BERARD Karine

Le r¨¦gime juridique des soins psychiatriques sans consentement et les dispositions l¨¦gales qui l¡¯entourent sont le fruit de la longue ¨¦volution de la collectivit¨¦ ¨¤ prendre en charge les personnes atteintes de troubles psychiques. Cette maturation, qui t¨¦moigne de l¡¯¨¦quilibre fragile entre le respect des libert¨¦s fondamentales et les imp¨¦ratifs d¡¯ordre public, explique en grande partie la reconnaissance tardive de ces patients vuln¨¦rables comme v¨¦ritables sujets de droit. A travers la loi n¡ã2011-803 du 5 juillet 2011 et la loi n¡ã2013-869 du 27 septembre 2013, le l¨¦gislateur a conserv¨¦ le syst¨¨me m¨¦dico-administratif des soins sans consentement qu¡¯il a ¨¦rig¨¦ au XIXe si¨¨cle. N¨¦anmoins, via ces deux derni¨¨res r¨¦formes, il l¡¯a att¨¦nu¨¦ en introduisant un contr?le obligatoire du Juge des libert¨¦s et de la d¨¦tention et a ¨¦largi ces prises en charge aux soins ambulatoires. Ce syst¨¨me est caract¨¦ris¨¦ par une dualit¨¦ des modalit¨¦s d¡¯admission : les soins ¨¤ la demande du repr¨¦sentant de l¡¯Etat (S.D.R.E.) d¡¯une part, et les soins ¨¤ la demande d¡¯un tiers (S.D.T.) d¡¯autre part. Ces deux blocs sont eux-m¨ºmes subdivis¨¦s en une pluralit¨¦ de mesures, chacune justifi¨¦e pour des motifs divers : urgence, absence de tiers, circonstances de fait, existence d¡¯un trouble grave ¨¤ l¡¯ordre public ou ¨¤ la s?ret¨¦ des personnes¡­ Si le r¨¦gime juridique des soins sans consentement est cens¨¦ pr¨¦voir une prise en charge adapt¨¦e ¨¤ chaque situation particuli¨¨re, en r¨¦alit¨¦, ces orientations sont souvent prises pour des raisons d¡¯opportunit¨¦ et ne correspondent pas toujours ¨¤ la r¨¦alit¨¦. Les contentieux issus de ce r¨¦gime juridique d¡¯exception t¨¦moignent des nombreuses atteintes aux droits subies par les patients qui en font l¡¯objet. Pour ces raisons, un toilettage de fond peut ¨ºtre envisag¨¦. Il passerait par la fusion des deux blocs d¡¯admission en un seul, par le prononc¨¦ des mesures par le juge et par un renforcement de la protection des droits et des libert¨¦s, dispositions qui devront s¡¯entourer de garanties plus effectives et de contr?les plus appuy¨¦s.

The legal regime of the psychiatric care without consent, and the relevant legal provisions that surround it, are the direct consequence of the long-term development of the society in managing the mentally disabled people. This process of maturing, which reflects the delicate balance between the respect for fundamental freedoms and the imperatives of public order, mainly explains the rather belated recognition of these vulnerable patients as real subjects of rights. Through the law n¡ã2011-803 of 5 July 2011 and the law n¡ã2013-869 of 27 September 2013, the legislator maintained the model of care and medical administrative system without consent, dating from the nineteenth century. Nevertheless, through these last two reforms, the system has been attenuated by the introduction of a mandatory control of the liberty and custody judge and expanded these medical cares at the ambulatory. This system is characterised by its own duality in terms of admission rules: the request for care on demand of the representative of State (S.D.R.E.) on the one hand, and of a third party (S.D.T.) on the other hand. These two sets of procedures themselves are subdivided in a plurality of actions, each one justified on various purposes: urgency, absence of a third party, factual circumstances, existence of a serious public disorder or threat to the safety of individuals¡­ Even if the legal regime for the medical care without consent is supposed to provide an appropriate care for each and every specific situations, often these policies are actually set for opportunistic reasons and do not always match reality. The disputes resulting from this exception legal regime demonstrate the many human rights violations suffered by the concerned patients. For these reasons, some tidying up can be envisaged. The latter would involve the merging of the two sets of procedures, the issuance of measures by the judge himself and a strengthening of the protection of civil rights and freedoms, provisions which will have to be surrounded by more effective safeguards and stronger controls.