Exclure - APPELpsy

Exclure(
!"#$%&'(%)#&(%
%
*''$+%,""$-.'$+/%
%
0.% &"1% 2'% 3&"45% '+% &'% 6$"7'+% 89:% ;#1% '(+% ("-% 4"$"&&.1$'<% 6$=('-+'-+% >'(% 6.$+14#&.$1+=(% ;#1% ("-+% ?%
1-+'$6$=+'$@A%!"#$;#"1%#-%B+.+%;#1%'(+%'-%C.1&&1+'%"$D.-1('E+E1&%#-%F">G&'%>'%$'FH"#$('F'-+%;#I"-%
1F.D1-'%4"J+'#K%L%!"#$;#"1%=+.1+E1&<%'+%4'&.%.%=+=%la#volonté#sans#faille%>'%2'%3&"45<%("#>.1-'F'-+%
-=4'((.1$'<%M"1$'%1F6=$.+1C<%>I1-(4$1$'%&.%6(N4O"+O=$.61'%>.-(%&'%F=>14.&%L%%
%
:((.N"-(%>'%$=6"->$'%?%4'(%;#'(+1"-(%'-%.H"$>.-+%&'%>1(6"(1+1C%;#1%4O'$4O'%?%(P1F6"('$%Q&'%F">G&'%
89:R%6.$%les#effets%;#I1&%M.%6$">#1$'@%9'(%'CC'+(%("-+%6$=M1(1H&'(<%donc%4"--#(<%'+%donc%M"#&#(%6.$%&'(%
'K6'$+(@%S1%"-%.44'6+'%4'++'%6$=F1(('<%;#1%'(+%$.+1"--'&&'<%#-'%4"-4&#(1"-%(I1F6"('%T%la#loi#et#le#KCE#
n’organisent#pas#les#soins,#ils#sont#faits#pour#organiser#la#possibilité#d’exclure#des#circuits#de#soins.%
%
U"N"-(%4"FF'-+%4'&.%C"-4+1"--'@%U"#(%(.M'V%;#'%&'(%41$4#1+(%'K1(+.-+(%'-%S.-+=%W'-+.&'<%4'#KE&?%
;#1% >"1M'-+% >1(6.$.X+$'<% -I1-4&#'-+% .#4#-'% Y6$"4=>#$'I% >I'K4&#(1"-% >I#-% 6.+1'-+@% Z&(% ("-+%
F.K1F.&'F'-+%"#M'$+(%'+%F1-1F.&'F'-+%4"->1+1"--=(@%9I'(+%4'%;#I1&%(I.D1+%>'%>=+$#1$'@%!"#$%4'&.<%1&%
C.#+%#-%>1(4"#$(<%#-%>1(6"(1+1C%Q4P'(+%&'%6$"7'+%89:R<%'+%#-%F=4.-1(F'%Q4P'(+%&.%&"1R@%%
%
0'%discours<%"-%&'%4"--.X+%T%1&%'(+%.&.$F1(+'<%'+%>1+%T%4'%;#1%'K1(+'%'(+%-#&<%"-%.%#-'%("&#+1"-@%!.(("-(%
.#%mécanisme<%1&%'(+%4$#41.&<%'+%1&%C"-4+1"--'%.1-(1%T%
%
/@ [-% 'K+$.1+% &.% 6(N4O"+O=$.61'% >'% &P\$$]+=% ^"N.&% _`% 6"#$% &P1-(4$1$'% >.-(% #-'% &"1% ;#1% >"1+%
$=D&'F'-+'$%&.%F=>'41-'%Q"-%'-%C.1+%#-'%6$"C'((1"-%>'%("1-(%>'%(.-+=R%
A@ 9'++'%1-(4$16+1"-%'(+%-=4'((.1$'<%6.$4'%;#'%4P'(+%&.%4"->1+1"-%>P#-%$'FH"#$('F'-+%
a@ 0'% $'FH"#$('F'-+% '(+% ?% ("-% +"#$% -=4'((.1$'<% 6.$4'% ;#I1&% -IN% .% ;#'% &#1% ;#1% 6'$F'+%
>P1-+$">#1$'<%.#6$G(%>'(%6.+1'-+(%'+%.#6$G(%>'(%6(N(<%>'(%4"->1+1"-(@%
%
!"#$% &'% >1$'% .#+$'F'-+%T% 4'++'% &"1% $'->% 6"((1H&'<% 6.$% &P1-+$">#4+1"-% >'(% 4"->1+1"-(<% &1='(% .#%
$'FH"#$('F'-+<%#-'%6$"4=>#$'%>P'K4&#(1"-%>#%6.+1'-+%>#%(N(+GF'%>'%("1-(@%9I'(+%#-'%F#+.+1"-%
1-=>1+'%>.-(%-"+$'%4O.F6<%'+%4P'(+%#-'%(.&"6'$1'@%
%%
91+"-(%2'%3&"45T%b%S1%"-%1-M'(+1+%>.-(%>'(%D'-(%6"#$%;#P1&(%$'6$'--'-+%>#%+$.M.1&<%-P'(+E"-%.&"$(%6.(%
1 Geert Hoornaert est psychologue au Centre Médico-Psychologique du Service Social Juif à Bruxelles.
2 Texte présenté́ lors du Meeting du 21 octobre 2016, sous le titre : La loi sur les professions des soins de
santé mentale : Enjeux et dangers.

