Flurry of requests in child psychiatry services. Parents, worried, often the same answer: we will call you back when we have room, please wait. Behind the scenes, for lack of resources, we have to sort the waiting list. Prioritize urgent situations. Give priority to young children with early developmental disorders and to whom care must be provided as quickly as possible by seizing the opening offered by the cerebral plasticity of the first years of life. Favor “skin-prone” children who break teachers ‘ears, furniture, classmates’ feet, class dynamics and overwhelm a school. At best, there are teenage dropouts holed up in their homes, lonely behind their screens; at worst, adolescents who act out, suicidal or explosive. Forcing action, these situations mobilize part of the human and technical resources, insufficient, at our disposal.
But all the others? The discreet people who toil in silence, the children “snails” in learning and suffering from their difficulties, the minors mistreated physically and / or psychically, and so many others whose symptoms do not cry for help but who, underground and in without knowing it, design “bombs” which will be expressed tomorrow in the form of depression, self-inflicted or heteroaggressive acts, encysted disorders. For all of them, no means granted to the sectors – the local child and juvenile psychiatry services – by the public authorities. Only the reimbursement of private consultations over a few sessions, one-stop shops, expert platforms are provided for, away from the child’s living area – school, college, home, district – and who see him occasionally for an evaluation and a diagnosis before a referral to the local infant and juvenile psychiatry service, saturated! We must then turn to the private sector, a perilous approach. Psychiatrists, child psychiatrists, speech therapists are endangered species. And that’s why your daughter is silent! There is cause here to worry about the chronic underfunding of child psychiatry.
Both lace makers and ants
Alongside this distressing management which silently cuts down psychiatry every year, there are all these children already followed by our services for various disorders requiring complex care. So do we do the best we can, from guidance consultations – responsible in particular for evaluations, diagnoses, care projects and their organization – to multidimensional approaches involving several professionals from our teams in partnership, and increasingly, with the sectors private and associative. While it happens that we make lace makers with parents in great difficulty; or very often ants knitting, for a good number of children, the necessary and local links, with schools, colleges and high schools, child protection, local association networks, departmental disability centers. These MDPHs, thus the acronym, grant on medical certificate and heavy administrative formalities, for a given child human assistance in school environment, fixed prices for care in the private, for another a support by a medical institute. educational, a Sessad (1), an Itep (2), themselves overloaded.
Our consultation centers very often resemble buzzing and very lively hives where children and families from Europe, Africa and Asia come together, some of them in great precariousness. But we are suffocating from the pressure linked to the lack of means. “How to take things?” recently asked us an influential person questioned by a journalist in a popular district of Paris. Badly off in terms of the immense needs, these districts are a magnifying mirror of the situation in France for children with troubled psyches, a critical situation.
There is a need for joint action on several fronts and at different levels.
Certainly our consultation centers – medico-psychological centers, medico-psycho educational centers – are not, in their wording, centers of expertise. Without waiting for the diagnosis “label” by a dedicated platform, they treat the children of today, the adults of tomorrow. Is this cause worthy of interest enough to justify delegating it resources, human and financial, in proportion to increasing needs, commensurate with the growing social unrest and what demographic growth would require in certain regions or districts of large cities?
A reform of the financing of psychiatry, supposed to be implemented at the beginning of 2022, provides, in the long term, a pricing of support; the calculations exclude the pricing of team meetings around a child, one of the essential elements of care; they will quickly penalize excessively long support, beyond eighteen months. This is problematic when we know that it sometimes takes years to build or rebuild a bond with a child and / or his family. The funding allocation will give a place to quality. One would expect the quality of care. It is about the quality of the procedures of which we know the time-consuming power.
From figure to care
There is a time when we have to question ourselves about what we are doing: are we doing numbers or are we doing care? Options that are difficult to reconcile a priori, the care first thinks of what is fair and judicious for each child and tries to accompany him towards his adult being. The figure manages, a shortage in this case.
Field psychiatrists know the numbers. They are ready to invest in reflections on health economics, on humanist bases and with a long-term aim, where prevention and care at the right cost for all are common objectives. Thus, it will be necessary to take into account the effects on health of endocrine disruptors, video games, social networks, screens whose addictive effect has an impact on the immature brain of the child to the point of inducing disorders. autistic in appearance. It will therefore be necessary to question the factors generating precariousness, the impact of which on the mental health of adults and their children is known. It will therefore be necessary to question the place given today to culture and higher education in the public sector. We are ready to work with all those who have understood that investing in the physical and mental health of children is not only humanly desirable but also essential for the future of a country.
Signatories : Dr C. Zittoun, Dr C. Libert, Dr J. Fortineau, Dr C. Desobry, Dr J. Chambry, Dr P. Belamich, pédopsychiatres, AFPP, Ile-de-France association of child psychiatrists, API, association of inter-sector child psychiatrists, FFP College of Child Psychiatry, French Federation of Psychiatry, FDCMPP, Federation of medico-psycho-pedagogical centers, SIP, Psychiatric Information Society, SFPEADA, French society of child and adolescent psychiatry and associated disciplines.
(1) Special education and home care service
(2) Therapeutic, educational and pedagogical institute, formerly rehabilitation institutes