La compétence psychiatrique au service d’une régulation pluridisciplinaire : à propos des SAS psychiatriques

Objective

To provide a comprehensive overview of the deployment of psychiatric SAS (Healthcare Access Service), focusing on the experiences of LIVE and PEGASE (Exchange program to improve interprofessional care access management), in the Rhone and Gironde regions, and on the PRISME project, in the North region.

Method

The data presented in this article are based on oral presentations made at the AFERUP Congress in December 2023 (feedback from the LIVE, PÉGASE, and PRISME teams) and during the first day of the “psychiatric SAS's National Coordination”, which took place in Lyon in October 2024. For this event, the local organizing committee distributed a data collection form for each psychiatric SAS: it was filled out on-site when a team representative was present (Bordeaux, Créteil, Lille, Lyon, Paris, and Poitiers) and was sent to the doctors responsible for each psychiatric SAS when they were absent (Nantes, Rennes, Saint-Étienne, and Toulouse).

Results

The onset of the Covid-19 pandemic led to numerous upheavals, with successive lockdowns remaining the most evocative illustration. The healthcare sector was also affected, with the reorganization of emergency services, the deprogramming of thousands of procedures, and the temporary closure of care facilities, including CMPs (medical-psychological center) and outpatient psychiatric care. Against this particularly anxiety-provoking backdrop, several hotlines were set up for the general public. Some of these prefigured the creation of phone platforms for information, assessment, and guidance in mental health, such as LIVE and Questions Psy, followed by psychiatric SAS, in partnership with the SAMU-Centre 15-SAS in their respective departments. Currently, there are 9 operating psychiatric SAS and 5 under construction. While the principles of a graduated response to callers’ needs and unscheduled care remain central and common to these different systems, they operate in heterogeneous ways. The experiences of LIVE and Questions Psy also highlight the need to develop numerous partnerships, both to publicize these lines and to build and maintain an up-to-date mapping of departmental resources. They also demonstrate the value of upstream regulation of emergency services to avoid default referrals and to offer genuine alternative care paths. However, the proportion of referrals from these services to emergency departments remains high, due in part to the saturation of ambulatory services and private practitioners, but also because of the identification and easier access to care for patients with more severe clinical conditions through calls to the SAMU-Centre 15-SAS.

Conclusion

Deployment of psychiatric SAS represents a real opportunity both to guide users in the best possible way and to prevent this function from being taken over by emergency services. It also offers prescription assistance and tele-expertise to general practitioners. The scope of these systems is set to evolve beyond the SAMU-Centre 15-SAS and phone regulation platforms, requiring to develop team mobility and semi-emergency consultations.