Testimony of a nurse in Psychiatry

Testimony of a nurse in Psychiatry

July 21, 2011.



What I find interesting in this article, is that this nurse in psychiatry denounces may be without account abuse, sadistic acts, exaggerated drug distribution.
It is a testimony of choice as seen and experienced by one of those who practise "psychiatric care" in France.

Why the State is not his nose there is another issue but it is enough to know that manufacturers of pharmaceutical products represent a fabulous for financial strength, seems to me a response that is standing. I could add another answer to this "why", it is the power of Psychiatry. Not not the psychiatrists, but the latent idea of men has always been to have the grip on other men and psychiatry is it not this?

Isn't any political ulterior dream to be able to do what he wants in the population? And have a "science" that would allow this is not the wish of each? If psychiatrists found this magic wand would be fabulous for policies and if they do fail and scandals burst, our politicians can always say that they know nothing, they are probably "responsible but not guilty!"
Who handles that? I do not know. What I know however with certainty is that patients are costs.

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The decline of French Psychiatry

A former nurse in psychiatric sector book us her back on 30 years of business, and, disappointed by the evolution of the French psychiatric sector, explains why he resigned.

Emmanuel Digonnet is a former nurse in psychiatric sector - "profession" that no longer exists since Bernard Kouchner has removed this specialization for nurses in 1992. After more than twenty years in Office, permanently frustrated by the direction taken by the public service of "Psychiatry", he resigned. If he practice more, however he speaks very well of his former trade and of the reasons that pushed him to do more exercise

How do you begin?

I arrived in Psychiatry by chance, for "food", early 1980s reasons. When I started, I knew nothing; for me, psychiatry was the support of patients excluded from society for mental reasons. Mental illness was then to me if it was visible: autism, posturing, the cris…
For a year and a half, I was assigned in a service where you placed the most difficult patients, those problematic in other services. This was my first confrontation with the horror asylum and abuse : as for the police in police stations or in the workplace penitentiary guards, fear had transformed some nursing sadists. After alerted my direction, I was transferred to another service. I have discovered a new way to work, relying on medical interviews therapeutic and giving a real place to nurse in the treatment of patients. I am so passionate to discipline.
From 1982 to 1998, I accompanied and participated in an evolution of Psychiatry, symbolized by the closure of psychiatric hospitals. Indeed developed a workers pole, with ambition to move care in the city, with people. Usually hospitalized patients could finally live at home, seeing a nurse regularly. Others, addressed by social assistants and practitioners, attending therapeutic home centres newly open: he was of small units, with a few beds for hospitalization, a team of doctors and nurses. Free of material we are misstatement the same work at the hospital, but with more flexibility. Especially because we were little or less situated buildings where lived the patients - and not to thirty kilometres in the Paris suburbs, "then where is the crazy". Be admitted into a psychiatric hospital has always been complicated, treatment in these centres was much simpler.
These home and care centres offered therefore a true closeness and real availability. They changed at the same time the image of the psychiatric patients, which accepted more naturally be monitored and honored more appointments. Family, friends and the patient could play down care, get there being less stigmatizing than to be "hospitalized in Sainte-Anne. And these centres allowed - finally - unclogging hospitals, and thus to improve working conditions. This is anymore the case now; at the hospital, it is no longer that manage beds. From 16 hours, all managers spend their time on the telephone to find a bed to sleep their patients, the number of places available is insufficient.
For nurses also, things were different in reception centre: we were independent. It was not only to apply the requirements of the physician, but a real collective work. We shared with the rest of the team, and we could make appointments or to receive patients. A heady days.

It did not last?

