[Ethics, mental health and freedoms - The contribution of regional ethical reflection spaces].

The action of the Regional Ethical Reflection Spaces does not only concern the field of contemporary bioethics but also affects many issues concerning mental health that we may have to face in clinical practice and teamwork. To keep trying to identify the conflicts of values in ethical issues is an absolute necessity, which implies that we support a "living together" relying on a "thinking together" for both the sake of each of us and for the sake of all of us. Our duty is then to resist collectively to prevent any possible deleterious excesses on both human and therapeutic points of view.

[From psychiatric care to psychic care, for an ethic of restraint].

This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.

[Care pathways, care of the pathway: the underside of a debate].

The coordinated care pathway consists of entrusting the attending physician with the coordination of care of the patient for the realization of medical follow-up with the ethical concern of a responsible consultation of the caregivers. This, so that medical practices and care devices are turned towards efficient care but also integrative, a qualitative search for life combining continuity of care and promotion of global health. This evolution towards greater respect for patients' rights requires that decisions taken be intelligently regulated in a context where caregiving interventions are still very prevalent and potentially intrusive in regard to the privacy of the persons being cared for.

[The expectations of families in Ehpad].

Taking into account the needs and expectations of families in residential care facilities for the dependent elderly (Ehpad) leads to their satisfaction with the care given to their institutionalized relative. A relational charter participate to prevent conflicts and misunderstandings between the various formal (caregivers) and informal (families) care providers at the bedside of residents. Families must feel invited to the Ehpad and recognized in their place in their role of care, at least relational.

[The right of elderly people in old people's homes to have a fulfilling emotional and sexual life].

The sexual life of elderly people living in residential institutions for the dependent elderly (Ehpad) is a sensitive subject that is rarely discussed. Particular difficulties sometimes arise when they have cognitive problems. Affectivity and sexuality in old people's homes must be approached with tact and maturity by the carers.

[In old people's homes, carers face Covid-19].

Many ethical issues were raised by the pandemic crisis. Caregivers were under great pressure and stress in their work in residential care facilities for the dependent elderly (Ehpad), both with residents and their families. The implementation of ethical support tools was only gradual, particularly for the management of residents' deaths.

[Dignity and access to care in psychiatry].

The notion of dignity is not synonymous with autonomous freedom (autonorma). It has an objective dimension, which is based on the individual's belonging to humanity. This is often neglected in psychiatry, even though it is what leads to the universal prevailing over singular preferences when a value specific to the human condition and to the suffering that inhabits it is at stake.

[Sexual abuse in elderly].

Seniors at home and in institutions can be victims of sexual abuse. Older women are more often victims than men. Sexual violence is often accompanied by physical violence and theft of property.

[Cognitive aging apart from dementia].

Cognitive aging apart dementia results from different genetic programming, different according to individuals. The aging of the various cognitive and very heterogeneous cognitive functions largely depends on the life course of each person. Social factors, in particular the environment in which a person lives, may or may not accelerate the processes of cognitive aging.

[Consent in mental health, between semiotic object and figure of psychiatric care].

Working on the question of consent in psychiatry means studying closely the word given by a patient, who, before being mentally ill, is a person with a real human value. It is a question of eliciting consent, of seeking it tirelessly rather than demanding it, so that it never becomes a procedure imposed by the fact of setting a purely formal condition, at the risk of otherwise abandoning it to the power of the psychiatric doctor. This is all the more important as the criterion of free care, including today both free hospitalization and freely deployed outpatient care, remains as an essential benchmark of the therapeutic alliance, the consent of the patient.

[Covid-19 infectious disease is also a psychogeriatric disease].

Severe forms of Covid-19 infectious disease often affect the frail elderly. They can induce inaugural psychiatric manifestations or aggravate the underlying psychiatric pathologies. Some of these pathologies persist after the acute episode and require specific management.

[From the person receiving care to the subject of care: the I-you relationship in psychiatry].

The subjective recognition by those involved in care, of people with psychiatric disorders, is not self-evident. Caregivers, in the general sense of the term, often find it difficult to recognise the personal freedom and dignity of psychiatric patients. Care is, however, inseparable from the relationship of trust and the mobilisation of the patient's ability to freely express choices and to participate in decisions concerning him; a central ability in the caregiver-patient relationship.

[Psychogeriatry in the epidemic context].

