Saturday December 2, Armand R., aged 26, was arrested after the stabbing murder of a German-Filipino tourist in Paris. Two other people were also injured with a hammer by this suspect, who was “affected by serious psychiatric disorders” and presented a “psychotic profile”. How are patients who could potentially be dangerous treated? The answers of Dr Michel David, psychiatrist and former president of the French Federation of Psychiatry.
Armand R, young man of 26 years old “suffering from psychiatric disorders and presenting a psychotic profile“, is the main suspect in the attack which took place on Saturday December 2, 2023 in Paris. The man is accused of having killed a German-Filipino tourist with a knife and of having injured two other people, using with a hammer.
How are dangerous patients treated in psychiatry? The answers of Dr Michel David, psychiatrist and former president of the French Federation of Psychiatry.
Differentiate between radicalization and mental illness
First of all, the doctor wants to clarify an important point: distinguishing between the radicalization of a suspect and the presence of a mental pathology. “The dangerousness of an individual can be criminal or psychiatric. Al Capone, for example, was criminally dangerous, but was not affected by psychiatric danger.“first defines the doctor.”Then, whatever the ideology, whether religious, political, environmental… In this case, the psychiatrist does not have to intervene.”
What to do when dealing with a dangerous individual due to mental illness?
The case where the psychiatrist plays a role is therefore the one where the patient presents psychiatric danger, due to a mental pathology which would lead him to act out. “When a patient says that he hears voices that have dictated something to him, for example. In this case, the psychiatrist can treat the patient, even without his consent, there is a legal exception which allows this” adds the psychiatrist.
In which case should the patient be hospitalized?
The hospitalization of a patient without their consent is governed by two main methods: it will be done at the request of a third party, who alerts them to the state of health of their loved one. “This represents 80% of hospitalizations without consent” explains Dr. David. “A psychiatrist must confirm that the condition of the patient in question requires hospitalization and the patient will be admitted”.
The second scenario is that of a serious disturbance of public order. “In this case, it is the prefect who requests compulsory hospitalization. A medical opinion will then confirm the mental disorder from which the patient suffers. indicates the psychiatrist.
Good in his body, good in his head!
What is the discharge like after hospitalization?
Once the patient is hospitalized, he is taken in for treatment. Then comes the time for its release. “In this second phase, either the person is well, they can therefore leave the hospital with follow-up care which will continue outside, or they are not stabilized or reluctant to continue care and they will be offered hospitalization. ambulatory, for which we will impose follow-up procedures. further details the specialist.
Generally, an obligation to follow up every month with a psychiatrist will be imposed, sometimes with a meeting with a psychiatric nurse in the interval, but not always, due to lack of resources. “The lack of resources does not allow us to follow patients more closely, but in any case, these are difficult patients to monitor. The monitoring framework exists, we simply need to be able to apply it better“concludes the doctor.