Last week, a man fatally stabbed his neighbor in Faa’a. The investigation is still ongoing. But the suspect, suffering from psychiatric disorders, would have been out of care. This was also the case of the man shot dead by mobile gendarmes in early January. Or even the minor who had stabbed a student at Henri Hiro college, before ending his life in detention. Could these tragedies have been avoided if these patients had continued their medical treatment? Violent acts of people with psychiatric disorders are in fact very rare…and they remain mostly victims of violence.
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“I wanted to know where it was for …, in fact we are waiting for it”, asks Ludivine Togna on the phone, care coordinator nurse.
This patient, expected in the psychiatric department for her follow-up, will not come. The medical team is concerned, but does not let her go.
Ludivine Togna intervenes in the early detection of psychiatric pathologies, from the age of 16. Changing the image of psychiatry, breaking taboos, to better support patients and their families. Because the earlier treatment begins, the less chronic risk there is.
But decompensations (degradations) and relapses are also part of the daily life of these caregivers. “I would not say that we are used to it, of course it is experienced as a failure for us, we try to do the maximum. We do psycho-education which makes patients aware that it’s a disease, it can be treated and it’s important to have a treatment, that you can’t get out of it on your own”, explains Ludivine Togna.
“You have to realize that the brain is an organ that is also damaged and can also be sick, like many other diseases that cannot be seen”
Martin and Yesica return from their home visitation tour. Between them, they follow 69 patients in Faa’a and Moorea…Essential links in the follow-up of these chronic diseases, and to avoid a break in care. “Each patient has their own reason for stopping it, after as a general rule, it is part of the symptoms which is the denial of the disease. So the non-acceptance of care. All our work is there: to make the patient understand the disease , to the family, to the entourage, to accompany them in everyday life“, emphasizes Martin Tevenon, a state-certified nurse in psychiatry.
Yes, but here we are, the geography of Polynesia does not allow equitable access to care for all patients. Only two centers exist: in Papeete and Taravao. Missions take place regularly, depending on the isolation of the islands. Some patients only see their psychologist or psychiatrist once a year. No hospitalization structure either for the care of drug addicts, when we know that certain psychotic disorders lead to an appetite for addictive substances.
Psychiatric pathologies still suffer from a taboo. Mental illnesses sometimes cause shame or fear. And the tolerance of those around you can also delay access to care.
Finally, the supply of care remains insufficient in relation to the number of inhabitants. Only 12 psychiatrists per 100,000 inhabitants. This is almost twice less than in France, which has 23 psychiatrists per 100,000 inhabitants, one of the highest ratios in Europe. “People who suffer from severe psychiatric disorders are more victims in fact of violence, of the dangerousness of others, or of harming themselves before harming others. Finally, it can exist in certain very rare situations”says Dr. Johan SEBTI, head of the psychiatry department.
Addictions (paka, alcohol, ice cream) or a violent environment increase the risk of aggressive action. Justice pronounces individualized sentences. The impairment of discernment must be medically established. It will be taken into account to also judge the dangerousness of the defendants and the attenuation of their responsibility at the time of the facts.. “When there is an attenuation, of course it is taken into account by the jurors and the magistrates. But when we are not in the attenuation in relation to the psychological and psychiatric profile, the sentence is indeed adapted to the profile of the people. Hence the interest in carrying out expert appraisals of these people, and here we have a real problem in finding psychiatric experts”notes Thomas Pison, Attorney General at the Papeete Court of Appeal.
There are no figures on the number of prisoners suffering from a psychiatric illness.
In the event of a break in care, the doctors first advise the families to talk about it with the patient so that he resumes his treatment, to appeal to associations (SOS Suicide or Taputea Ora) or to contact the care teams or Samu.
A 2015 WHO study found that 40% of the Polynesian population suffered from past or current mental disorders.
