“They are the forgotten ones of the crisis. Marion Leboyer repeats, she is extremely worried. In the midst of a coronavirus epidemic, this professor of psychiatry at Paris-Est Créteil University made the same observation as her colleagues. A white plan for hospitals, a blue plan for nursing homes and nothing for psychiatry. "We fear a real loss of opportunity for the sick," she says.
So the FondaMental Foundation, dedicated to the mental pathologies it directs, launches a call for help in the columns of the Parisian - Today in France. His tribune, signed by a hundred doctors and associations, calls for more attention towards this fragile and often stigmatized population. They must, they say, be considered among those most at risk of being affected by Covid-19 and of developing serious forms of the disease. Because among the 12 million French people, suffering from anxiety, mood, psychotic, schizophrenic, autistic disorders, a certain number may have difficulty in respecting the rules of confinement and barrier gestures because of problems with concentration. or memory impairment. They also present twice as many physical pathologies, such as cardiovascular or respiratory disorders, than the general population.
Fear of rising suicides
The urgency is there especially as the reality on the ground challenges. "Where are our patients? »Resumes Marion Leboyer. Psychiatric emergencies? Less crowded. Are Covid units open for these patients in hospitals? Half empty. "It is the first time that I see that in 25 years, usually, we are overwhelmed by requests. If the patients do not move, it is probably out of fear of the virus. "They probably fear being contaminated in the hospital and access to care seems more complicated at a time when doctors are overwhelmed by the epidemic," explains Dr Corentin Rabu, head of a psychiatric department. at the Henri-Mondor hospital in Créteil (Val-de-Marne).
He distinguishes two groups of patients. The first one can wait to see a psychiatrist. The second, on the contrary, needs urgent care. Especially since in this anxiety-provoking period, their mental disorders are likely to worsen. “Patients with depression are already finding it very difficult to ask for help. If they think it's more difficult today, they may not do it. Fear, an increase in the number of suicides. "If you are in mental distress or if you have symptoms of the virus, don't wait! "Continues Rachel Bocher, head of a psychiatry department at the Nantes University Hospital (Loire-Atlantique). Marion Leboyer implores: “Don't stay alone. We are here ! "
Here is the text of the FondaMental Foundation call.
Covid-19: there is an urgent need to rethink the place of psychiatry in the health system
“The major health crisis we are going through is testing our health care system and our ability to protect the health of the most vulnerable among us, as well as that of the personnel responsible for caring for them. In this unprecedented context, the repercussions of which affect all medical disciplines, the unpreparedness of psychiatry sounds like an alert and reminds, once again, that the patients in our care remain in the blind spot of our public policies.
While all the hospitals had been mobilized on March 6 with the launch of the white plan, it was not until March 23 that instructions were drawn up for the attention of psychiatric establishments, without giving any concrete means for their implementation. implemented. At a time when health emergencies are increasing on all sides, the patients followed in psychiatry weigh too light to benefit from sufficient consideration.
However, almost 2.5 million people are treated in psychiatry, ambulatory or hospitalization, and their great vulnerability in this epidemic context makes us fear an intolerable loss of luck. At a time when the pandemic is hitting us all, these people must be treated with the utmost attention.
Vulnerable psychiatric populations
The increased prevalence of associated pathologies (cardiovascular disorders, diabetes, hypertension, etc.), 1.5 to 2 times higher than in the general population, constitutes, as we know, a risk factor for severe Covid infection -19 for our patients. They suffer from impaired memory and concentration and may also find it more difficult to respect the rules of confinement and “barrier gestures”. At the same time, those who were followed regularly in psychiatric care centers can no longer go there today, and therefore risk seeing their pre-existing pathology worsen. Add to that isolated psychiatric hospitals without equipment provided for somatic care and a strong stigmatization of our patients who often expose them to degraded care pathways in a usual context, the reasons for our concern are great.
History unfortunately invites us to the greatest vigilance. During the Second World War, the abandonment of psychiatric populations had resulted in the death of 76,000 people in psychiatric hospitals supposed to protect them, including 45,000 from hunger and cold. This shock was the founder of great transformations and gave birth to contemporary psychiatry.
Rethinking our practices and preparing for the future
The current context, although hardly comparable to the 1940s, confronts us with a historic challenge and must allow the care of patients followed in psychiatry to evolve. Many psychiatric services are already engaged in a race against the clock and are adapting their practices to meet, here and now, the specific needs of patients facing the Covid.
