L’objectif de cette étude est d’évaluer les styles d’attachement dans une population de patients rencontrés en Équipe Mobile Psychiatrie Précarité à Paris, hormis les migrants, afin d’aider à l’établissement d’une alliance de travail et d’améliorer le suivi de ces patients.

Dix-huit patients en situation d’exclusion sociale rencontrés en Équipe Mobile Psychiatrie Précarité, hormis les migrants, âgés de 28 à 65 ans, ont été recrutés entre décembre 2018 et juillet 2019. Les styles d’attachement des sujets ont été évalués à l’aide du questionnaire Relationship Style Questionnaire–Codage Révisé, afin d’obtenir la prévalence de chaque style d’attachement dans cet échantillon.

Les analyses montrent un taux d’attachement insécure de 83 % dans cette population, avec une prédominance du style détaché retrouvé chez 39 % des sujets.

Le taux d’insécurité de l’attachement très élevé dans cette population pointe l’importance du rôle de Base de sécurité que devraient représenter les Équipes Mobiles Psychiatrie Précarité pour les patients rencontrés, première étape indispensable pour pouvoir les amener à des soins psychiques prolongés. La pertinence de thérapies basées sur l’attachement dans cette population est discutée. Ces équipes pourraient avoir un rôle de soin à part entière, au-delà de leur fonction d’interface et d’orientation.

The mission in Mobile Psychiatry Precariousness Team is to access and maintain psychiatric care for patients experiencing social exclusion. Professionals are faced with some difficulties to carry out their work. Homeless people have four times more psychiatric disorders than observed in the general population; they have difficulty accessing care, and most of them have experience serious childhood trauma. For these reasons, integrating attachment theory seems to help improving the care of these patients. The objective of this study is therefore to evaluate the attachment styles of a population of patients met in Mobile Psychiatry Precariousness Team in Paris.

Non migrants adults were recruited in patients met in Mobile Psychiatry Precariousness Team, in a situation of precariousness and social exclusion, between December 2018 and July 2019. A questionnaire was completed with socio-demographic data; psychiatric diagnosis were noted; and attachment style was evaluated with the self-administered questionnaire Relationship Style Questionnaire - Revised Codage. Descriptive analyzes were carried out for socio-demographic data, psychiatric disorder, and attachment styles. Means and standard deviations for the four categories of attachment (secure, preoccupied, avoidant, disorganized) were calculated, as well as the prevalence of each attachment style. Each patient could be classified in secure or insecure. Only patients with a higher score at one of the four categories can be classified in one of them.

Eighteen patients (8 women, 10 men), aged 28 to 65, were included. Eleven patients had several psychiatric diseases. Three patients were classified as secure, and 15 as insecure. Eleven patients could be classified in 4 categories: 7 were avoidant and 4 were preoccupied. Therefore, the rate of insecure attachment reached 83% in this sample, with a predominance of the avoidant style for 39% of the subjects.

The high rate of insecure attachment in this population may lead caregivers in Mobile Psychiatry Precariousness Teams to build a working alliance with these patients, in order to stand as a Secure base for them, as a first step to a durable entry into psychic care. The authors underline the relevance of attachment-informed therapy in this population. Finally, the Mobile Psychiatry Precariousness Team, as an outreach structure of care could or should take the lead for this population. Further studies are needed to test these hypotheses.