Aux portes de la rue ou quand les institutions produisent l’exclusion : les sortants d’hôpitaux psychiatriques

Homelessness and Research: Methodological Obstacles and Lessons Learned from a Psychological Study in Parisian Homeless Services

“…We believe that some of these concerns were based on common misunderstandings that exist in France on the dichotomous roles of social and medical services in providing care for the homeless population [12,34]. Shelter staff members are not trained in psychology or psychiatry, and they do not have the time or resources to provide such care.…”

“…Shelter staff members are not trained in psychology or psychiatry, and they do not have the time or resources to provide such care. Homeless institutions, for example, frequently complain that psychological and psychiatric services are not sufficiently present onsite [12,13]. As a result, social service and shelter staff do not have the opportunity to understand the role of a psychologist or psychiatrist because they are not present when the interventions occur.…”

“…As a result, social service and shelter staff do not have the opportunity to understand the role of a psychologist or psychiatrist because they are not present when the interventions occur. It is perhaps for this reason that psychiatric services frequently report receiving inappropriate referrals from homeless shelters for individuals who actually require social, rather than psychiatric, interventions [12]. Furthermore, psychologists and psychiatrists lack understanding of the particularities of the homeless population and do not always consider their needs sufficiently, for example when organizing discharge after a period of hospitalization [12].…”

“…Research into the psychological rehabilitation of homeless people is lacking in France. Social workers engaging with homeless people may also lack appropriate training to recognize the need for referral to a psychologist [12]. More data are essential, as well as more research into tackling homelessness from a psychological standpoint [13,14].…”

Entretenir les possibles

“…Bien que les espoirs portés par les activistes de ces mouvements aient laissé place à certaines désillusions, notamment liées à des récupérations de leurs revendications par une politique libérale du « moindre coût » et au constat d'abandon de certains malades se retrouvant à la rue ou sans soin (Baillon, 1998;Baronnet et Alberghini, 2018;Henckes, 2018;Saint-Arnaud, 2001), il faut reconnaître que la remise en question de l'hôpital psychiatrique comme institution forte a débouché sur un véritable « virage ambulatoire » (Vanier, 1996) observé, à des degrés et sous des formes variables (Eyraud et Velpry, 2014;Piérart et al, 2014), dans la plupart des pays occidentaux. Comme le souligne Nicolas Henckes, elle a donc largement participé à l'évolution des modes de prises en charge des personnes touchées par les troubles mentaux : Si des voix isolées défendent la nécessité de conserver des lieux d'asile pour accueillir les personnes les plus vulnérables, c'est dans des structures mieux insérées dans le tissu social et à bien des égards désinstitutionnalisées que sont cherchées les solutions.…”