They are in their thirties and have a whole professional life ahead of them. One is a hospital director, Aurélien Vautard, the other, a psychiatrist. They remember the genesis of this monument of a book that they hold in their hands “Mental health in France”. They say “It was winter 2022, it was gray, we were down. » Aurélien is deputy director of the Charles Perrens psychiatric hospital, and Florian Porta Bonete, psychiatrist, head of department.
At this time, Charles Perrens’ emergency rooms are overflowing, many young people, many more girls, the figures from Public Health France are panicking all over France, adding to their despondency. Macbeth will come to extend his hand to them: “There is no such long night that does not reach the dawn” This quote from Shakespeare which speaks of exhaustion, but also of hope. They decided that day to put an end to the complaints, to roll up their sleeves and fight using words, “to act through writing”. From this gray day was born a collective work, where no less than 114 mental health actors wrote their inventory, their hopes, their solutions, a real plebiscite to save psychiatry.
How did you construct this work, of almost 800 pages?
Florian Porta Bonete : The first one we contacted was Boris Cyrulnik, and he answered us straight away. He was ready to write the introduction and mobilize with us to find other speakers whose contacts he had. His enthusiasm galvanized us. We have not suffered a single refusal, all mental health professions are represented, doctors, but also administrators, nurses, psychologists, teachers, and even patients. The book relies on the skills of an editorial committee.
In your opinion, what is the state of psychiatry in France, given the figures that you describe as “scary”?
Aurélien Vautard. There are 15,000 psychiatrists and child psychiatrists in France, or 23/100,000 inhabitants, but it is their territorial distribution that is stuck, so in Corrèze, there is not a single child psychologist, and only 2 psychiatrists per 100,000 inhabitants in the Meuse. , while there are 76/100,000 in Paris. To this, we can add very worrying mental health indicators in the country, thus 1 in 5 French people today are affected by a psychological disorder, and there is a suicide in France every 40 minutes. If we add the economic impact, there is reason to speak of panic: 163 billion euros in overall costs are caused by mental disorders, which roughly corresponds to the deficit of the French State in 2023.
This overconsumption of medications is a symptom of the absence of alternatives, in particular difficulty accessing care.
What do you expect from the publication of this collective work? A reaction from the general public, that of the government?
FPB. Both. We need to shake things up, reinvest the field of mental health, as was done with the first cancer plan in 2003. We would like to see the emergence of a psychiatry plan of the same order, with the creation of a national institute of psychiatry and mental health, like the INCA (National Cancer Institute) This work has a common mission in a collective spirit, far from the wars of chapel, which have done us harm…
Chapel wars, what are they about? Different emerging methods around personal development, psychotherapies, the debate on psychoanalysis?
FPB. This book is based on a scientific basis, at a time when new practices flirt with pseudo-sciences, esotericism, beliefs of all kinds, without ever asking the question of their scientific plausibility, with data evaluated. All this can lose people. The book assumes a scientific basis to defend psychiatry, and all practices now recognized.
163 billion euros in overall costs originate from mental disorders, which roughly corresponds to the deficit of the French State in 2023.
We are one of the countries in Europe that consumes the most psychotropic drugs. How do you explain it?
A.V.. Indeed, this overconsumption raises questions, which particularly concerns anxiolytics, even though they pose dependence problems. As for benzodiazepines, the most prescribed, their link with the increased risk of neurodegenerative pathologies is still not clear. This overconsumption is a symptom of the absence of alternatives, particularly difficulty in accessing care. In addition to the shortage of practitioners, the non-reimbursement of consultations poses a problem. Certainly, the State is starting to move with the “My psychological support” system, but we still need to go further to meet population needs.
Since Covid, Santé Publique France has been warning about the psychological suffering of children and adolescents, a serious public health issue. In your work, many child psychiatrists sound the alarm. What remedies?
JPB. The latest bulletin from Public Health France reports a +246% increase in psychiatric hospitalizations among young girls between 10 and 14 years old, since the health crisis. Clearly, there is a before and after Covid. We are beyond a crisis phenomenon, the situation has persisted since the confinements without weakening, without us fully understanding its origin. These suffering young people will be the adults of tomorrow. We are calling for an action plan commensurate with the seriousness of the situation. We must quickly loosen the numerus apertus (the number of student places), broaden the scope of skills of nurses, particularly through advanced practice. We need to shake up the labs, to innovate, to find new classes of drugs, effective with fewer side effects.
AV. The National Institute of Mental Health that we are calling for would also be the place where we could innovate, in terms of access to psychotherapies, the contribution of neuroscience to accelerate diagnoses, we could identify possible pathologies or rule them out, thanks to imaging, biological assessments, AI. Today, it takes between 7 and 10 years to make a diagnosis in a young person. The Institute would also be the place to reinvent prevention.
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“Mental health in France” preface by Boris Cyrulnik, with the participation of 114 mental health actors, under the direction of Florian Porta Bonete and Aurélien Vautard. (LEH Edition) www.leh.fr
