms. Most are double, even triple or quadruple: if a patient has Covid-19, it’s a good bet that the whole department will catch it. Unlike a conventional medical service, psychiatric hospitalization units have common living spaces where the transmission of the virus is facilitated..
The hospital is redesigned from A to Z, with “bunkerized” units. The psychiatrist continues: “We completely emptied a unit in order to transform it into an incoming unit: each person is in septic isolation in their room for five days. It is not usual, but we are obliged to protect the rest of the patients and the staff. .“He points out that, of course, patients in septic isolation are controlled, rigorously followed clinically, correctly treated, and some benefit from a prescription of sedatives a little higher than usual to calm down. “These new quarantine measures can be relatively anxiety-provoking for the patient, especially when he is in the midst of delirious decompensation. Many of them were unable to respect the barrier measures in the acute phase of the episode.“The use of septic isolation was therefore essential in a certain number of cases,” he explains.We had a lot of requests from the outside, with people who were experiencing confinement badly, delirious puffs, extreme anxiety, decompensation from chronic mental illnesses: and no other choice but to hospitalize them.“But each time we entered, we took the risk of contaminating a space that evolves behind closed doors to protect itself from the virus.
System D at the psych hospital
Patients flock, the confinement of new arrivals is five days because “we could not have done more, in terms of available beds, even if the incubation of Covid-19 can go up to 15 days“. Then they are integrated into the downstream units and taken care of by the nursing staff. This isolation measure is necessary. At this stage, at the very beginning of the epidemic, the hospital is poorly endowed: “We initially had little to protect staff or patients. The masks only arrived later. We disinfected everything with our own cleaning products. We didn’t have an overcoat. So we dedicated a number of patient pajamas, washed daily, to use as gowns. When you arrived in the incoming units at that time, patients and nursing staff were all dressed in pajamas! Fortunately it only lasted a few days but it still marked us“.
On the spot, “we do not have a sufficient technical platform to take care of serious Covid patients“, sums up the doctor, to insist on the need to limit the number of transmissions at all costs.
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