When contextual realities hinder the process of welcoming new patients in psychiatric emergency units / Quand les réalités contextuelles entravent le processus d'accueil aux urgences psychiatriques

Introduction: Questioning the implementation of care in psychiatry requires a reflection on and around the moment when patients first arrive at an emergency unit. In other words, it is necessary to take a look at the contextual conditions of this first moment of care. Our objective is to study the ingredients that contribute to the development or maintenance of a welcoming attitude. Methods: Grounded theory allowed us to better understand the complexity of the phenomenon by meeting people working in crisis and psychiatric emergency units. Results: The results present three pathways associated with the welcoming process: (1) pathway to activate the process; (2) pathway to weaken the process; (3) pathway to counteract the weakening pathway and feed the activation pathway. Reintroducing time to think and "spaces to speak" remains a challenge in the welcoming of patients in psychiatric emergency units. Discussion: A welcoming reception depends on a favorable context-societal, political, institutional and environmental-being fostered and maintained in the professional and personal world of professionals.

Introduction: S'interroger sur la mise en place des soins en psychiatrie nécessite de prime à bord de nourrir une réflexion sur et autour du moment de l'accueil des patients au sein des services d'urgences. Dit autrement, de porter un regard sur les conditions contextuelles de ce primo moment du soin. Notre objectif est d'étudier les ingrédients qui participent au développement ou au maintien d'une attitude dite accueillante. Méthode: La théorisation enracinée nous a permis d'approcher au mieux la complexité du phénomène, en allant à la rencontre d'intervenants exerçant en unité de crise et d'urgences psychiatriques. Résultats: Les résultats exposent trois voies impliquées dans le processus d'accueil : (1) voie d'activation du processus ; (2) voie d'affaiblissement du processus ; (3) voie pour contrer la voie d'affaiblissement et alimenter la voie d'activation. Réintroduire le temps de penser et des « espaces du dire ¼ reste l'enjeu à l'accueil des urgences psychiatriques. Discussion: Accueillir dépend avant tout qu'un contexte propice ­ sociétal, politique, institutionnel et environnemental ­ soit encouragé et maintenu dans l'univers professionnel et personnel des intervenants de la crise.

"We Become a Madman to Be Calmed"-Patients' Voices: Crossing the Threshold of Psychiatric Emergency Departments.

Crossing the threshold of a psychiatric emergency room is a real ordeal. It is a passage that upsets, worries and sometimes paralyzes. However, it can also become an opportunity if psychological suffering is welcomed, accepted and understood. The welcome is the starting point for care. Our objective is to understand the meaning given to the phenomenon of "being welcomed" by patients experiencing psychiatric emergencies. The research is based on Grounded Theory Methodology (Glaser and Strauss, 1967) to explore and understand the complexity of the phenomenon. The results reveal that being welcomed can be considered as a rite of passage taking place in four successive phases, which are themselves organized into four interactive dimensions. The welcome as a rite of passage constitutes a powerful psychic support which arranges the transitional space in which the individual finds themself, and accompanies the identity transformations, the anguish, and the various sufferings which are not lacking in these moments of crisis.