Entre récit clinique et justification médico-légale : analyse du critère de dangerosité dans les rapports médicaux circonstanciés de mise en observation psychiatrique en Région de Bruxelles-Capitale
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- Context: In Belgium, the placement under psychiatric observation follows the law of protection of mentally ill people of 1990 (Loi relative à la Protection de la Personne des Malades Mentaux) and is based on the dangerousness criterion. Yet this very concept remains a difficult one to objectify, as it is observed in a clinical, medico-legal and contextual reasoning, often formulated in situations of emergency. Method: This retrospective documentary study, mostly quantitative and completed with a qualitative approach, analyses 325 detailed medical reports (DMR) written in the psychiatric emergencies of the CHU Brugmann between 2023 and 2024 for patients who were afterwards directed towards the Centre Hospitalier Jean Titeca to be placed under observation. Results: The results show a predominance of hetero-aggressive behaviour, a majority of objectified formulations, but also an important share of clinical subjectivity. No DMR explicitly mentions the use of a standardised tool. The retrospective use of the Crisis Triage Rating Scale (CTRS) highlights some more debatable files from a medico-legal readability perspective. The qualitative analysis shows that dangerousness is often present, but scattered across the clinical report rather than developed in the section dedicated to the analysis of dangerousness. Discussion and recommendations: This dissertation underlines the importance of a more thorough, contextualised and adjusted approach of the dangerousness criterion. A reasonable structuring of the evaluation could strengthen the clinical traceability, the legal readability and the respect of fundamental rights, without replacing the clinical judgement of the practitioner.