Publications on the mental health of the French follow and resemble each other. Three years after the start of the Covid-19 pandemic, mental disorders have reached unprecedented levels. The youngest are not spared, since it is estimated that approximately 1.6 million children and adolescents are suffering.
Faced with this public health challenge, the offer of care in child psychiatry is not up to scratch, according to the Court of Auditors. In a report published on Tuesday March 21, the court calls for “revitalizing child psychiatry”, today characterized by “an unsuitable offer, unclear care pathways and inefficient governance”, according to Pierre Moscovici, first president of the Court of Audit.
This situation is partly the result of the “ambulatory shift” initiated ten years ago by France, i.e. the transfer of care traditionally provided in the hospital to liberal professionals or structures such as infant-juvenile medical-psychological centers (CMP-IJ). Between 1986 and 2013, the number of hospital beds in adult and child psychiatry fell by 58%. Result: the CMP-IJs, which have become the main gateway to psychological care, are overcrowded, and families no longer know where to turn.
Less well-endowed rural areas
Poorly calibrated, the offer is also poorly distributed. “In the current state of the organization of care, and in particular in the CMP-IJ, some of the patients followed only suffer from mild disorders, to the detriment of the care of children suffering from more severe disorders, in other words, the specialized care is not graduated enough,” explained Pierre Moscovici during the presentation of the report. Psychiatric emergencies for children do not exist (with some exceptions), young patients may find themselves hospitalized in pediatrics or adult psychiatry, far from the recommendations for good care.
These access difficulties particularly concern rural areas, which are generally less well endowed with liberal professionals. The Court of Auditors therefore recommends, in these territories under pressure, to increase the number of hospital beds, after a precise assessment of the needs by the regional health agencies.
The number of child psychiatrists in free fall
The low supply is also due to the growing lack of specialists. Between 2010 and 2022, the number of child psychiatrists fell by 34%. Of the 532 psychiatrists trained each year, only 100 turn to child psychiatry. It would take the double, estimates the Court of Auditors, for which the university course and research in this field must be better valued in order to reinforce the attractiveness of the profession.
The court makes several other recommendations, which could be implemented with constant resources – psychiatric care for children and adolescents represents approximately 1.8 billion euros in expenditure each year. First, the development of an exhaustive inventory of the epidemiological situation of mental disorders in children in France, to be updated at least every ten years, in order to assess needs more precisely. Then, the improvement of the training of general practitioners and pediatricians in the detection of mental disorders, those who are at the forefront.
Other avenues to lighten the load of the CMP-IJ: relying more, for mild disorders, on psychologists and nurses in advanced practice (IPA), who are required to take an increasingly important place in the healthcare system. Moreover, “it is important to clarify the function of IPA, in liberal as in establishment”, underlines the report. The Court of Auditors will soon publish a flash audit on this subject.
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