V. Jardon a, ⁎ 
, C. Debien a, S. Duhem b, M. Morgiève c, d, F. Ducrocq e, G. Vaiva a, f, g
, C. Debien a, S. Duhem b, M. Morgiève c, d, F. Ducrocq e, G. Vaiva a, f, g
a Pôle
de psychiatrie, médecine légale et médecine en milieu pénitentiaire,
hôpital Fontan, rue André-Verhaeghe, CHU de Lille, 59037 Lille, France
b Inserm, centre d’investigation clinique, CHU de Lille, 59037 Lille, France
c Centre de recherche médecine, sciences, santé, santé mentale et société (Cermes3), CHU de Lille, France
d Institut du cerveau et de la moelle épinière (ICM), hôpital Pitié-Salpêtrière, 47, boulevard de l’Hôpital, 75013 Paris, France
e Pôle de l’urgence, hôpital R.-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59037 France
f SCA-Lab UMR 9193 CNRS, faculté de médecine pôle recherche, 1, place de Verdun, 59045 Lille, France
g Fédération régionale de recherche en psychiatrie et santé mentale des Hauts-de-France, 3, rue Malpart, 59000 Lille, France
L'encéphale Sous presse. Épreuves corrigées par l'auteur.
Disponible en ligne depuis le dimanche 25 novembre 2018
Résumé |
Les
tentatives de suicide constituent un facteur de risque majeur de
récidives et de décès. Les comportements suicidaires sont polyfactoriels
et rendent inefficace une stratégie unique de prévention. L’adhésion
aux soins est mauvaise dans un contexte où les liens sociaux sont
souvent en souffrance. Deux catégories de programmes ont montré leur
efficacité : les dispositifs d’intervention intensive et les dispositifs
de veille. Ces derniers peuvent recouvrir différentes modalités :
envois de courriers, remise de carte de crise comportant un numéro
d’urgence, rappels téléphoniques. Un essai contrôlé randomisé, ALGOS, a
combiné ces différentes stratégies dans l’algorithme suivant :
délivrance d’une carte de crise pour les primosuicidants ; rappel
téléphonique des non-primosuicidants 15jours
après leur sortie des urgences ; envoi de cartes postales
personnalisées mensuellement pendant 6 mois en cas d’échec de l’appel ;
information du médecin traitant. Cette étude a été adaptée en soins
courants en 2015 dans les départements du Nord et du Pas-de-Calais sous
le nom de VigilanS. L’algorithme a été légèrement modifié par la remise
de la carte de crise à tous. L’équipe de recontact, formée à la gestion
de crise, gère tous les appels sortants et entrants vers les patients,
leurs proches et leurs soignants. Un jeu de 4 cartes postales peut être
envoyé en cas d’appel téléphonique non concluant. S’appuyant sur une
philosophie de veille, VigilanS a développé un véritable savoir-faire de
gestion de crise, nécessitant une supervision médicale constante et de
solides capacités de mise en réseau.
Abstract |
Background |
Attempted
suicide is a major risk factor of further re-attempts and death.
Self-harm behaviors are related to multiple causes explaining why it is
ineffective to have a single and simple strategy to offer after the
clinical assessment in reducing morbidity and mortality. Furthermore,
treatment adherence is known to be especially poor in a context where
social connection seems compromised and a source of pain. Effective
interventions can be divided into two categories: intensive intervention
programs (care at home, supported by a series of brief psychotherapy
interventions) and case management programs that rely on a “stay in
contact” dimension. These programs, initiated by Jerome Motto and its
short letters may consist of: (1) sending letters or postcards after
discharge of the ER; (2) giving a crisis card that offers a crisis
telephone line and a crisis unit for hospitalization if needed, and; (3)
placing a phone call at some time distance after the discharge. The aim
is to enhance a “connectedness feeling” with the patient. These
different strategies have proven to be even more effective in some
specific subgroups, highlighting the heterogeneity of this population.
Each modality of contact was well accepted and generated a positive
involvement of the patients.
Method |
It
led to the idea of combining these different strategies in an algorithm
built on the specificity of identified subgroups. A randomized
controlled trial, named ALGOS was carried out in France to test this
algorithm in 2011. The algorithm consisted of: (1) delivering a crisis
card for first attempters; (2) giving a phone call for re-attempters to
re-assess their situation between the 10th and 21st day after their
discharge, and to propose a new intervention if needed, and; (3) in case
of an unsuccessful call or a refusal of proposed care, sending
personalized postcards for 6 months. All of this was supported with
shared information to the general practitioner of the patient. This
study was further adapted to routine care in 2015 in the northern
departments of France, Nord and Pas-de-Calais (4.3 million people),
taking the name of VigilanS. The inclusion consists of sending a form
for every patient assessed after a suicide attempt in the two
departments to the medical staff of VigilanS in order to provide
information about the patient and the context of his suicide attempt.
The algorithm has been modified in giving the crisis card to all the
patients whether it is a first attempt or not. An information letter,
explaining the aim of the monitoring is also given to the patient, and
to his general practitioner. The calling staff is composed of 4 nurses
and 4 psychologists, all trained in suicidal crisis management. They use
a phone platform located in the Emergency Medical Assistance Service
(SAMU) of the Nord department on a halftime basis and manage the
incoming calls from the patients as well as the outgoing calls towards
the patients, their relatives and their medical contacts. A set of
4 postcards (1 per month) can be sent if needed in case of an
inconclusive or a failed phone call.
Conclusion |
Built
on a monitoring philosophy, VigilanS has further developed a real
crisis case management dimension requiring enough time to insure an
effective medical supervision and strong networking abilities. A
specific time is also needed to take care of all the technical aspects
of the organization. This program expertise, designed by Northern
departments to prevent suicide, can be shared with other French or even
foreign territories.
Le texte complet de cet article est disponible en PDF.
Mots clés : Arbre décisionnel, Évaluation, Prévention, Suicide, Surveillance, Téléphone
Keywords : Decision tree, Assessment, Prevention, Suicide, Monitoring, Telephone