If psychiatry remains the poor relation of health in France, the situation of child psychiatry is even worse.
Between 750,000 and 850,000 children and adolescents benefit from care every year, out of approximately 1.6 million children suffering from mental disorders.
On the increase since the Covid, these disorders cover a wide range ranging from anxiety symptoms to depression, including anorexic disorders or suicidal thoughts.
In question a “
saturated care offer
” and “
too little graduated courses
”, alerts the Court of Auditors in a report published on Tuesday.
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However, it is essential to stop the problems early in order to prevent them from getting worse: 35% of adult psychiatric pathologies begin before the age of 14, 48% before the age of 18 and 62.5% before the age of 25.
Implementing a prevention policy is therefore a public health issue but also a major economic issue.
In fact, the cost of mental illnesses is high, around 600 billion euros, or 4% of GDP in the countries of the European Union, and 81.3 billion euros in France (3 .7% of GDP).
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The main cause of this situation is the lack of attractiveness of the profession of child psychiatrists, whose number has decreased by 34% between 2010 and 2022, from 3,113 to 2,039.
In the city, general practitioners or specialists are still too unfamiliar with the characteristics of the mental disorders of children and adolescents and
therefore “do not yet sufficiently play their role as a gateway to the course of care
”, notes the Court.
Saturated, the medico-psychological centers cannot respond within short deadlines.
And at the hospital, “
the so-called “outpatient shift” policy, which replaces full-time hospitalization with outpatient care, has had the effect of reducing the number of beds by 58% in ten years”
.
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In addition, the care offer does not sufficiently take into account the diversity of disorders and risk factors, even though these vary greatly, in particular according to psychosocial factors.
“
Some of the patients followed in the medico-psychological centers suffer only from mild disorders, to the detriment of the care of children suffering from more severe disorders
”, deplores the Court.
Finally, while France is in the average of European countries in terms of access to child psychiatry care remains unequal depending on the region: in 2021 there were on average 0.17 beds per 1,000 inhabitants under the age of 18 in national level but 8 departments had none "
resulting in refusals of admission and prioritization of the most serious situations
“, says the report.
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Expenditure dedicated to child and juvenile psychiatry care in health establishments in 2019 is estimated at 1.8 billion euros, concentrated in the public sector.
Modest, the expenses of city psychiatry represent only 23 million euros per year, while they represent 1 billion for social and medico-social establishments.
If the government has been mobilizing since 2018 in favor of psychiatry with its roadmap for mental health, its action has so far only resulted in a "pile
of plans that are difficult to read
", regrets the Court.
To facilitate access to care for children and adolescents, it recommends creating "childhood and adolescent centres" with a centralized call number, strengthening the training of doctors and pediatricians so that 'they can perform a front-line screening role, but also enhance the attractiveness of the profession by promoting hospital-university courses and supporting research.