The situation started to deteriorate in the early 1990's, with the development of a purely accounting management of the hospital. Our Department declined the allotted budget, and managers realized that a centre of five beds required as many nurses as a service of twenty beds to the hospital - without taking into consideration the number of heavy hospitalizations and relapses by this system avoiding…the
The administration then gradually did close reception centres. To do this, it was sufficient that managers do more give them the means to operate 24 hours a day: after a while, the principle was emptied of its substance. When more than a building with three beds, no one remained to deal, managers prevailed: "you see that it does not work: it must be close."
Another important step, the removal of the specialization "Psychiatry" for nurses in 1992. Bernard Kouchner, then Minister of health, has justified this decision by a requirement of European standardization; a European directive stated however that French Psychiatry nursing training was high quality and invited the members of the EU to be in rapprocher… In fact, this deletion was primarily to save.
Since 1992, therefore, all nurses follow the same curriculum, with only a few courses of Psychiatry. Today, a few generalist nurses, passionate about Psychiatry, successful to form quickly once employed in specialized services, but others choose default psychiatric services, because it must be earning a living, and are often not the height. The observation of the inadequacy of the training being unanimous, the beginning of the 2000s saw flower a number of "training box" private, meant to compensate for these deficiencies.
In any event,. diploma of psychiatric nursing has always been considered a "sous-diplôme". To its deletion, in 1992, former graduate - like me - did not have the right to go to work in general hospitals. Basically, this meant that the "subhuman" were cared for by "sous-infirmiers". Even today, if I see someone make over by a car, I have not the right to ask an infusion or to give them a soins… while I am authorized to do so for a hospitalized person in a psychiatric. What does it mean? That it is less serious if I am wrong?
In the early 1990's, also saw the introduction in the "quality approach" hospitals - pure import of industry - with its lot of protocols and procedures. Procedure for a patient on hosts, procedure for a patient that it takes in isolation room, etc. This is reassuring: you fill forms, you nicks boxes! Regardless of that terms such as "phobia" or "obsession" did not watertight boundaries, since it is to create a classification of mental diseases so that managers can make sense. The idea is to encode the patient. Today, a patient is 810.12 - "alcoholic depressive tendency." This is foolish: be "alcoholic depressive trend", the patient is a man or a woman, who was fifty years or eighteen, such past, such parcours…

What was the impact of this "quality approach" on your work?

This is the kind of reasoning could be heard on the part of managers: "you for a 11, you have a DMS 18 days (average length of stay). The service side is nine days. Therefore, you merdez. "Reduce your DMS". To do this, it was enough to stuff the patient of anaesthetic drugs, and the tower was race It is is thus clearly operated a passage from the management of the patients in the management of the budget. The Ministry reduced the budget while the needs - them - not detract.
Behind all this, there is the idea of not recognizing the specificity of mental illness. It is much simpler to say that schizophrenia is a virus or genetic problem against which it is enough to invent a drug. As this view is supported by pharmaceutical laboratories - themselves in part to the origin of this classification of diseases, to be able to say: "Such type of disease." Such drug! " With sometimes disastrous results. If we take the example of hyperactivity - which I do not deny the symptoms - shows that Labs offer drugs with "visible" in the short term effects but which are more long-term disaster. The bottom of the problem is the paramount place occupied by the labs in the hospital. There is to see the number of formations that they are providing or "sponsor": when they talk about some of their courses, the internal medicine speak the "Lilly course" or the "Janssen course"...

And nobody protests?

In 2003, the profession organized the States General of Psychiatry that led to a series of recommendations to the Minister of health, Jean-François Mattei. There is nothing compris… The fight then intensified after a speech by Nicolas Sarkozy to Antony, in December 2008. In response to the murder of a young man at Grenoble released patient of a psychiatric hospital, the President proposed ultra-sécuritaires measures, such as video surveillance or electronic bracelets. You need to know that such speech was disastrous, even effects when it is not followed by concrete measures. It grows for example the prefects to refuse authorizations to exit of patients, and it becomes very difficult to get out a patient to work progressively to reintegration.
For my part, I thought that resistance could come from trade unions, and I've long been unionized and union activist. Before discontent, both unionism often comes to the defence of individual interests, rather than a commitment or political views. I me am so invested in an association dedicated to research in psychiatry - another way to try to change the system. One of the facts of a weapon of this association, even if we finally lost the trial, was to lodge a complaint against a dozen pneumologists after the explosion of the AZF plant in Toulouse. These doctors had refused the temporary installation of patients in mental health services in their service with odious terms - "noisy people", "sales", "which can fire"...
Today there are movements of resistance to this case of the public service of Psychiatry, or even from caregivers or patients, led by their families. But they face two major pitfalls. The wars of chapels, so dear to generations of psychiatrists quick to excommunicating for their egos. And the image of mental illness to a population which, fault information, is not ready to accept the liberalisation of the care and the presence of mentally ill in the streets.

Why did you quit?

