Several actors in the hospital world see in the knife attack perpetrated on Tuesday a new illustration of the difficulties of French psychiatry, a sector plunged into a deep crisis for several decades.
Psychiatry is the “poor relative” of the French health system. This alert, launched by politicians and caregivers for years, is revived by the fatal attack on a nurse at Reims hospital on Monday May 22. The suspect, a 59-year-old man, suffers from schizophrenia and paranoia and had been followed for decadesaccording to the prosecutor in charge of the investigation. Even if it is not possible at this stage to determine what precise role pathology played in the passage to the act, several actors in the world of psychiatry see in this drama a new illustration of the difficulties of this sector.
>> At the hospital, “attacks are daily”, testify caregivers
“It is a dramatic event which remains exceptional, but it is the sign of all the dysfunctions of a care chain in France”, estimates on franceinfo Antoine Pelissolo, head of the psychiatry department of the Henri-Mondor hospital in Créteil (Val-de-Marne). A similar analysis is made on the trade union side. The deadly attack at the Reims University Hospital “immediately raises the question of the catastrophic situation of the care of the mentally ill in our psychiatric establishments”reacted on Tuesday Force Ouvrière Health in a press release.
“A big problem in monitoring these patients”
By the very admission of the Minister of Health, François Braun, before the deputies on Tuesday, “our psychiatry, like emergencies, like maternity wards, like our health system, it has been in trouble for years, we know it”. For years, organizations of hospital psychiatrists have deplored the “advanced decay” of the sector and the “great contempt for the government”. Four unions even called a strike last November to denounce the bed closures. “We are mobilizingsince 2003 to alert on this very deep crisis of psychiatry, which has been perpetuated for thirty years”insists to franceinfo the Reims psychiatrist Patrick Chemla, member of the national council of the Union Syndicale de la Psychiatrie. “This tragedy confirms us in the idea that we must continue to mobilize.”
Psychiatry is confronted with problems common to the whole hospital, but amplified by the specificities of mental disorders. These often require long-term follow-up and drug treatments must, most of the time, be accompanied by psychotherapy, which involves long consultations. “There is a big problem in monitoring these patients”, points out Christophe Prudhomme, spokesperson for the association of emergency physicians in France (Amuf), with the site actu.fr. According to him, “a lot of violence is linked to psychiatric patients who are cared for in unsuitable premises. At Samu 93, where I work, when a patient decompensates, we don’t know what to do. We hold him down, we give him an injection and we sends to the emergency room. And after that, it’s zero follow-up”illustrates the emergency doctor of Seine-Saint-Denis.
Ever fewer hospital beds
To respond to these heavy costs, the means of the public hospital appear unsuitable. For many patients, especially children and adolescents, finding an appointment with a specialist can take several months. While care needs have increased since the Covid-19 health crisis, the number of hospital beds in psychiatry continues to decrease, year after year (by 0.9% in 2021, after a drop of 1.2 % in 2020), according to a report published in September 2021 by the Department of Research, Studies, Statistics Evaluation (DREES). “In the Paris region, at the moment, we have 15% of the beds which are closed”, counts the psychiatrist Antoine Pelissolo. Patients whose state of health requires hospitalization are therefore sent home or wait “for days and days in the emergency room”.
These conditions can have disastrous consequences for hospitalized patients. In 2021, several dozen psychiatrists denounced, in The Parisianan excessive use of confinement, seeing it as the “shame” of their discipline because of excessive pressure on caregivers. “There have never been so many restraints, placements in isolation centers, because the young people who arrive are not properly trainedregrets Patrick Chemla. Psychiatric interns no longer have training in psychotherapy and, on the nursing side, the psychiatric specialty has been abolished.
A specialty shunned by future practitioners
Another point in common with the hospital: the lack of staff. These shortages would thus concern “five out of six hospitals”, alerted the unions of psychiatrists when they called for a strike last November. “About 30% of hospital practitioner positions are currently unfilled”, pointed for her part Isabelle Secret-Bobolakis, secretary general of the French Federation of Psychiatry (FFP), on franceinfo, in March 2022. This situation is likely to last, because the specialty is shunned by future practitioners. In 2022, psychiatry still stagnated in 40th place, out of 44, of the specialties chosen by medical students, according to statistics from national ranking tests (ECN).
Known for a long time, the crisis of psychiatry has thus returned to the political arena. “We have a hospital that is going badly, which is already poor, and within that, psychiatry is the poor relation in the hospital”castigated Wednesday the deputy La France insoumise François Ruffin, at the microphone of Europe 1, calling for more “of humanity”. On the right, voices are also raised to denounce the lack of means. President of the Les Républicains party, Eric Ciotti, called in a press release published on Twitter has a “great psychiatry plan”.
Nevertheless, “it’s not by snapping our fingers that we will have more doctors tomorrow, we will have to wait ten years”has already warned the Minister of Health in the National Assembly. “We are going to live through tense moments in terms of psychiatry” in the coming years, also admitted on Tuesday on RTL Arnaud Robinet, president of the French Hospital Federation (FHF) and mayor of Reims. “How does a person who has been deemed irresponsible in view of his mental state find himself in the wild, in complete freedom, with a break, perhaps, in treatment? The solution, I don’t know it, is a whole chain that needs to be reviewed”concluded the aedile.