[French psychiatric therapeutic system for adults, an overview of mental health legislations].
In this article, the authors present an overview of the current French psychiatric therapeutic system for adults and legislation focusing on hospitalization procedures and patients' rights advocacy. The aim of this article is to compare the psychiatric therapeutic system in France with that in Japan and to reflect on problems related to involuntary hospitalization in Japan, especially "hospitalization for medical care and protection." French psychiatry has been developing for about 150 years, and is based on the 1838 Statute (la loi 1838). Historically, J-E. Esquirol, defined two modalities of hospital admission: voluntary hospitalization and compulsory hospitalization. The 1838 statute also stipulated in-patients' rights. In the 1960's, the sector psychiatric therapeutic system, "sectorisation," was introduced in France. According to this system, the continuity of treatment is regarded as important and all people with psychiatric disorders are treated continuously by the same therapeutic team in a sector that comprised of 70,000 inhabitants. Following this, the psychiatric ordinance of 1986 defined additionally 12 types of new therapeutic structures. It elaborated French community psychiatry with various intra-/extra-hospital institutions, and also encouraged "hospitalization with consent" (Hospitalisation libre), thus placing more importance on the subjective judgements and autonomy of patients. In accord with "sectorisation", the law of 1990 concerning hospitalization and the advocacy of inpatients' rights defined new procedures of psychiatric hospitalization: "hospitalization at the request of a third party" (Hospitalisation sur demande d'un tiers) and "compulsory hospitalisation" (Hospitalisation d'office). The reform of the law in 2011 went so far as to change the name of each category of admission: i.e. substituting "psychiatric medical care" for "hospitalisation". It also introduces an evaluation system to review involuntary hospitalization after 24 hours, 72 hours and 15 days during the early stages of hospitalization. This demonstrates the importance of judicial inspection in advocating for clients in determining the continuation of the psychiatric hospitalization. In discussion, we propose three suggestions in terms of quality of treatment and patients' rights advocacy concerning the future reform of psychiatric legislation in Japan: 1) institute an evaluation system to examine the validity of involuntary hospitalization, especially in the early phase of hospitalization; 2) recognize the necessity of making third parties such as Psychiatric Review Board or the courts responsive to the needs of psychiatric patients 3) ameliorate the Japanese Protector System for patients to bring it in line with contemporary contractual treatment of patients and to show a greater respect for patients' autonomy.
Omiya Kousei Hospital.
Kazunari
K
Oshima
Yuichiro
Y
Abe
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D005602:France; D006801:Humans; D007564:Japan; D008603:Mental Health / Q000331:legislation & jurisprudence*; D028701:Patient Rights / Q000331:legislation & jurisprudence