Caring for a suicidal patient
analysis and observation during an internship inside
a psychiatric hospital IN Paris.
The mental health system in France is organized according to a geographical sectorization policy; which meant that patients are hospitalized according to their age and place of residence.
My internship took place in one of the adult sectors of a psychiatric hospital in Paris. Inpatient units in these psychiatric wards attend to persons who require hospitalization and continuing care.
As an intern, my primary role was to provide personalized health care for the mentally ill.
Miss F was one of my patients. She is a 24-year old Armenian national. She came to study in France because of a grant that she won in her country. Miss F initially has a degree in literature, and she speaks 4 languages. Miss F is an only daughter, her mother is a film actress in Armenia. She grew up with her grandmother while she never knew her father.
In the summer of 2012, Miss F returned to Armenia to visit her dying grandmother and after her death, her own mother fell into depression. Even though, she has no family in France, she returned to Paris to work as an interpreter where Miss F met her ex-companion.
According to the medical dossiers, Miss F has been living for three months in a young workers’ home. In fact, it was the home-director who brought her to the emergency hospital because Miss F locked herself in her room without food or water for several days. Miss F was then transferred to the psychiatric hospital with a medical diagnosis of depression and suicidal risk.
It was in 2013 when she arrived in our psychiatric sector.
Miss F’s case was not easy because she was quite withdrawn. She rarely ate and didn’t communicate with any health professionals nor with other patients. She stayed most of the time in her room, and she never participated in any activities.
During our medical interviews, she didn’t want to talk about her past. Miss F only lamented how anxious she was. That she cannot sleep at night and her only project in life was to die, as quickly as possible.
We placed her under medications. Her treatments were all in liquid form because during her first week of hospitalization, Miss F hid all her tablets and planned to take them all at once. She was on the verge of snapping out, meaning, of high suicidal risk.
My medical team made strict monitoring and observation
of her mood and body language.
Being in several treatments, it was important to ensure that Miss F takes her medications to avoid further risk of suicidal acts.
I continued my medical interviews with her. After several attempts, she confided how much she loved her ex-companion, but that she separated from him because he was violent towards her. He wants Miss F to convert to the Muslim religion, even forced her to wear a veil and has often imprisoned her in their apartment. She sobbed and said that her ex-companion was a very jealous man, and he threatened to kill her.
According to Miss F, during their 2-year relationship, her ex-companion refrained her to go out with friends. Once he even lacerated off some parts of her ears so that she could no longer wear earrings and thus “no longer make herself beautiful”.
Miss F stated that her ex-companion and her father are all perverts, and she can no longer trust men.
Miss F said that she lost hope in her life because of her mother who was never present, her grandmother gone, not knowing who her father is, the failure of her relationship with the man she loved and her job dismissal…
She doesn’t want to continue living anymore.
I listened intently to Miss F. I reassured her that our medical team supports her. But I was firm in telling her that she cannot leave the hospital yet, as she is under a hospitalization contract because she is a danger for herself. I told her that this contract was for her safety and I explained to her that she should not lose hope because we have an efficient medical support group and hospital activities that can help her for reintegration.
Later on, I sent Miss F to be accompanied to the hairdresser, sport, occupational therapy and registration at the employment center (Pole Emploi). I often praised Miss F after these activities to encourage her to restart her personal and professional life.
On the 14th day of her hospitalization,
Miss F had to face the High Court because according to French law,
all forced psychiatric hospitalization must be analyzed in court.
Being under such contract Miss F exercised her rights to express her contradictions
regarding the prescribed psychiatric hospitalization.
In front of the jury, Miss F evoked her freedom to die and her choice to commit suicide. She even asked the judge for liberty, so she could undergo euthanasia. After studying her case, the judge decided to maintain the hospitalization (according to the French law of July 5, 2011, relating to admissions in psychiatric care).
Miss F was very disappointed with the decision, but she understood the judge’s explanation that the French law forbids harming one’s self and others.
Depression is one of the most common pathologies in the world. It affects 7% of the French population.
The major risk is suicide among very depressed patients.
In France,
Mental Illness affects 1 adult in 4,
and Someone commits suicide every hour
so what needs to be done?
There are several hypotheses to explain depression. In the case of Miss F, it is the psychological, psychoanalytic & cognitive hypothesis. That is, after several life disappointments, the patient did not go through normal grieving and favored instead her pessimistic thoughts. (Miss F said that she lost hope in her life because of her mother who was never present, her grandmother gone, not knowing who her father is, the failure of her relationship with the man she loved and her job dismissal. She doesn’t want to continue living anymore).
Until the end of my 2-month internship, Miss F continued to have suicidal thoughts. Despite her treatments, sports prescription, occupational therapy, and psychotherapy, she can not reconcile her internal woes. For Miss F, her life is a great failure, and she no longer sees the future nor the reason to live.
I am sharing with you this experience today, to show you what caring for these type of patients entails for us health professionals.
Yet despite personal emotions, we health care providers still try to maintain our professionalism through active listening, emphatic attitude, respect of silence and keeping the proper distance for better management of difficult situations in psychiatry.
The most frequent Mental disorders observed in France are :
depression, bipolar disorders, schizophrenia, anxiety disorders, and addictions.
In psychiatry, we deal with various illnesses that have different manifestations depending on a person’s personality and as the number of mentally ill patients grows each day and so are the variations of their psychiatric maladies.
It has been 6 years, but I can still remember Miss F. I sincerely hope that wherever she may be, she has learned to love herself and have found a new reason to live.
– Clinician Nancy🍀
P.S. Names are changed to protect the identity and rights of the patient and my medical team.
Textes de référence :
- French law of July 5, 2011, relating to admissions in psychiatric care.
- Article: R4311.5-6 of the French Public Health Code concerning the medical role in mental healthcare.
- UNPS, INPES, OMS France, Santé Publique France
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