'-% >$"1+% >P.++'->$'% >P'#K% ;#P1&(% 4""6G$'-+%Lc% SI1&(% -'% &'% C"-+% 6.(<% "-% (.-4+1"--'@% 9'% ;#1% >"-4%
(P"$D.-1('<% 4'% -P'(+% 6.(% &'(% ("1-(<% 4P'(+% #-'% 'K6"(1+1"-% >'(% 6.+1'-+(% .#K% 6"#M"1$(% '-% 6&.4'<% '#KE
F]F'(%'K6"(=(%.%>'(%4"-+$.1-+'(%=4"-"F1;#'(@%
%%
0'%dispositif<%&#1<%M1'-+%>#%gatekeeping#theory<%'+%"6G$'%#-'%F#+.+1"-% $.>14.&'%>.-(%&.%>=C1-1+1"-%
4&.((1;#'% >'% 4'% ;#P'(+% #-% 6.+1'-+<% >'% 4'% ;#P'(+% #-% 6(N4O"&"D#'<% '+% >'% 4'% ;#P'(+% #-'% $'-4"-+$'%
O#F.1-'%>'%;#'&;#I#-%;#1%("#CC$'%.M'4%4'&#1%?%;#1%4'&.%(I.>$'(('@%%
%
d-%6.+1'-+<%>G(%;#P"-%&I1-(G$'%>.-(%&'%>1(6"(1+1C%>#%89:<%$'e"1+%>P.H"$>%#-'%-"#M'&&'%>=C1-1+1"-<%;#1%
'(+%>"#H&'@%\%D.#4O'<%?%&.%4.('%P'-+$='P<%4I'(+%#-%C$.D1&1(=%;#1%.CC$"-+'%>'(%('#1&(%+$"6%O.#+(%'+%>'(%
&1(+'(% +$"6% &"-D#'(<% #-% ]+$'% 61+"N.H&'F'-+% 6'$>#% >.-(% #-% &.HN$1-+O'% >P"CC$'(% 1&&1(1H&'(f% 1&% C.#+% &'%
(.#M'$@%\%>$"1+'<%?%&.%("$+1'<%4P'(+%#-%6$"C1+'#$<%#-%$=4.&41+$.-+<%#-%$'C#V-15%1-D$.+%T%1&%C.#+%&'%7'+'$@%
:-+$'%4'(%>'#K%=+.+(%>#%6.+1'-+<%1&%N%.%&P'(6.4'%>'%(.%F=+.F"$6O"('%;#1%(P.44"F6&1+%'-+$'%/%?%/g%
(=.-4'(@%
%
9P'(+% >.-(% 4'++'% 4"-M'$(1"-% F=+.6ON(1;#'% ;#P1-+'$M1'-+% &PEvidence# Based@% !"#$;#"1% C.#+E1&% ;#'%
&P"6=$.+1"-%;#1%M.%$'H.6+1('$%&'%C$.D1&1(=%'-%(.&.#>%("1+%Evidence#based%L%9P'(+%C$"1>'F'-+%&"D1;#'@%
S1% &.% F=+O">'% (P.M"#.1+% 1F6.$C.1+'<% 1&% $'(+'$.1+% #-'% F.$D'% 6.$% "h% &'(% (.-4+1"-(% 6"#$$.1'-+% ]+$'%
6'$e#'(% 4"FF'% 1-7#(+'(%f% "-% 6"#$$.1+% ('% +$"F6'$% >'% 41H&'@% S1% &.% F=+O">'% (P.CC14O'% 4"FF'%
1-C.1&&1H&'<%4'%;#1%'(+%M1(=%'(+%.++'1-+%T%?%F=+O">'%1-C.1&&1H&'<%&.%C.#+'%$'M1'-+%C.+.&'F'-+%.#%6.+1'-+<%
'+%&'%(.-4+1"--'$%('$.%7#(+'@%
%
:+% &'% 6(N% >.-(% 4'++'% .CC.1$'%L% !"#$% &'% 89:<% 1&% '(+% &.% 61G4'% F.X+$'(('% >'% 4'% 6$"7'+% ;#1% "$D.-1('%
&P'K4&#(1"-@%Z&% '(+% 1-M1+=%?% -'% 6&#(%$=C&=4O1$<%?% +"#+%+$.O1$<%?% >'M'-1$%#-%6'+1+% :14OF.--% >#%("1-@%Z&%
>'M$.%7#(+'%$'+"#$-'$%#-%6'#%?%&P=4"&'<%6"#$%;#P1&%.66$'--'%?%H1'-%4.4O'$%&'%H.$H'&=%;#P1&%.%>.-(%
4'++'%F.1-%;#P1&%+'->@%
%
[-%M'$$.%H1'-+i+%(1%(.%C"$F.+1"-%1FF#-1('%&'%6(N%4"-+$'%&.%+'-+.+1"-%>'%>'M'-1$%4'%C"-4+1"--.1$'<%
4'+%'K=4#+'#$% .#% ('$M14'%>#%F.&% H.-.&@% j'% 4"-(1>G$'%6'$("--'&&'F'-+<%'+% 4P'(+% (.-(% "$D#'1&<%;#'%
F"-%'K6'$+1('%'+%F"-%1->=6'->.-4'%F"$.&'%'(+%(#6=$1'#$'%?%4'&&'%>'(%'K6'$+(@%j'%-'%(#1(%6.(%&'%
('#&<% &"1-% >'% &?@% jP"66"('% .M'4% '#K% #-% )[)% >=41>=% ?% 4'(% F.4O1-.+1"-(<% #-% )[)% ;#1% '(+% -"-E
-=D"41.H&'<%4.&F'%'+%$.+1"--'&%>.-(%(.%(#H(+.-4'<%'+%=M1>'-+%6.$%4'(%F"+1C(@%