[Evaluation of autonomy in chronic mental patients. Problems, assessment tools, results]

The autonomy of adult patients suffering from chronic psychiatric disorders is a notion in which we need to take an interest due to evolutions in patient care. The tendency of deinstitutionalization in the United States, in Italy and to a lesser degree in France has generated certain perverse effects when: capacities for self sufficiency, learning abilities to be developed, and substitutes to be set up, were not correctly evaluated from the outset. Many methods conceived mainly in the United States and in Canada were elaborated with such a diversity of approaches that, even today, for self-sufficiency, an instrument for evaluation which is universally prevalent and used, still does not exist in the way that has been possible for other clinical dimensions. The ability to accomplish the daily tasks for survival, the ability to reach decisions in life, the ability to enter into and sustain relationships with others do not embrace the dimensions explored by the scales of general psychopathology, of functional repercussions or of the quality of life. Moreover, the evaluation of these abilities is highly dependent on cultural characteristics. To adapt the existing methods to the French sociological realities or to conceive and elaborate simple and reliable procedures from our practices in professional and social reinsertion is a compulsory step in developing research in this field. Public Authorities and the teams on the ground should grasp the characteristics for innovation and its abilities for raising the hopes of patients, every bit as much as the actual progress in therapeutic practice.