First, I have a "pause" on humanitarian mission, it has changed me much. Except that in return, the attitude of the management to me was also changé… It was not a frontal opposition, but small successive bullying: prohibition to visit a colleague service met during the mission, refusal of a request for training, removal of my tickets restaurant…
Directorate and took his revenge on my trade union activity and on an episode that she had not digested. At a time, due to the disastrous management of the hospital and the permanent search for economies, there was a shortage of sanitary pails for patients locked in isolation room - and therefore without access to toilets. One of them was even defecate on a sheet of Earth… There, I said no: the asylum in 1982 I had known, I would not repeat twenty years later. With a few colleagues, we therefore alerted the media. The national press has landed, but its members had accepted that the angle of the sensational. We denounce "abuse of patients by the hospital", they had included "abuse of patients by nurses. And they came to see were nurses who tortured with patients… A journalist for M6 to whom I explained our positions replied: "But it has no interest." Why you ameutez this world? »
Colleagues having opened the service to the press had been punished in an indirect way for years. I had testified to face discovered, so forcément… On the side of "abuse", following our "fuss", a commission of inquiry had been appointed. But the game was distorted, his mission was to investigate the safety of isolation rooms. Its members therefore verified that there were alarms to fire, glass armoured, etc. A shame.
It is this that led me to resign. I remain a careful and informed citizen, but I don't want to participate in this evolution. Or attend such returns back.
Ces derniers sont légions. Prenons l’exemple du maintien des patients à domicile : le principe est bon s’il s’inscrit dans le cadre du soin, avec une ou deux visites par jour ; sauf que dans les faits, il s’agit plutôt de refus d’hospitalisation et de non-assistance à personne en danger par manque de places à l’hôpital. Autre exemple : la « garde à vue psychiatrique », soit la possibilité de garder un patient 72 heures en observation. En soi, ce n’est pas une mauvaise idée, car elle permet d’optimiser l’orientation du patient. Mais dans le dispositif mis en place, il s’agit d’une « vraie » garde à vue : si le patient s’en va pendant cette période, les autorités considèrent qu’il s’agit d’une évasion. C’est révélateur.
La peur du fou est très répandue dans la société. Et politiques et médias n’hésitent jamais à l’attiser. C’est ainsi ce qu’ils font en nommant évasion le fait qu’un patient prenne la tangente, au lieu d’évoquer une sortie sans autorisation. Il ne s’agit pourtant pas d’un enfermement, mais d’une hospitalisation sous contrainte… L’enjeu de la terminologie utilisée par la presse ou par les politiques est ici fondamental.
At least, this terminology is said the arbitraire…
Psychiatric hospitals are places of lawlessness, where patients are deprived of their liberty and held for weeks without that justice does say. The France is also regularly condemned by the European Commission to the rights of man. Theoretically, there are many instances of control as the CDHP2, which can be entered by anyone. Except that bluff! The controller of the CDHP is the doctor-Chief of sideline, he receives a letter from a patient and calls her boyfriend: "Well, I got a letter from one of your patients." The buddy response: "It is totally insane." The last time it came out, he did this, done…i "In the end, there is an infinitesimal proportion of patients leaving hospital by this bias.
Psychiatry surfing at this time on a safe, drift in good part policy response to various facts. The image of the introduction of the Protection of workers isolated (ITP) in hospitals, after an intervention by Nicolas Sarkozy. It is a device as a phone, with a button on which support assault, of etc… It is also equipped with said device "human death", which fires when the casing remains too long horizontally. Go to work in the morning is saying would "I take my box 'dead man'...". ", it is the horror! And I know but former colleagues who are satisfaits…
Use a PTI device, is to accept that it does not increase the workforce. That replaced a colleague by a housing. The problem is that nurses refusing these practices are found in delicate situations. The day where they are attack - because it can happen-, the incident will not be considered as accident at work. It is vicious.

The safe, it is also the explosion from fifteen years of hospitalizations under stress (office and request for a third party). When a dedicated mamie disturbed the neighbourhood, it brings more social, family and neighbors; now, is preferred to sign a certificate of hospitalization of office. And it locked people who will find it difficult to get out. Because there is very little of reception structures to organize the output. And because it is required to settle the hospital before leaving. the amount of the hospital package for example being higher than that of the disabled adult allowance, this can be very difficult for some.
The safe, they are also cameras in the rooms - yet this is stupid: when a patient is not well, it need more presence, and not a camera. These are electronic bracelets, to be sure that this is not out of a given perimeter - which allows to avoid the accompanied by a nurse or a health care assistance. It is the increase in prefectural output test refusals. To summarize: this is the maximum confinement.