Thus, a growing number of psychiatric establishments have created units dedicated to Covid-19, based on collaboration with general practitioners or internists and specific treatment protocols to allow the treatment of infected psychiatric patients, while preserving the health care providers.
At the same time, the need to free up hospital beds was accompanied by early discharges for a large number of hospitalized patients. The healthcare teams had to accelerate outpatient care by developing new methods of remote monitoring to prevent psychiatric decompensations or the risk of suicide. Intensive telephone follow-up combined, in some cases, with home intervention units set up in emergencies, is one of the measures deployed to limit the risk of breakdown of care and relapse.
More generally, the pandemic and the resulting confinement confront psychiatry with a major new challenge: how to respond to the emergence of states of psychological suffering within the general population (irritability, insomnia, anxiety, sadness, addiction to tobacco and alcohol) and prevent situations of post-traumatic stress or depressive states that could result? While it is difficult to predict the psychological impact of this crisis in the population, the first Chinese data nevertheless alert us: a study has shown, in the most affected regions, that symptoms of post-traumatic stress were reported in 7% of the population.
In France, the boom in teleconsultations, both in hospitals and in private practice, seems to be the first solution to this unprecedented context. But more structured responses must be provided, based both on training caregivers in psychological intervention methods and on the development of dedicated tools for populations (self-care guides, online psychological consultations). Likewise, a rigorous epidemiological evaluation as well as the establishment of pharmacological watches are necessary to draw the lessons necessary for the adaptation of our health system to offer a supply of quality psychiatric care.
The innovations in progress can, and must, inspire French psychiatry. We call for a necessary union of the forces of French psychiatry to prepare for the future and to initiate a demanding dialogue with the health authorities. Psychiatry should no longer be considered as a supplement to the healthcare system but as one of its major resources, which contributes to the health of many of our fellow citizens. We demand dedicated organizational tools (definition of emergency plans) as the means which will enable us, tomorrow, to respond to a new epidemic situation and its negative effects in terms of mental health on the French population. It is in the interest of the patients, but also of the whole population. "
The signatories: AJPJA (association of young psychiatrists and addictologists); AMADO Isabelle, PU-PH psychiatrist, Paris; AMOUZOU, Christian, liberal psychiatrist, Seal; ANDRÉ Christophe, retired psychiatrist, Paris; AOUIZERATE Bruno, PU-PH psychiatrist, Bordeaux; ASTRUC Bernard, liberal psychiatrist, Paris; ATTALI David, psychiatrist (internal), Paris; BALDACCI Antoine, psychiatrist (internal), Paris; BAUP Nicolas, liberal psychiatrist, Paris; BELZEAUX Raoul, psychiatrist, Marseille; BENYAMINA Amine, PU-PH addictologist, Créteil; BERENGUER Michel, hospital and liberal psychiatrist, Marseille; BERKOVITCH Lucie, CCA psychiatrist, Paris; BLANC Jean-Victor, hospital psychiatrist, Paris; BOCHER Rachel, hospital psychiatrist, Nantes; BOËLE Amélie, liberal psychiatrist, Paris; BOUDIN Pauline, hospital psychiatrist, Le Mans; BOUVET de LA MAISONNEUVE Fatma, liberal psychiatrist, Montrouge; BULTEAU Samuel, hospital psychiatrist, Nantes; CANCEIL Olivier, hospital psychiatrist, Paris; CAPDEVIELLE Delphine, psychiatrist PU-PH, Montpellier; CHARVET Camille, psychiatrist (internal), Paris; CHEVANCE Astrid, psychiatrist (internal), epidemiologist, Paris; CLARET-TOURNIER Anne, hospital psychiatrist, Paris; CLAUDEL