La formation des professionnels en psychiatrie légale : résultats d’une enquête en Occitanie

Abstract

Objectives

Since the enactment of the French law of 4 March 2002, patients’ rights have been the subject of constant legislative evolution and particular attention from many independent administrative authorities. In psychiatry, these have led to numerous legal reforms over the years. Moreover, psychiatry is a medical specialty with abundant, long-standing and more than ever topical interactions with the judicial system (psychiatric care without consent, isolation and restraint, court-ordered care, psychiatric care in prisons, treatment of perpetrators of sexual violence, judicial expertise or the question of lack of criminal responsibility due to a mental disorder). In response to the many legal questions asked by medical and paramedical teams, and to the growing interest in research in forensic psychiatry, a unit called EPL (Espace de Psychiatrie Légale) was created, composed of a multidisciplinary team, based in the department of Haute-Garonne, France. In order to adjust its scope of intervention, a questionnaire was distributed to mental health professionals to assess their training needs in forensic psychiatry. In this article, we aim to present and discuss the results of this survey.

Methods

We used a self-assessment survey designed by the multidisciplinary team of the EPL and which was filled out online by the respondents. The target population was all the professionals working in mental health facilities, members of the FERREPSY Occitanie research federation. The questionnaire consisted of several sections relating to the respondents, the typology of patients under their care, the professionals’ daily practice, and training in and knowledge of forensic psychiatry. We included some open-ended questions on the situations encountered that may have presented difficulties and on the impact of legislative changes on the daily practice of professionals. All responses were analyzed anonymously.

Results

From 05/05/21 to 17/07/21, 155 professionals responded. Most of them were psychiatrists (32.3%), healthcare managers (20.6%) or nurses (18.7%). The majority were women (78.7%) and had been working in Haute-Garonne for more than 5 years (74.2%). 56.1% of the professionals worked in outpatient units, 37.4% in inpatient wards and 74.8% in adult psychiatry. This questionnaire revealed a strong need for training in forensic psychiatry. Indeed, 94.8% of respondents wanted to receive training in forensic psychiatry, which contrasts with the number of people who had already received training in this area (15.5% in initial training, 32.3% in continuing education). The results highlighted that the most common forensic situations encountered in daily clinical practice concerned areas where professionals considered their knowledge to be insufficient. In addition, the self-assessment scales used were able to highlight specific training topics that should be developed.

Conclusions

The results of this survey therefore establish a basis for making adjustments to future educational interventions involving forensic psychiatry, which, although it has only recently emerged in France, embraces issues that have always concerned the management of patients receiving psychiatric care.