The development of the coronavirus epidemic is disrupting the organization of medical units and increasing the burden of care for nursing staff. Care facilities for the elderly are particularly exposed. Staff express legitimate fears about this, especially since they are particularly at risk of contracting the virus.

[Accommodation facility for dependent elderly people, ensuring relational proximity after health emergencies].

The health emergency linked to Covid-19 has been stressful for staff working in nursing home, and doubly painful for residents faced with the risk of infection and the reality of family separation. We explore in this article some psychological consequences resulting from their experience in the waning health crisis, hoping that the experience gained will allow greater efficiency in the event of a resumption of the pandemic.

[Representation of intimacy in aging].

The elderly person has the right to respect for their dignity and privacy. Society needs to change its perception on various aspects regarding seniors, including sexuality. A reflection and specific trainings for caregivers should be systematic.

[Sexuality in the elderly].

Negative stereotypes are often conveyed in the area of older adults' sexuality. Contrary to popular belief, sexual desire persists in elderly. Sexual activity has a positive impact on psychological well-being but it must be adapted to the elderly body because it can be hindered by somatic pathologies or medications.

[Compassion fatigue and empathetic suffering].

Compassion fatigue and empathetic suffering are terms generally applied to health care providers caring for elderly people. An exhaustion accompanied by acute emotional pain results of tension and preoccupation with the suffering of those being helped. Learning to recognize it and to manage its symptoms is the first step toward healing.

[Precariousness, dignity, access to care].

Social and medical precariousness is frequent among the elderly. It is more pronounced in some marginal or migrant populations. Difficulties in accessing care may be linked to the inability to communicate via the French language.

[Seniors' precariousness, social factors hindering access to care].

The precarity of the elderly is a threat that becomes more and more consistent when diseases, disabilities and handicaps become established. Access to care becomes an imperative. The difficulties of implementing palliative and support measures lead to growing precariousness.

[Issues of the delisting of anti-Alzheimer's drugs in France: between the law and ethics].

Going back to the delisting of drugs for Alzheimer's disease under the double prism of the jurisprudence of the State Council and from a sidestep of ethics is a requirement about the persistence of still passionate debates: the patients and their families feel abandoned, practitioners in the field distraught, and learned societies alarming the public authorities and their instances without any response to date. How the only drugs available, in responder patients, to slow down the inexorable progression of Alzheimer's disease, can finally be defunded, after three Superior Health Authority reassessments (2007, 2011, 2016) and therefore virtually removed from the therapeutic panel of physicians, while their beneficial effects, although modest on cognition, remained very actual on other symptoms such as apathy or hallucinations? How can this decision not to be understood as a signal of a disengagement from the state? How to maintain the trusting relationships between the patients, their families and caregivers, made of worry and patience?

[Understanding the suffering of the elderly].

Alzheimer's disease is an organic disease of the brain affecting mainly elderly people. Drawing on patients' imaginations on a daily basis or art therapy allow them, despite the cognitive impairments, to construct symbolic objects, analogues, to help give back meaning to their life. If the use of symbolisation when evoking the real object is not possible, the meaning is therefore constructed using the figurative dimension, an analogue substituting the lost and absent object, too painful to evoke again.

[Front Populaire, liberty and psychiatry: using history].

The desire to modernise the approach to psychiatric care aims to confirm the patient's place as subject and to reposition him or her in a context of empowerment. This article describes the contextualisation of the mental health dimension, through the democratic impetus given by an 'emancipatory' form of psychiatry.

[Vulnerability linked to age and memory disorders].

Violence towards elderly people can be hidden or trivialised. It often results from misunderstandings adding an argumentative edge to the relationship. Its prevention involves respecting elderly people's wishes and acknowledging their efforts and their anxieties and not simply pointing at the inadequacy of the resources available in a practice still too often seen as discriminatory.

[Ageing, a hidden form of violence].

Violence towards the elderly can occur in various forms. These include domestic or institutional abuse but other more covert forms exist. The complex conditions of their appearance, both in the elderly victim as well as in their abusers imply a pluridisciplinary repsonse.

[The capacity to mobilise care ethics in psychiatry].

Every act of care must have the patient's free, informed and lasting consent. Seeking prior consent to every care procedure which may concern the patient's liberty and dignity is a fundamental part of psychiatry. This approach helps to give meaning to the patient's words.