Bertrand, hospital psychiatrist, Paris; COHEN David, child psychiatrist PU-PH, Paris; SCHIZOPHRENIES COLLECTIVE; COSTEMALE-LACOSTE Jean-François, liberal psychiatrist, Lyon; COURTET Philippe, PU-PH psychiatrist, Montpellier; DE CARVALHO William, liberal psychiatrist, Paris; by MARICOURT Pierre, hospital psychiatrist, Paris; DENIS Faustine, assistant psychiatrist of hospitals, Paris; DEL CUL Antoine, hospital and liberal psychiatrist, Paris; DELORME Richard, PU-PH child psychiatrist, Paris; DUBEAU Marie-Charlotte, liberal psychiatrist, Biarritz and Paris; DUBERTRET Caroline, PU-PH psychiatrist, Colombes; ETAIN Bruno, PU-PH psychiatrist, Paris; FOULON Christine, liberal psychiatrist, Paris; FOSSATI Philippe, PU-PH psychiatrist, Paris; GAILLARD Adeline, liberal psychiatrist, Paris; GAILLARD Raphaël, PU-PH psychiatrist, Paris, president of the Pierre Deniker foundation; GEOFFROY Pierre, psychiatrist MCU-PH, University of Paris; GERARD Alain, liberal psychiatrist, Paris; GOZLAN Gui, director of SAMSAH prepsy, Paris; GOUREVITCH Raphaël, hospital psychiatrist, Paris; GOURION David, liberal psychiatrist, Paris; GUEDENEY Antoine, child psychiatrist PU-PH, Paris; GUILLIN Olivier, PU-PH psychiatrist, Rouen; HAFFEN Emmanuel, PU-PH psychiatrist, AFPBN; HENRY Chantal, PU-PH psychiatrist, Paris; HOERTEL Nicolas, psychiatrist, MCU-PH, Paris; HOUENNOU Josselin, psychiatrist, PU-PH, Créteil; JAFFRE Claire, psychiatrist (internal), VP SIHP, VP PEPS, Responsible for mental health mission at ISNI; JAMET Laëtitia, hospital psychiatrist, Le Mans; JARDRI Renaud, child psychiatrist PU-PH, Lille; JAVELOT Hervé, hospital pharmacist, Strasbourg; KATZ Julien, hospital psychiatrist, Créteil; KOENIG Marie, psychologist, MCU, Saint-Denis; LAPREVOTE Vincent, PU-PH psychiatrist, Nancy; LLORCA Pierre-Michel, PU-PH psychiatrist, Clermont-Ferrand; LEAUNE Edouard, CCA psychiatrist, Lyon; LEBOYER Marion, PU-PH psychiatrist, president of the FondaMental Foundation, Créteil; LE BERRE Catherine, psychiatrist (internal), Paris; LEMOGNE Cédric, PU-PH psychiatrist, Paris; LEROY Jean-Christophe, President of the International Days of Schizophrenia, Evian; MASSON Marc, psychiatrist, Garches; MICHON-RAFFAITIN Pascale, liberal and institutional psychiatrist, Paris; MILLET Bruno, PU-PH psychiatrist, Paris; MOUAFFAK Fayçal hospital psychiatrist, Saint-Denis; MOUCHABAC Stéphane, hospital psychiatrist, Paris; MORO Marie-Rose, child psychiatrist PU-PH, Paris; MORVAN Yannick, MCU psychologist; NABHAN ABOU Nidal, hospital psychiatrist, Rennes; OLIE Emilie, MCU-PH psychiatrist, Montpellier; OLIE Jean-Pierre, PU-PH psychiatrist, full member of the Academy of Medicine; OPPETIT Alice, hospital psychiatrist, Paris; PÉLISSOLO Antoine, PU-PH psychiatrist, Créteil; PÉLISSOLO Stéphany, psychologist, Paris; PINABEL François, liberal child psychiatrist, Paris; PLAZE Marion, hospital psychiatrist, Paris; PURPER-OUAKIL Diane, child psychiatrist PU-PH, Montpellier; RABU Corentin, hospital psychiatrist, Créteil; RADEL Christine, hospital psychiatrist, Antony; RAFFAITIN Fréderic, liberal psychiatrist, Paris; RAINTEAU Nicolas, CCA psychiatrist, Montpellier; RAUTUREAU Philippe, hospital and liberal child psychiatrist, Paris; REMY Brigitte, hospital psychiatrist, Paris; SARFATI Yves, PU-PH psychiatrist, Paris; SCHÜRHOFF Franck, psychiatrist PU-PH, Créteil; SCHRÖDER Carmen M., child psychiatrist, Strasbourg; SCHWAN Raymond, PU-PH psychiatrist, Nancy; SMADJA Sarah, hospital psychiatrist, Paris; SPERANZA Mario, child psychiatrist PU-PH, Versailles; THOMAS Pierre, psychiatrist PU-PH, Lille; UNAFAM (national union of families and friends of the sick and / or mentally handicapped); URBACH Mathieu, PH, Le Chesnay; VINCKIER Fabien, hospital psychiatrist, Paris; WEBER Florence, professor of sociology and anthropology, Ecole Normale Supérieure, Paris; YOUNG Héloïse, assistant child psychiatrist, Le Chesnay; YRONDI Antoine, psychiatrist, MCU-PH, Toulouse; WALTER Michel, PU-PH psychiatrist, Brest.