John Libbey Eurotext

L'Information Psychiatrique


Therapeutic accommodation with “Housing First” Volume 89, issue 3, Mars 2013

Psychiatre des Hôpitaux, 94413 Saint-Maurice, France, EPS Maison-Blanche, Groupe Momentané d’Entreprises, Associations Aurore, Charonne, l’œuvre Falret, association des Cités du Secours Catholique, Centre d’Action Sociale de la Ville de Paris, Paris, France
  • Key words: therapeutic accommodation, living at home first, therapeutic contract
  • DOI : 10.1684/ipe.2013.1043
  • Page(s) : 233-40
  • Published in: 2013

In Marseille, Toulouse, Lille and Paris, a study of the highest importance has begun to demonstrate that access to basic housing for people who have been excluded is one of the best ways to deal with their problem. What does this involve? In Canada and the United States, the “ Housing First” won in all the studies (which were numerous) as opposed to “ Treatment First.” In Housing First, people who are in the street suffering from severe mental disorders and possibly addiction are offered immediate access to housing provided they accept a follow-up at home by the multidisciplinary team who are responsible for active community treatment. The Treatment First approach involves the granting of permanent housing for homeless patients who have successfully participated in a program of compliance and abstinence. We can only congratulate this initiative to conduct such a serious and scientific study in the current climate. In France, we too often sin due to the lack of assessment, and it is time that we commonly accept that accommodation is therapeutic. In fact, any approach to psychosocial rehabilitation must begin with accommodation, which is primarily the place where the individual will be able to reconstruct and attain their life ambitions. This is what we have tried to admit for over 30 years in order to defend the notion of “Therapeutic Accommodation”! Therapeutic apartments (or protected or associated, etc.) which is the most effective formula for the most needy patients. Remember that what is therapeutic in therapeutic apartments is of course the “therapeutic contract” signed between the user and a healthcare or medico-social team. This contract obviously commits each party to a project for life as well as assuring the continuity of patient care and follow-up including home care.