They are psychiatrists, interns, psychologists, nurses… And all of them are crying out to the new Prime Minister, Élisabeth Borne, in a tribune “Let's create jobs to avoid sinking!
".
The equation no longer works.
On the one hand, the Covid-19 pandemic is creating an unprecedented influx of patients to psychiatric emergencies: suicidal crises, delirious outbursts, depression.
“Especially among young people, without landmarks, anxious about the future.
When you lose hope, it takes a long time to find it, ”warns Antoine Pelissolo, psychiatrist at Henri-Mondor hospital, in Créteil (Val-de-Marne).
On the other, "15% of beds are closed in AP-HP hospitals, for lack of nurses", continues this head of department.
Admittedly, these difficulties are not new, but they are getting worse, the consequences are “dramatic”.
Height of this tension, one Sunday in April, in a hospital in the Paris region, 18 patients, all in very serious condition, found themselves waiting, when they had to be hospitalized, urgently.
To "welcome them, reassure them, monitor them", that day, only a psychiatrist and a nurse were there.
The signatories of the platform warn: "This overflow of reception capacities translates into hours and days of waiting on a stretcher or a chair in a corridor, running away, agitation, even fights, and inevitably overwhelmed and exhausted professionals, wishing only one thing: to change jobs, hospitals, or even professions.
Such a waste.
".
Another consequence, according to Antoine Pelissolo: “The use of isolation and restraint is on the rise because caregivers can sometimes be overwhelmed by the situation, which should not happen”.
And faced with the influx of requests, the patients, once hospitalized, according to the psychiatrist, come out more quickly, “result, they relapse”.
The text of the forum: "Let's create positions to avoid sinking!"
"One Sunday in April in the emergency room of a large hospital in the Paris region, 18 patients are waiting for psychiatric care, all in serious situations requiring immediate hospitalization: suicidal crisis, delirious puffs with agitation, extreme depressive states, etc. .
To welcome, assess, reassure, monitor, treat, contact families and hospitals for these 18 patients: a psychiatrist and a nurse, and insufficient premises.
This overflow of reception capacities translates into hours and days of waiting on a stretcher or a chair in a corridor, running away, agitation, even fights, and necessarily overwhelmed and exhausted professionals, only wishing one thing: changing jobs, hospitals, or even professions.
Such a waste !
The situation of overcrowding in psychiatric emergencies is not new, it is getting worse from year to year, in adult psychiatry as well as in child psychiatry.
But, since the pandemic, we are experiencing a dramatic acceleration of this gear.
Two main reasons: the very sharp increase in the need for psychiatric care on the one hand, and the closure of a large number of beds in specialized services due to a shortage of nursing staff on the other.
Read also“The fear is that there will be a tragedy this summer”: France faces a worrying shortage of caregivers in hospitals
For many acute psychiatric states, and all the more so in degraded social contexts, recourse to hospitalization is unavoidable.
It is certainly necessary to intervene upstream of crises and
on an outpatient basis
, and this is being done better and better.
But there will always be situations imposing a time of hospitalization.
However, working in psychiatric care units, especially the most intensive ones, is particularly trying and stressful.
This is teamwork which can be exciting but which requires spending a long time with patients and supporting them in their suffering.
Fortunately, many caregivers have this vocation and this skill, and thanks to them very good therapeutic results can be obtained.
But alas, everything is done today to dissuade them from investing in it and finding meaning in it: they are asked to do it ever faster, with fewer staff and fewer means, and weigh on them more and more administrative charges.
The numbers are calculated as accurately as possible, often without taking into account the specificities of psychiatric care and the vagaries of absences and difficult situations (peak numbers of patients, various crises, etc.).
This loss of meaning and this pressure of time and savings to achieve generate a
vicious circle of shortage
.
Not enough at the base (even when all positions are occupied), caregivers leave our hospitals or are absent for health reasons, which further reduces the available workforce.
Staff are then asked to replace each other from one service to another, to work overtime, and to change their schedules constantly.
This encourages them to jump ship even more, with a domino effect on all psychiatric and emergency services where the workload increases.
The main reason for staff discouragement is not the amount of remuneration but working conditions, stress, the feeling of exhaustion and insecurity, and the gap between professional aspirations and the reality of imposed work.
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While we are short of candidates, it might seem illusory to set upward personnel targets.
But not displaying such normal ambitions only feeds the shortage: the positions are not attractive when the candidates find that, in any case, there will be insufficient numbers of them to treat properly.
The definition of minimum ratios of caregivers per service is a vital necessity, demanded by all those who are worried about the future of our hospitals (Senate report in 2022, general controller of places of deprivation of liberty, etc.).
The authorities refuse to do so, fearing that they will not have the means to finance such measures, but this abstention risks costing our society much more very quickly.
The closure of services, even hospitals, can only lead to human tragedies through the absence of care, with obvious economic consequences: unemployment, work stoppages, social complications, etc.
We must continue to develop ambulatory care, crisis prevention and recovery-oriented practices but, as long as they are necessary, maintain hospitalization teams in sufficient numbers to avoid any mistreatment.
The solution therefore exists.
Who will finally be able to take this courageous decision to loosen the shackles that constantly constrain hospital staff and lead us to shipwreck?
Hospital management must balance their budgets and respect employment ceilings, and the ARS cannot grant budgets that they do not have.
The Minister of Health does not seem to have this power, the commitment must come from
above
.
Be that as it may, and
whatever the cost
, if nothing is done in this direction, a very bleak future awaits us.
