La sécurité des personnes dans les hôpitaux psychiatriques

Tout le monde se souvient de ce geste qui a horrifié la France entière dans la nuit du 17 au 18 décembre 2004 au cours de laquelle Romain DUPUIS, patient du Centre Hospitalier Spécialisé des Pyrénées à Pau, a tué à l’arme blanche une infirmière et une aide-soignante.

Actuellement interné à l’Unité pour Malades Difficiles (UMD) de l’hôpital psychiatrique de Cadillac en Gironde, le jeune homme a été déclaré pénalement irresponsable par un collège d’éminents experts psychiatres qui estiment qu’au moment de la commission de l’infraction, le discernement était aboli, l’auteur des faits étant considéré comme inaccessible à la sanction pénale. Au-delà de la procédure elle-même, cet épisode tragique et douloureux a relancé le débat de la sécurité dans les hôpitaux en général et dans les hôpitaux psychiatriques en particulier, sans évoquer les évasions régulières de malades potentiellement dangereux séjournant dans des unités spécialisées.

Certes, au lendemain des événements susdécrits, un Observatoire des violences hospitalières, piloté par la Direction de l’Hospitalisation et de l’Organisation des Soins (DHOS) du ministère de la Santé, a été créé.

Certes, le Plan Psychiatrie et Santé mentale 2005-2008, présenté le 4 février 2005 par le ministre de la Santé, a fixé 4 priorités : l’investissement hospitalier (triplement des aides prévues pour la psychiatrie par le Plan « Hôpital 2007 »), les moyens humains (moratoire sur les fermetures de lits dans les services psychiatriques, hausse du nombre d’internes en psychiatrie), l’amélioration de la formation des infirmiers et le développement des alternatives à l’hospitalisation.

Certes, le plan prévoit également 750 millions d’euros d’investissements sur 5 ans pour les hôpitaux psychiatriques.

Mais, pour l’heure, c’est une circulaire DHOS/O2 n°2006-177 qui a été publiée le 20 avril 2006 et qui est relative aux modalités de mise en oeuvre des crédits relatifs aux mesures de sécurisation des établissements de santé exerçant une activité de psychiatrie pour l’exercice 2006. ((BOSP n°2006/05 du 15 juin 2006, p. 51))

L’auteur de la circulaire insiste sur la nécessité de mettre en oeuvre un programme spécifique d’équipement des structures en petits dispositifs et travaux de sécurité, permettant de prévenir les incidents ou d’organiser à leur égard une réponse rapide et adéquate. On nous explique par ailleurs que ce programme bénéficie de l’allocation de crédits spécifiques pour l’année 2006, venant s’adjoindre aux crédits prévus au titre du plan « Psychiatrie et Santé mentale », pour un montant total de 18 millions d’euros.

Une somme qui apparaît insuffisante au regard des nécessités d’un secteur dont tous les acteurs savent qu’il est sinistré depuis plus d’une vingtaine d’années et pour lequel les ministres de la rue de Ségur ont choisi d’attendre la réalisation d’événements tragiques pour commencer à réagir. Affaire à suivre.

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