Fire in Paris : an issue of psychiatric follow-up ?

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In the night of 4 to 5 February, a fire ravaged a building in the Sixteenth arrondissement of Paris, killing 10 people dead and 96 injured. Quickly, a resident of the building is suspected. Essia B., 40 years old, has a heavy psychiatric history and was known in the district for previous acts of pyromania. Can you explain this passage to the dramatic act with a problem of psychiatric follow-up ? The responses of the psychiatrist Antoine Pelissolo.

interview by Lucien Fauvernier – updated February 11, 2019 at 14:24

The suspect who allegedly set fire to the building in the Sixteenth arrondissement of Paris has a heavy history of psychiatry. How to explain such a passage to the act, as she had just come out of hospital, psychiatrist 6 days ago ? Has there been a misdiagnosis ?

Antoine Pelissolo : the output of A hospital is always prepared extensively. The doctors ensure to the maximum that it is completely safe. But the medicine is not a science, always perfectly accurate… A change of psychic state quite fast, even in a week, can happen. Different events can occur and push the person that were thought to be stabilized to a relapse, particularly if there is a problem of taking drugs or alcohol, as this seems to be the case in this case. Regardless of the profile of the patient, take a decision to exit is never simple. But it is granted after consultation of several experts and is always thoughtful. I don’t think we can call into question, a posteriori, its merits in this case.

If the suspect is convicted, will she, according to you, be held responsible for his actions ?

Antoine Pelissolo : there are, in general, in these cases, two cases of figure. At the extreme, the psychiatric expertise can make the judge the decision of a total abolition of discernment. In this case, it is believed that the person is absolutely not responsible for his actions. It is therefore déresponsabilisée, out of the court system, and is supported by psychiatry. But this is quite rare, which mainly deals with psychotic states advanced where you can be sure that the facts have been committed while under the influence of a hallucination in which the person had no conscience. The most common case is a judgment of the attenuation of the discernment, which may lead to partial responsibility. In this case, the existence of a mental pathology is taken as a mitigating circumstance, but the person can be condemned. Especially if alcohol or drugs come into play. The justice considers that it is an aggravating circumstance, which is the result of a voluntary action. Even in the context of a mental pathology, we can consider that the person could avoid putting themselves in condition to do a major crisis.

Is there a recourse other than the police for the people who would have a neighbor to the profile of psychiatric disorder and which is inquièteraient a suspicious behavior ?

Antoine Pelissolo : This situation is still a problem. The police intervene when there are threats or immediate risks such as violence committed against people. However, when there is no immediate threat but that there are disorders or abnormalities of gait or mental health, the first step, ideally done by the patient’s family, is to contact instances medical as the UAS. Medical emergencies must intervene if there are really elements of medical patents. This is not yet very formalized in France, but a work has begun with the psychiatric services, for something specific to be put in place in these situations. Today, these are often the fire-fighters, who play the role of intermediary, but they are more cautious vis-à-vis the risks incurred. They will always prefer to be surrounded by the police or a medical service. If there is a concern diffuse, advice centres such as the CMP may be stopped. Of course, they are now struggling to make themselves available, but there is also, a work is done so that they can be responsive even when the patient is not himself the applicant. All that is certain is that even if these cases remain relatively rare, there must be an offer that is well structured to respond to the concerns that may create a person in situation of psychic suffering.

 

To go further

==> 5 myths about the link between disease-psych and violence decrypted

Unpredictable Violence, high crime rate, a strong tendency to aggression… The mentally ill are often stigmatized as being dangerous to others. A representation out of touch with reality as evidenced by the decryption of these 5 ideas received by Livia Velpry, a sociologist specializing in the field of mental health.

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