L’implication de l’entourage dans la décision d’hospitalisation en psychiatrie, via des soins à la demande d’un tiers (SDT), a pu être remise en question ces dernières années, notamment pour limiter l’impact émotionnel chez le tiers. L’objectif principal de cette étude était d’évaluer si le fait d’apporter au tiers des informations sur les soins sans consentement (SSC) avait un impact sur son vécu de la SDT. Les objectifs secondaires étaient les suivants : identifier d’autres facteurs pouvant impacter le vécu du tiers lors de la mise en place de SDT, et évaluer l’impact de celle-ci sur la relation entre le tiers et son proche hospitalisé, ainsi que les facteurs pouvant l’influencer.

Un questionnaire a été adressé à des membres d’une association de proches de patients atteints de troubles psychiatriques (UNAFAM), ayant déjà été tiers dans le cadre de SDT.

Parmi les 166 répondants, 85 (51,2 %) avaient reçu des informations concernant les SSC, et on retrouvait chez eux un soulagement plus fréquent au moment de l’hospitalisation (p<0,01) et à distance (p<0,01), et un sentiment de violence vis-à-vis de leur proche moins fréquent à distance de l’hospitalisation (p=0,02), comparativement à ceux n’ayant pas reçu d’informations. L’impact négatif de l’hospitalisation sur la relation entre le tiers et son proche hospitalisé était plus faible (p=0,04) chez les tiers ayant reçu des informations.

Rencontrer les tiers pour leur donner des informations sur les SSC au moment d’une SDT pourrait améliorer son vécu de la situation et limiter l’impact négatif de l’hospitalisation sur sa relation avec son proche.

In France, the family and friends of a patient with a psychiatric disorder can legally be involved in the decision to involuntary admission to psychiatry through care at the request of a third party. This involvement has been questioned in recent years, notably to protect this third party. The main objective of this work was to assess whether providing the third party with information on care without consent when providing care at the request of a third party (SDT) had an impact on the third party's experience. The secondary objectives were to identify other factors that might impact the third party's experience of the SDT, and to assess the impact of the SDT on the relationship between the third party and his or her hospitalized relative, as well as the factors that might influence it.

The study was based on a questionnaire, constructed after meeting several members of an association of relatives of patients with psychiatric disorders : UNAFAM. This questionnaire questioned the context of hospitalization, the information provided concerning care without consent, the experience of the third party at the time of hospitalization and at a distance, and the impact of hospitalization on the relationship between the third party and his or her hospitalized relative, both at the time of hospitalization and at a distance. This questionnaire was then sent to UNAFAM members in three randomly selected regions. It was specified that it was only intended for people who had already been a third party during SDT. The results were received anonymously.

Among the 166 respondents, 85 (51.2 %) had received information about involuntary admission, and there was more frequent relief at the time of hospitalization (P<0.01) and at a distance (P<0.01), and less frequent feelings of violence towards their loved one at a distance from hospitalization (P=0.02) compared to those who had not received information. The negative impact of hospitalization on the relationship between the third party and their hospitalized relative was lower (P=0.04) among third parties who received information. The fact that the doctor was perceived as being mainly responsible for the decision to hospitalize also preserved the third party's experience and relationship with his or her relative. However, third parties who understood their involvement as an administrative necessity reported less frequent relief (P=0.01), and the negative impact of hospitalization on their relationship with their relative was higher (P=0.01). Conversely, the fact that they felt integrated into the care and listened to by the health care team was correlated with a better experience of the situation by the third party, and a lesser negative impact of hospitalization on the relationship between the third party and their relative.

Providing information to the third party about involuntary admission at the time of an SDT could improve his or her experience of the situation and limit the negative impact of hospitalization on his or her relationship with his or her loved one. Although it seems important for the third party to feel that the majority of the decision to hospitalize is made by the physician, including him/her in this decision could improve his/her experience of the situation and limit the negative impact of hospitalization on the relationship between the third party and his/her family member.