»
The petitioners
1. AKOUAKOU Laura, specialist educator, Cergy
2. BARRETEAU Sylvie, child psychiatrist, Asnières-sur-Seine
3. BENYAMINA Amine, professor of psychiatry, Paris-Saclay University
4. BIZARD Sarah, hospital psychiatrist, Argenteuil
5. BONHOURE Adriana, specialist assistance, Villejuif
6. BONNOT Olivier, professor of child and adolescent psychiatry, Nantes
7. BORWELL Baptiste, hospital psychiatrist, Marseille
8. BOUAZIZ Noomane, hospital psychiatrist, Neuilly-sur-Marne
9. BOUCHER Morgane, hospital psychiatrist, Créteil
10. Mathilde BRAGEOT, hospital practitioner, addiction psychiatrist, Paris XXth
11. CANCEIL Olivier, hospital psychiatrist, Saint-Maurice Hospitals
12. CANTERO Alain, psychiatrist, head of department, Saint-Maurice Hospitals
13. CARRET Vincent, psychiatrist, Marseilles
14. CHENE Margaux, intern in psychiatry, Paris
15. CLAVEL Estelle, hospital psychiatrist, Villejuif
16. CLÉMENT Judith, peer health mediator, Paris
17. COHEN David, professor of child and adolescent psychiatry, Paris
18. CONDEMINE Marie, psychologist, Paris
19. CONSOLI Angèle, professor of child and adolescent psychiatry, Paris
20. CORTÈS Marie-José, President of the Union of Hospital Psychiatrists, Mantes-la-Jolie
21. CRAVERO Cora, child psychiatrist, hospital practitioner, Paris
22. DEMERY Malika, psychiatrist, Briançon
23. DUBERTRET Caroline, professor of psychiatry, head of the AP-HP department, Colombes
24. DURANTÉ Étienne, intern in psychiatry, Villejuif
25. DZIERZYNSKI Nathalie, Medical Head of Psychiatry Unit, Tenon Hospital, Paris
26. FOGLIA Noémie, specialist educator, Argenteuil
27. FOLIGNÉ Marine, psychiatrist, hospital practitioner, Paris
28. Guillaume BACKGROUND, hospital psychiatrist, Marseille
29. GORIOT Élisabeth, former senior health manager, La Ville-du-Bois
30. GOUSSET Robin, hospital practitioner psychiatrist, Clamart
31. GRANGER Bernard, Professor of Psychiatry, Cochin Hospital, Paris
32. GRAU Léa, psychiatrist, Argenteuil
33. Laurence GUEZ, psychiatry attaché, Tenon hospital, Paris
34. HIRSCH Raphaëlle, hospital psychiatrist, Marseille
35. HUMBAIRE Camille, Hospital psychiatrist, Villejuif
36. HUPPERT Thomas, child psychiatrist, Argenteuil
37. IAMANDI Alexandra, hospital psychiatrist, Villejuif
38. JANUEL Dominique, professor of psychiatry, EPS Ville Evrard, Neuilly-sur-Marne
39. JEAN-FRANÇOIS Paul, hospital psychiatrist, Villejuif
40. KORCHIA Theo, head of clinic, Marseille
41. LAIDI Charles, hospital psychiatrist, Créteil
42. LAMISSE Christophe, head of psychiatry and mental health, Argenteuil
43. LANÇON Christophe, Professor of Psychiatry, Marseille University Hospital, Marseille
44. LE BLANC Eve, hospital psychiatrist, head of department, Paris
45. LE GUEN Emmanuel, hospital psychiatrist, Paris
46. LECONTE Dominique, family peer support worker, Garches
47. LEGUAY Denis, psychiatrist, president of Mental Health France, Angers
48. LIEVRE Bertrand, hospital psychiatrist, Joinville-le-Pont
49. LLORCA Pierre-Michel, Head of Department, CHU Clermont-Ferrand
50. LOPEZ Ofelia, psychologist, Saint-Maurice
51. LORIC Marie, psychiatrist, Créteil
52. MAKSOUDIAN Azad, hospital psychiatrist, Paris
53. Éric MALBOS, hospital psychiatrist, Marseille
54. MALLET Luc, professor of psychiatry, CHU Henri-Mondor, Créteil
55. MARULAZ Laurent, hospital psychiatrist, Villejuif
56. MIFORT Béatrice, Psyado liaison nurse, Argenteuil
57. MONSONEGO Hélène, head of department, Clamart
58. MONTAGNIER Delphine, hospital psychiatrist, Paris
59. MOREAU Elsa, psychologist, Paris
60. NKAM Irène, hospital psychiatrist, Créteil
61. NUEVO Julia, psychologist, Vanves
62. OTMANI Ouardia, hospital psychiatrist, department head, Paul-Guiraud hospital, Clamart
63. PAQUIS Jean, hospital psychiatrist, Saint-Claude
64. PELISSOLO Antoine, professor of psychiatry, CHU Henri-Mondor, Créteil
65. PERISSE Didier, child psychiatrist, Paris
66. PIGNON Baptiste, hospital psychiatrist, Créteil
67. RAFFIN Marie, hospital psychiatrist, Paris
68. RICHIERI Raphaëlle, professor of psychiatry, Marseilles
69. SAYOUS Romain, hospital psychiatrist, Créteil
70. SPINU Ramona, hospital practitioner, Argenteuil
71. TASTEVIN Maud, head of clinic, Marseille
72. TEPES SIMWAMI RODICA, hospital practitioner, Argenteuil
73. VALENTIN Marie, psychiatrist, Argenteuil
74. VIDAL Camille, hospital practitioner 94G17 Paul-Guiraud hospital group, Thiais
75. ZHENG Monique, hospital practitioner, Clamart