While caregivers have been warning about the state of young people’s mental health since 2020, child psychiatry will occupy a large place during the child health conference, which takes place on Friday.
By saturating pediatric emergency services since 2022, the triple epidemic of Covid-19, influenza and bronchiolitis has revealed to the general public the deep crisis facing pediatrics. This is why, after the organization of 23 round tables, more than 120 hearings and the analysis of more than 2,000 written contributions, the child health conference begins Friday, May 24. The objective: to respond to the concrete concerns of health professionals, improve the care of children and fight against the health inequalities that affect them.
In a report submitted to the government on April 23, the members of the steering committee worked on around twenty measures to resolve this crisis. Among these remedies, at least three concern child psychiatry. Franceinfo spoke with Guillaume Bronsard, child psychiatrist at the Brest university hospital center (Finistère), who participated in the development of this report.
Franceinfo: What do you expect from the pediatrics conference which takes place on Friday?
Guillaume Bronsard: First, youth mental health must become a national cause. Because it makes very long as psychological suffering, neurodevelopmental disorders or psychotrauma are brought to the forefront, sometimes in a chaotic manner. We are at a moment where we could connect everything, whether it is bullying, suicidal issues or learning difficulties at school. We must put all of this under a single and visible umbrella so that the population and professionals can identify it.
Then, there should be an increase in direct and rapid reception resources, such as adolescent centers, but also the liberal sector and private psychologists. In particular by strengthening the Monpsy system and better reimbursement for consultations. Finally, there is an unprecedented problem of lack of hospital beds.
“Today, many young people admitted to the emergency room for a suicide attempt cannot be kept, due to lack of space.”
Guillaume Bronsard, child psychiatristat franceinfo
There would not be a need for many beds, because hospitalization times in adolescents for crisis situations do not exceed three or four days. But this period of time is essential for the adolescent and his family.
Indicators of young people’s mental health show that it has not improved since the end of the Covid-19 crisis and the lockdowns. How do you explain it?
This trend existed well before the health crisis. In fact, we have seen a slow and steady increase in expressions of suffering for twenty years. The crisis has aggravated this phenomenon and above all has destabilized all the structures surrounding children, such as schools and the social protection system. This has very strong effects on the youngest, since they have an absolute and indisputable need for the security of adults. The health crisis is therefore more of a symptom of a situation that existed before and which has worsened. It is estimated that there are 60% more requests for support today compared to twenty years ago.
What is this increase due to?
First of all, tolerance for psychological suffering has decreased. Screening is better carried out and prevention works better. In addition, patients are treated earlier. Which, again, is positive. It is therefore not necessarily a sign of worsening of the situation, but rather the omen of more effective screening and better referral to us, the child psychiatrists.
Then, we note a demographic aspect, with an increase in the child population compared to around thirty years ago. Finally, with the improvement of child psychiatry on certain subjects, such as autistic disorders, neurodevelopment or psychotrauma, many resources from general child psychiatry have been diverted towards very specialized systems.
So, if you combine the increase in the population, a sharp increase in screening and identification, with a drop in resources for general psychiatry, the result is queues of twelve or eighteen months to get an appointment. you in a medical-psychological center or in a medical-psycho-pedagogical center, which is unacceptable.
Do you also notice that today’s young people are doing worse than previous generations?
It is more difficult to measure, because they are subjective criteria. What is certain is that there are many more requests for psychological care than before. These are entirely appropriate and timely needs; not at all unnecessary whims or complaints from patients.
Do you mean that it is not a “generation effect”, more “fragile” than the previous ones?
It is at the same time a scientific, societal and almost philosophical debate: is complaining a sign of fragility? I do not think so. Obviously, there are situations that were not reported before that are now, as is the case with harassment. But that doesn’t mean people weren’t suffering. It just means they were silent.
“I wouldn’t say that young people are more fragile. They have a different relationship to intimate suffering.”
Guillaume Bronsard, child psychiatristat franceinfo
The Drees study published on May 16 reveals that hospitalizations for suicide attempts and self-mutilation are still on the rise among adolescent girls and young women. Why are they more affected than boys of the same age?
Here again, this was already the case before the health crisis. The phenomenon is more significant among young girls, who express their discomfort in this way and later, while it is the opposite among young children. More boys are taken into care, probably because they express their discomfort in a much more visible way, through behaviors that we call “externalized”, by being agitated, brutal or noisy. Society has very little tolerance for this type of behavior and will therefore respond more quickly when a child is disruptive. This is why boys are followed earlier.
Among girls, it is much more internalized: this violence is turned on themselves and is silent. This explains the delay in receiving treatment, which usually begins in adolescence. Girls generally express long-standing psychological insecurities, which did not begin at puberty, but which will reveal themselves at that time, with more visible expressions of suffering, such as scarification, suicide attempts and disorders. food. Unlike simply withdrawing into oneself, as they could do when they were in elementary school or at the beginning of middle school.
Are they the only ones to be more exposed to these psychological disorders?
No. Since the health crisis, abused children, victims of violence, incest or more generally children in child welfare protection (ASE) have also been affected. This is a highly vulnerable population, which needs special attention and dedicated resources, but which does not have access to care. It’s terrible.
What means would child psychiatry need to respond to these new demands?
Currently, French child psychiatry follows approximately 700,000 to 800,000 children. It should be double. The prevalence of psychiatric disorders in children is estimated between 10 and 13%. Added to this, between 5 and 8% of children and adolescents do not have any problems in the medical sense of the term, but they are suffering psychologically and would need advice and follow-up.
“Even if governments gave us enough to double our resources, that would not be enough to solve the problem.”
Guillaume Bronsard, child psychiatristat franceinfo
We still have a lot of difficulty recruiting psychologists, psychiatrists and specialized nurses. To be able to meet the estimated needs, not only do we need resources, but it will take a lot of time. About ten years.