Bien que la Cour de Cassation ait rappelé que le juge ne pouvait se substituer à l’avis médical, 29,5 % des mainlevées étaient motivées par l’absence de critères d’admission en soins psychiatriques sans consentement (SPSC). Nous avons comparé le contenu des certificats médicaux issus de dossiers de mainlevées justifiées exclusivement par l’absence de critères d’admission à des certificats témoins issus de dossier qui n’ayant pas fait l’objet de mainlevée.

Nous avons inclus comme cas tous les certificats médicaux obligatoires issus de dossiers de mainlevées exclusivement justifiées par l’absence de critères d’admission survenues au Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences du 1^er novembre 2017 au 31 octobre 2018. Une note globale évaluant le contenu et l’argumentation (description de l’évolution clinique et symptomatologique, niveau de discernement, capacité de consentement et du mode de SPSC) leur était attribuée.

Soixante-quinze certificats médicaux ont été comparés à autant de certificats témoins. La note globale était plus basse en cas de mainlevée (2,92±1,08 contre 3,28±0,88 chez les témoins, p=0,026). Les avis motivés issus des dossiers de mainlevée décrivaient moins souvent la symptomatologie psychiatrique (58,8 % contre 94,1 % chez les témoins, p=0,015). Ce défaut était associé à un risque 12,51 fois supérieures de mainlevée (IC 95 %=[1,16 ; 135,19], p=0,038).

Les mainlevées motivées exclusivement par l’absence de critères d’admission témoignent d’un réel défaut de rédaction des certificats médicaux. Des travaux doivent se poursuivre pour en identifier les facteurs et obtenir des médecins qu’ils soignent mieux leur rédaction pour mieux soigner leurs patients.

In France, a systematic control of compulsory psychiatric admissions has existed since the enactment of the law of July 5th 2011. The Court of Cassation clarified that the liberty and custody judges (JLD) cannot supersede the medical opinion described in the medical certificates. In 2015, the JLD ordered the release of 8.4 % of all compulsory psychiatric admissions. The goal was to compare the quality of medical certificates derived from judicial release based on medical grounds with non-released witnesses from the cohort of compulsory psychiatric admissions ordered in the Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences (GHU-Paris) between November 1, 2017 and October 31, 2018.

We included as cases all the medical certificates derived from judicial release based exclusively on medical grounds from the release cohort of the GHU-Paris from November 1, 2017 to October 31, 2018, concerning the systematic control 12 days after compulsory psychiatric admissions. A witness whose compulsory care had been maintained was matched according to the same judge, place and date of hearing, mode of compulsory care and site of hospitalization. Each certificate was analyzed according to a reading grid relating to the good decisions in matters of compulsory admission and medical certificates’ redaction. An overall score, based on the description of the clinical and symptomatic evolution, the level of discernment, the capacity of consent and the mode of compulsory care was awarded to each certificate.

Seventeen release files were included in the comparative study. Globally, the clinical progression, psychiatric symptoms, level of consciousness and ability to consent did not differ in the two groups. The grade of quality of certificate was lower in case of withdrawal (2.92±1.08 VS 3.28±0.88, P=0.026). Psychiatric symptoms in “justifiable notice” (the last medical certificate prior to the judicial hearing) were less specified in case of withdrawal (58.8 % VS 94.1 %, P=0.015). Not describing any symptoms led to a 12.51 risk of withdrawal (95 % CI=[1.16; 135.19], P=0.038). Even with witness certificate, clinical progression was noticed in only 85.3 % of cases, in 89.3 % of psychiatric symptoms, in 68.0 % of level of consciousness and 80.0 % for the ability to consent.

Judiciary releases of compulsory psychiatric admissions exclusively based on medical grounds are not arbitrarily decided by the JLD but are based on a failure to draw up medical certificates. Doctors must comply with a careful drafting of all medical certificates: description of symptoms, clinical course, level of consciousness and ability to consent. It is necessary to be attentive to judiciary releases based on medical grounds to evaluate and improve medical practices concerning the drafting of medical certificates.