With progressing needs, and chronic saturation of beds in psychiatry, day hospitalization (HDJ) remains an often overlooked device. However, it represents an innovative, intensive mode of management, and resolutely turned towards psychosocial rehabilitation.
“The public, like some practitioners, still associates HDJ with old devices, with a little intensive offer, or reserved for very disorganized profiles. However, what we offer is an intensive, modern program, based on convincing data and turned towards rehabilitation. But as long as this reality is not better known, patients will remain without access to these care”, regrets Dr. Florian Coromines, a liberal psychiatrist practicing in the Saint Luke psychiatric clinic in Nice.
This clinic has 49 beds in full hospitalization. Since the release of the pandemic, this service has not been full. In parallel, day hospitalization, however with advanced therapeutic programs, is not always full. “This situation illustrates a deficit in knowledge of the system, both on the side of professionals and the general public”, comments Dr Coromines, who ensures responsibility.
A second line treatment, to avoid relapse or get out of the spiral of sick leave
Patients hospitalized in this unit should be sent by a psychiatrist. “When I meet a patient for the first time, I rely on the mail of my colleague, but I conduct an interview as if it were a first contact. I ask him: what are your projects and your needs?” Because here, the objective is clear: to avoid, when possible, complete hospitalization, accompany resistant disorders, or support a return to autonomy over time.
Disorders requiring active care
“We receive patients with severe, resistant, sometimes chronic depressions, disabling anxiety, or even personality disorders.” The setting is deliberately intensive: several half-days, or even days per week, with targeted therapeutic groups. “Many of our patients have been arrested, sometimes for a long time, and fail to resume a professional activity. Their disorders require active care.”
And this is one of the major assets of HDJ (1): “We offer groups of cognitive behavioral therapies, diagrams, cognitive remediation or even dialectical therapy. These are scientifically validated care, but only patients can benefit from patients who have the means to pay consultations (HDJ is taken care of by health insurance, editor’s note).”
Objective of these intensive activities: prevent the worsening of disorders, the appearance of comorbidities and promote recovery. “” Chronic anxiety slowly affects the brain, in particular the hippocampus (brain structure which plays a central role in cognition, memory, learning and location in space, editor’s note). We see patients sometimes only 40 years old who are developing cognitive disorders -reversible -pouvant evoking, wrongly, a neurodegenerative disease like Alzheimer’s, linked to their massive, permanent anxiety. “ Thanks to cognitive remediation workshops, patients relearn how to mobilize their memory, their attention, their mental flexibility. “” These are altered functions in anxious and depressive disorders. The brain is rehabilitated. “
A care against isolation
Dr. Florian Coromines points to another important virtue of HDJ: ending isolation.
“Some patients welcomed at HDJ had not left their home for weeks. We are working with approved taxis so that they can come. Without this, many of them would be completely isolated. Avoidance is the fuel of anxiety. We must create the conditions for a progressive return to the social bond.”
Among the reconstruction stories, that of a patient today inserted, has an exemplary value. “I knew him in the midst of a crisis, I first hospitalized him, then welcomed in a day hospital. He followed a therapeutic education in depression, resumed his work, and today, I am in liberal. He is fine.”
In this flexible but structuring device, caregivers believe in recovery, provided that the means follow. “”Working here is being able to offer a real care. Without the day hospital I would be limited in what I could offer to patients. ” A strong conviction, at the heart of a system in tension.
1- This work is made possible thanks to the commitment and competence of a qualified and motivated multidisciplinary team, made up of two neuropsychologists, a nurse, a caregiver, a care manager and a medical secretary, coordinated by Dr Florian Coromines.
“Make known day hospitalization to treat better”
“Make the day’s hospitalization known to treat better”. This is the objective of Alix Vallespi, director of the Saint Luc clinic and Dr Florian Coromines, psychiatrist responsible for HDJ. Cross interview.
What are the indications of an HDJ?
It concerns patients with psychiatric disorders which require follow -up, without breaking with their daily lives; Some of our patients work, have children. Thanks to the day hospital, they can receive care while remaining in real life. The device makes it possible to preserve a subtle balance between continuity of care and support in the social fabric.
How is this HDJ organized?
The unit has 20 places for modular days or half-days, depending on the needs: a few mornings, or afternoon, or sometimes several days per week. And we continue to offer a meal on site, because this informal moment is precious for patients with social isolation. This time has also disappeared in other structures, for budgetary reasons. A pricing reform makes the model of full days less advantageous than before, where the meal was valued in invoicing.
Can we go so far as to accommodate a patient five days a week?
It happens. But it is temporary and always motivated by a clear clinical necessity. As soon as this is no longer justified, the frequency is reduced.
The challenge is not to allow dependence on the system to settle; The goal is empowerment, not chronicization.
Day hospitalization must have a start and an end. The care project is always reassessed: I see patients very often. And if one objective is achieved, we can set another.
And after HDJ?
The team watches during hospitalization to maintain outing projects, voluntary interruptions or therapeutic breaks to prevent sustainable installations without justification.
However, the post-hospital remains a challenge. We still miss downstream structures. Partnerships are forging with other structures.
What do you think is still obstructing the use of day hospitalization?
Behind the care courses hides deep resistance: the fear of hospitalization in psychiatry, in general. For many patients, accepting hospitalization, even during the day, is like admitting that they have “touched the bottom”.
And yet it is often a saving step. Many say then: “I had a distorted image”. Hence the urgency of better aware of the day hospitalization, as a prevention tool. This could avoid aggravations, even dramas.
An increasingly vulnerable youth
Another concern front for mental health professionals: young adults. The structure is increasingly welcoming patients aged 18 to 25, isolated, out of school, outdated. “Some have massive isolation, a loss of link with the outside world, which may make one think – in an attenuated form – to Japanese hikikomori, these young cuts from the world for months, even years. This is not exactly what we observe here, but some features are getting closer. Among my patients, I have a patient in this situation; She was hospitalized for four months. She is now followed here, she is better, she comes out. Supporting these patients is the obstacle course, but there is no fatality, ”insists Dr. Coromines.
