La résistance à la sectorisation : exemple du gouvernorat de Nabeul en Tunisie

Sectorisation was introduced in Tunisia in 1999. The objective of this study was to examine the difficulties and resistance to the sectorisation of psychiatric care in the state of Nabeul. A transversal study was conducted over a period of 5 months from 1 November 2014 to 31 March 2015 on 96 patients resident in the state of Nabeul and treated at Razi hospital. Patients were aged between 18 and 69 years old ( sex ratio equal to one), 55.2% were single and 46% had a low socioeconomic level (n=44). Chronic psychotic disorder was diagnosed in 64.3% , depression in 12.3%, bipolar disorder in 18.8% and mental retardation in 3% of cases. Most of them refused to continue psychiatric treatment in the second or the first line of care. Resistance to sectorisation was associated with a low socioeconomic level (P = 0.039), availability of a companion (P = 0.04), celibacy (P = 0.04), gender (P = 0.05) and negatively correlated to psychotic disorder diagnosis. It was concluded that the environment plays an important role in the choice of the place of care. Subjects treated for mental illness were found to have greater trust in the structures that treated the acute episode of their illness, and paradoxically felt less stigmatized in Razi hospital.