Projet ÉCHINOPS : collaborer avec les forces de l’ordre pour les échappés du système de santé

De Benedictis, Luigi; Bouchard, Amélie; Thériault, Gabriel; McGuire, William; Goulet, Marie-Hélène; Larue, Caroline

doi:https://doi.org/10.7202/1114413ar

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Objectifs Au Canada, on estime que 5 à 31 % des interventions policières se font auprès de personnes ayant des troubles de santé mentale. L’objectif de cette revue sur la littérature scientifique est de soulever une myriade d’enjeux dans l’approche de ce type de patients en communauté. Nous illustrons ensuite ce contexte avec une initiative montréalaise : le projet ÉCHINOPS (Équipe communautaire hybride d’interventions novatrices OSBL-Psychiatrie-SPVM).

Méthode Une recherche bibliographique classique large a été effectuée en juin 2022 sur Pubmed, EMBASE, PsycINFO et CINAHL, avec les descripteurs MeSH Police, Law Enforcement, Crisis Intervention, Mental Health Services, Mental Disorders, Mentally Ill Persons, Intersectoral Collaboration, Interprofessional Relations, Interdisciplinary Communication, Patient Care Team, et une quarantaine de mots-clés, pour générer plus de 1100 articles. La recherche a été effectuée sans limite de temps ni de langue. Deux membres de l’équipe de recherche ont lu titres et résumés pour éventuellement retenir une centaine d’articles. Après une recherche en « boule de neige » sur les listes de référence des articles repérés, environ 110 articles ont été retenus. La gestion documentaire a été réalisée à l’aide du logiciel Zotero version 6.0.37. Les documents inclus devaient être écrits en anglais ou en français. Nous avons ensuite organisé nos données en sections pour synthétiser les enjeux : Interactions entre patients et policiers et justice procédurale ; Usage de la force et morbidité ; Transports vers un centre hospitalier ; Judiciarisation ; Consultation et résolution de situations sur scène ; Accès à des soins de santé mentale et hospitalisations ; Expériences et satisfaction des citoyens et bénéficiaires ; Expériences et satisfaction des dispensateurs de soins ; Aspects économiques.

Résultats Depuis les 40 dernières années, la désinstitutionnalisation des services psychiatriques a conduit à une augmentation des contacts entre la clientèle en santé mentale et les forces de l’ordre. Tout en témoignant d’un changement de culture quant au rôle des agents de la paix dans la population générale, des initiatives partout dans le monde mettent en lumière un besoin grandissant de formation supplémentaire sur la maladie mentale et d’interdisciplinarité entre les services policiers et le système de santé. Cette nécessité exige l’élaboration de partenariats et de nouveaux modèles de collaboration dans la communauté.

Conclusion Composée d’infirmier(-ère)s en santé mentale et de psychiatres communautaires, l’équipe du projet ÉCHINOPS travaille en collaboration avec les corps policiers pour jouer un rôle de consultant et pour mettre en oeuvre et consolider des pratiques mixtes d’interventions psychosociales et policières de proximité dans la communauté auprès de personnes ayant des troubles de santé mentale. Le fonctionnement de l’équipe s’inspire des modèles d’équipes d’interventions mixtes dites Co-response ou Street Triage qui ont fait l’objet de plusieurs projets au Canada et dans d’autres pays occidentaux. Une telle équipe d’intervention mixte a pris son envol dans le cadre d’un projet-pilote dans l’est de Montréal depuis janvier 2022.

Mots-clés :

police,
psychiatrie communautaire,
équipe mixte,
nursing

Abstract

Objectives In Canada, it is estimated that 5 to 31% of police interventions involve people with mental health disorders. The objective of this review of the scientific literature is to raise a myriad of issues in the approach to these patients in the community. We then illustrate this context with a Montreal initiative: The ÉCHINOPS Project (Hybrid Community Team for Innovative Interventions NPO-Psychiatry-SPVM).

Method A bibliographic search was carried out in June 2022 on Pubmed, EMBASE, PsycINFO and CINAHL, using MeSH words Police, Law Enforcement, Crisis Intervention, Mental Health Services, Mental Disorders, Mentally Ill Persons, Intersectoral Collaboration, Interprofessional Relations, Interdisciplinary Communication, Patient Care Team and about 40 different key words, leading us to more than 1100 articles, regardless of the time and language of publication. Two members of the research team read the titles and abstracts to retain about 100 articles. Snowball research of bibliographies eventually lead to a sample of about 110 articles. We used the software Zotero version 6.0.37 to manage the sample. They had to be published either in French or English. We then organized our data into sections to summarize the issues: Interactions Between Patients and Police Officers and Procedural Justice; Use of Force and Morbidity; Transport to a Hospital Center; Judicialization; Consultation and Resolution of Situations on Stage; Access to Mental Healthcare and Hospitalizations; Experiences and Satisfaction of Citizens and Beneficiaries; Experiences and Satisfaction of Healthcare Providers; Economic Aspects.

Results Over the last 40 years, the deinstitutionalization of psychiatric services has led to an increase in contacts between mental health patients and law enforcement. While demonstrating a cultural change regarding the role of police officers in the general population, initiatives around the world highlight a need for additional training on mental illness and growing interdisciplinarity between police services and the healthcare system. This need requires the development of partnerships and new models of collaboration in the community.

Conclusion Made up of mental health nurses and community psychiatrists, the ÉCHINOPS Project team works in collaboration with police forces to play a consulting role and to implement and consolidate mixed practices for people with mental health issues. The team’s operation is inspired by the models of mixed intervention teams known as “Co-response” or “Street Triage” which have been the subject of several projects in Canada and other Western countries. A mixed intervention team has taken off as part of a pilot project in Montreal’s East-end since January 2022.

Keywords:

police,
community psychiatry,
collaboration,
nursing

Parties annexes

Bibliographie

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