L’accueil familial thérapeutique de patients atteints de troubles mentaux est une spécificité ancienne du centre hospitalier spécialisé d’Ainay-le-Château. En parallèle à la prise en charge psychiatrique, une prise en charge somatique est assurée par des médecins généralistes dont le rôle est le suivi médical au quotidien des patients, y compris pendant les hospitalisations dans les unités internes du centre hospitalier, l’assurance de la mise en place des actions de prévention en santé publique, la surveillance des comorbidités des traitements antipsychotiques. Faisant office de médecins traitants, les praticiens participent au projet de réhabilitation des patients en offrant une prise en charge organique complète et rapide, en diminuant le nombre et la durée des hospitalisations institutionnelles, en anticipant les effets secondaires des thérapeutiques psychiatriques. Les médecins généralistes assurent aussi la prise en charge de la douleur, les consultations spécialisées externes, la surveillance des bilans biologiques et une prise en compte des pathologies graves engageant le pronostic vital par la mise en place de soins palliatifs et d’accompagnement. Les patients hospitalisés en accueil familial thérapeutique au centre hospitalier spécialisé d’Ainay-Le-Château bénéficient ainsi d’un accompagnement mixte et complet associant la réhabilitation psychiatrique et une surveillance médicale complète tout au long de leur hospitalisation, y compris, pour certains patients, pour des projets à long terme. Nous présentons dans cet article l’organisation médicale de cette prise en charge et ses spécificités.

Foster care is a therapeutic specificity of Ainay-le-Chateau Hospital (Allier, France). The goal of foster care is to promote the rehabilitation and reintegration of the patient. It combines support by a care giver and institutional care. It offers to patients who cannot live alone, but do not justify in-patient care, a therapeutic care in a stable family environment. An initial treatment plan determines the duration of the stay, more or less long term. In addition to psychiatric care, a somatic treatment of patients is organized by qualified practitioners in general medicine. These practitioners provide medical monitoring of patients. Every patient benefits from a treatment plan including monitoring of medication side effects, medical comorbidities and prevention. General practitioners work in collaboration with the nearby General Hospital when an admission is needed for any medical or surgical condition. They can also admit patients in a 10 beds unit within our institution. The hospital specializes Ainay-le-Chateau has adopted a medical organization that provides follow-up for major comorbidities according to present recommendations in this field, thus adding an important element of rehabilitation. Medical consultation assesses vital parameters of patients, monitoring of side effects, nutritional evaluation, and prevention of malnutrition (in partnership with a dietician), assessment of pain, psychiatric comorbidities. Screening protocols are organized for cancer. These protocols are established in accordance with the recommendations of the High Authority of Health. In addition to general medical activity, two consultations have been implemented and validated by the decision-making bodies of the hospital, a follow-up consultation for chronic pain and a specific evaluation of daily autonomy. Pain in psychiatry is often difficult to assess in-patients with mental illness and the usual scales of assessment may be difficult to implement. This consultation provides weekly monitoring of chronic pain patients and the adaptation of analgesics, in partnership with psychiatrists to avoid drug interactions with psychotropic drugs. This consultation also allows anticipating possible hospitalizations and allowing patients to take maximum advantage of the rehabilitation project of foster care. Considering the relatively high proportion of elderly patients, a specific consultation has been established to evaluate daily autonomy in this age group, in order to prepare admissions in institutions for old age patients whenever necessary. During this consultation are evaluated cognitive abilities of the patient, the risk of fall, nutritional parameters, independence from the grid resource AGGIR iso 2 and occupational activities. Care givers provide information to complete this assessment.