Mister President,
The National Commission of Psychiatry began its work since last spring.
As coordinators of the child psychiatry group, we would like to express to you, through this open letter, our gratitude but also our constructive concern.
Our ambition remains that of a discipline as committed as ever to our youngest fellow citizens and their families, often in a very vulnerable situation.
One month after the Mental Health Conference that you carried out and wished for with all the professional partners, users and families, child psychiatry is grateful to you in several ways.
All these years of scarcity have led many colleagues or hospital administrations to no longer request investments for child psychiatry because they are almost always refused, apart from external contributions such as the Hospital Foundation.
Signatories of the platform
Your speech touched us deeply by the precise observations, the delicate but real criticisms of previous policies that led to the health catastrophe we are experiencing today. The words were strong and they were heard. We are also grateful to you for the commitments that have been made. The discipline salutes the university recognition which is finally given to it, thus allowing France to leave the group of few countries (Belarus, Slovenia) which have not yet done so. You thus make it possible to improve the level of knowledge and skills of future child and adolescent psychiatrists.
It also welcomes the decision to put the medico-psychological centers back at the center of the care system, knowing that the inter-sectors of Infant-Juvenile Psychiatry and the adult psychiatry sectors will be on an equal footing in terms of the resources allocated. .
This organizational decision should allow a resumption of dialogue at a time when public policies have severely crumbled the healthcare network in the territories.
Finally, the effort on research and higher education, with, among other things, the generalization of the discipline in the faculties of medicine, extends what has already been initiated under your five-year term.
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However, beyond these heartwarming words and announcements, the discipline remains worried. First of all on investments. The funding announced corresponds in fact to psychiatry projects already selected for the Ségur de la santé and which remained unfunded in all disciplines. However, all these years of famine have led many colleagues or hospital administrations to no longer ask for investments for child psychiatry because they are almost always refused, apart from external contributions such as the Hospital Foundation.
Regarding the 400 additional posts announced for the medico-psychological centers, these will mix in the territories with the current 1,700 vacant posts and will therefore not constitute a new expense. We are told that we will be able to recruit associated professions. We welcome it. But with what attractiveness in terms of salary for the professionals of our teams: speech therapists, psychologists, psychomotor therapists, educators, nurses, social workers. With what quality of training for certain trades which have not experienced reform of the content of their teaching and training for years?
Will the recognition of our discipline and the announcements be enough to reverse the current trend which sees young doctors turning away from psychiatry and caregivers increasingly reluctant to make a long-term commitment?
Signatories of the platform
Replacing certain child psychiatrist activities with other actors is certainly possible, other countries are doing it happily.
But the quality of care must be at the rendezvous of patients and families.
Today, the majority of medical or paramedical consultations are carried out by dedicated and committed professionals but insufficiently, if at all, trained in child development.
We are therefore very concerned about the quality of care that will be provided now and in the years to come.
Finally, in terms of research, the funding announcements for the whole of psychiatry (120 million Euros) are unprecedented. But how will this large sum be distributed? Will it also be able to serve clinical research as close as possible to the conditions of care and the field? The main orientations for research in psychiatry having been rejected by an international committee, more than 40 million have already been allocated for a project which largely resumes the creation of an Institute for the Development of the Child that the 'INSERM and the CNRS have never agreed to finance in the past. While it is quite legitimate for such an institute to see the light of day in France,for what reasons should it be financed with mental health credits? Will these 40 million be subtracted from the 120 million announced? What will really come back to research in child and adolescent psychiatry knowing that these 120 million will be shared with our sister disciplines that are adult psychiatry and psychogeriatrics? Without counting addictology and perinatal psychiatry, two fields where we collaborate with our adult psychiatrist colleagues?two fields where we collaborate with our adult psychiatrist colleagues?two fields where we collaborate with our adult psychiatrist colleagues?
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Mr. President, our discipline remains worried and vigilant.
Vigilante to make the real accounts of the announcements and to the equality of the efforts on the territory.
Vigilant not to crumble resources as if sometimes it was necessary to divide to calm the resentment of professionals and families.
Vigilant to the principles of equality, justice and citizenship that you have so well known how to put at the center of your concerns and your public discourse.
Vigilant not to give in to the quality of care that we owe to our youngest fellow citizens.
The discipline will also always remain a partner of the State, of the General Directorate of Healthcare Provision and of the ARS to seek solutions to deal with the most urgent, which today consists of returning to basic concerns of another time: how to manage emergencies without qualified personnel in a pandemic context? How to find a bed when there are no more nurses to recruit? How do we explain to families that we have no other choice but to let a teenager (or a) without a solution come home? How to support children and adolescents, recognized as disabled by the Departmental House for Handicapped Persons, with an orientation in a medico-social establishment, but without a place allocated for many years?
Child psychiatry remains worried and calls with all its wishes that the post-election period does not witness a reset of the reforms and commitments announced.
Signatories of the platform
Will the recognition of our discipline and the announcements be enough to reverse the current trend which sees young doctors turning away from psychiatry and caregivers increasingly reluctant to make a long-term commitment?
A real reflection on the attractiveness of the child psychiatry professions exercised in the public hospital should in our opinion be undertaken.
Child psychiatry knows that you are very concerned about young people in general, and mental health issues in particular.
It has great hopes in the announcements and conclusions of the Assises de santé Mental Health and in the setting up of specific work within the framework of the National Commission of Psychiatry and hospital-university authorities.
She nevertheless remains worried and calls with all her wishes that the post-election period does not witness a resetting of the reforms and commitments announced.
We ask you to believe, Mr. President of the Republic, in the assurance of our deepest respect.
Signatories:
David Cohen, Assistance Publique-Hôpitaux de Paris-Sorbonne University, co-coordinator of the child psychiatry group of the National Commission for Psychiatry.
Anne-Catherine Rolland, Reims University Hospital Center, Reims Champagne Ardenne University, President of the child psychiatry sub-section of the National University Council, co-coordinator of the child psychiatry group of the National Psychiatry Commission.
Jean Chambry, Paris Psychiatry and Neurosciences University Hospital Group, President of the French Society for Child and Adolescent Psychiatry and Associated Disciplines, co-coordinator of the child psychiatry group of the National Commission for Psychiatry.
Christophe Schmitt, Specialized Hospital Center of Jury-les-Metz, co-coordinator of the child psychiatry working group of the National Psychiatry Commission.
