When the sector cannot adequately deal with social outcasts: a new approach to system patient care.

In health care, there is a frequent reference to the term 'system' by admin istrative and health care staff alike, but the term does not cover the resu lts of the present study. A psychiatric sector teams in Paris has described a particular approach which cannot be systematized, and which requires ava ilability and a capacity for ongoing adaptation. The patient population con sisted of social outcasts/socially underprivileged, for the most part homel ess persons. A retrospective study was first carried out on persons admitte d to the hospital over the past 5 years. It became apparent that the instit utional structure did not adequately meet the needs of these patients. A co mbined approach was therefore considered with the participation of selected social care partners, i.e., an institutional and a relational approach, th e former based on structure and locality and the latter focussed on the ind ividual. This new approach offers a range of complementary treatment and ca re possibilities. The limitations and advantages of both systems have been discussed. It is emphasized that treatment should in no way infringe upon h uman dignity and liberty, and that it is only to be used as a means of impr oving the patient's well-being. The use of a flexible system that provides maximum support for this fragile patient population is advocated. (C) 2000 Editions scientifiques et medicales Elsevier SAS.