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“We have a window of fire to change the outlook on mental health”, assures Frank Bellivier, ministerial delegate for psychiatry

We have probably never heard as much about mental health as during the Covid-19 crisis … Emmanuel Macron had promised to convene a National Conference on Psychiatry and Mental Health from January 2021. Postponed, this meeting, unpublished, will finally take place this Monday and Tuesday, in videoconference.

The president must take the floor to close these meetings. The opportunity to announce new help for caregivers, who have been facing an influx of patients in distress for months? Frank Bellivier, Ministerial Delegate for Mental Health since April 2019, answers questions from 20 Minutes.

In 2018, Agnès Buzyn said of psychiatry that it was “the poor relation of medicine”. Have things changed?

Since she made her statement, a roadmap has been published and 37 actions are being deployed. They are very numerous in care, prevention, social inclusion, and are part of two dynamics. Those which will bear fruit in the medium and long term, in particular the reform of the method of financing and the establishment of territorial cooperation. And those which aim to support psychiatry as immediately as possible. The mismatch between needs and supply is still glaring today.

The question of means is often central. Was there a significant effort?

There were exceptional investments in 2018, 2019 and 2020, and calls for projects for three years for the innovation fund in psychiatry (20 million euros) and the call for projects targeted on child psychiatry (20 million euros). ). The Ségur de la Santé has added an envelope of almost 80 million euros. In particular to strengthen medico-psychological emergency units (3.4 million euros per year), help regional psychotrauma centers (9.6 million per year), finance psychologists in health centers and homes (12 million per year), fund the unique national suicide prevention number (16 million per year). All of this is sustainable funding.

This is very insufficient, because it does not correct the lack of investment in recent years. But this creates a dynamic of reformulation of the offer. Psychiatry, with 24 billion euros per year, is the first financial item of health insurance. We have to reinvest, but there are also margins in this considerable envelope. So we also have to reorganize.

Reorganize how? At the level of trades?

The lack of psychiatrists is a structural difficulty that we will not resolve in two years. The effect of the end of market value in 2021 will be seen in eight years. In the meantime, we must find means to better cover needs with intermediate professions: psychologists, advanced practice nurses, etc.

What can be learned from the “Ecout’émoi” experiment, launched in 2019 in three regions, which organizes the identification and management of mental suffering among young people aged 11 to 21?

This is one of the experiments that prefigures the general model we have in mind: setting up generalist / psychologist pairs. It worked well, even if there are difficulties related to the cumbersome protocol. There were too many documents to fill out by the general practitioner and the psychologist because we wanted to make an accurate assessment, and this did not facilitate the inclusion of patients. In the following experiments, we did not do the same.

The Assises of mental health and psychiatry, announced in January 2021 by Emmanuel Macron, are finally held this week. What do you expect from it?

It is a very important moment. First symbolically, with the fact that at the highest level of the State, we recognize that mental health is a public health priority in the midst of the Covid-19 crisis. Then, concretely, it is fundamental that the president summons all the actors to take stock of the roadmap, and probably announce the continuation. We hadn’t had reform for a long time. This roadmap has the merit of existing and will be a first step in this commitment.

Some associations regretted that these Assises devote only “little space to medico-social” …

The development of the program was very difficult. There is a significant place left for prevention and social inclusion policies. As a result of this criticism, we have added a presentation which will take stock of the multidisciplinary approaches for recovery, which will show the importance of the articulation between the medico-social, justice, the city …

Has the health crisis had an impact on your work?

It has accelerated certain projects and slowed down others. We have seen telemedicine develop at an exponential speed, and it was one of the actions of the roadmap. The same goes for the listening and guidance platforms, which we have seen flourish. The mobile teams too: we were forced to limit admissions to the hospital and give priority to the outpatient clinic. In the slowed down sites, we were hampered in the deployment of support in prison.

Has the Covid-19 changed the outlook on psychiatry?

I have the impression that we have a window of opportunity to change the outlook on mental health, to destigmatize. The proof of this is the reception given to the Public Health France campaign “Talking about it is already taking care of yourself”, launched in April 2021, aimed in particular at 18-24 year olds. The Ministries of Higher Education and Justice have taken up this issue. The agriculture sector has a suicide prevention plan. Mental health is becoming a matter of systemic concern and that will help us.

We have the impression of getting our head out of the Covid-19 “tunnel” a little in this re-entry. Psychiatry services too?

The game is not won at all, especially in child psychiatry. The psychological impact is often persistent, it can last over time. In addition, the health crisis is having an impact on employment and the economic situation of certain families.

Many families, in fact, are faced with months of waiting for a first appointment with a child psychiatrist. How to improve this access?

Waiting a year for a kid who is not doing well is unacceptable! This is where tracking devices can play a role. We must continue to invest in child psychiatry, but also help the front lines to identify. For example by generalizing a generalist-psychologist pair. This means that a doctor, if he identifies that there is a need, can suggest that the family go see a psychologist and it will be taken care of. We are working on this model.

But wasn’t that already the objective of the “100% psycho child” package, implemented last June?

It looks like it. Except that we are in a generalized vision of the process and in the long term. The psy check was put in place as a matter of urgency and is not intended to be perpetuated. It should stop at the end of the year.

Another boost granted during the health crisis, that of the psy check for students, who were entitled to three reimbursed sessions, announced in March 2021. What is your assessment today?

It is also a temporary device, which must stop at the end of the year. We have seen a mobilization of psychologists in record time, and a few thousand students have benefited from it.

Do you think other avenues are priorities for improving the mental health of young adults?

We absolutely have to strengthen the collaboration between healthcare professionals and the school. We are starting to have interesting experiments for a more effective identification of young people with psychological difficulties. We want to provide National Education with a toolbox of medico-social skills. There is also the deployment of the program “first aid in mental health”, which allows the identification by peers of young people who are not doing well in higher education.


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