Extract
[...] The staff questioned overestimated the number of homeless among patients, the proportion of their nocturnal visits, and the frequency of social requests at the expense of medical requests. However, the data show that these patients have an objectively lighter workload (shorter hospital stay, fewer medical procedures, fewer hospitalizations). Despite this, they are perceived as more burdensome to care for. This feeling of overload is less due to technical constraints than to a psychological frustration: caregivers, trained to intervene quickly and effectively, struggle with the apparent ineffectiveness of their efforts in the face of these complex, chronic, and socially marked situations. [...]
[...] In fact, the article proposes a coordination strategy between the various services involved to better care for patients with psychosis and social disconnection. This article has clearly challenged my professional stance and the accompaniment of these people. In fact, I realized the difficulties encountered by this type of patient and the obstacles existing for adequate care by social workers. To be said, I should adopt a new proactive approach ensuring a durable follow-up of these people allowing them a better integration. [...]
[...] It is a matter of recognizing that, in the face of chronicity and exclusion, the goal is not always healing, but accompaniment over time. In parallel, it is essential to strengthen the coordination between social and psychiatric teams, to propose a global and coherent response. This institutional and cultural evolution could reduce the stigmatization of socially isolated psychotic patients, often abandoned at the margins of the healthcare system. Even when suspicions emerge, social workers are faced with administrative and relational obstacles: difficulty in knowing which psychiatric sector to address, impossibility of obtaining information due to medical confidentiality, and refusal of care by psychiatric teams if the patient does not make the initiative themselves. [...]
[...] Conclusion The article highlights the deep vulnerability of people with psychosis and social disconnection, victims of a double stigmatization linked to their mental disorder and social exclusion. This marginalization is reinforced by institutional dysfunctions, whether it is the abandonment of follow-up by psychiatric structures, the lack of training of social workers in detecting disorders, or the poor coordination between the health and social sectors. The healthcare system struggles to respond effectively to these complex situations, particularly due to a professional culture centered on rapid intervention and healing, which is ill-suited to the chronic needs of these patients. [...]
[...] The article highlights the partial failure of psychiatric and social institutions, which do not always ensure adequate follow-up, often due to a lack of training or a lack of analysis of situations. This progressive disaffiliation is also explained by a contradiction in the stance of caregivers: they must both guarantee the respect of the patient's freedom and ensure their accompaniment, which becomes problematic when patients no longer formulate an explicit request for care. Development The article highlights a form of stigmatization 'by omission': without overt hostility, professionals can, through passivity, allow patients to sink into wandering. [...]
