It is a spotlight – and it is not the first – on the state of child psychiatry in France. But faced with the alerts, shared by childhood specialists, on the prevalence of mental disorders among the youngest, the report made public by the Court of Auditors, Tuesday, March 21, has the merit of recalling, with supporting figures , the challenge of “access and [d’]a care offer to be reorganized”.
This is also the title of the 140-page report presented to the press on Tuesday morning by the first president of the Court, Pierre Moscovici. The culmination of around a hundred interviews, nearly 300 hearings, trips to four regions and two foreign countries – Sweden and Belgium – the report as presented by the senior official revolves around “three messages” : “The offer of psychic care is unsuited to the needs of young people ; the route, organized into “sectors” [un héritage des années 1970], is difficult to read and saturated; finally, governance is poorly adapted”despite the political determination displayed since 2018 and the adoption by the government of a “roadmap” on mental health.
At the center of the report, suffering children and adolescents. The magistrates of rue Cambon, while insisting on the lack of recent epidemiological data, put forward the figure of 1.6 million young people concerned. Between 750,000 and 850,000 of these minors benefit annually from care provided in child psychiatry. In essence, we measure the extent of those who do not benefit from it, so the Covid-19 crisis has increased – and brought to light – the extent of the needs.
Lack of “first line” care
At the center of the report, too, caregivers, establishments and treatment centers in tension. In the current state of the organization, in particular in the infant and juvenile medical-psychological centers – these “CMP-IJs” considered as the gateway to the course of care –, the Court notes that some of the young people monitored only suffer from “mild disturbances”, to the detriment of the care of children affected by more severe disorders.
The gap between needs and supply reveals structural difficulties of access: lack of health care ” First line ” adapted to the diversity of disorders, insufficient gradation of care, territorial inequalities. A few figures reflect these tensions over the long term: thus the reduction in the number of child psychiatrists by 34% between 2010 and 2022. Over the period, the number of these practitioners fell from 3,113 to 2,039, according to the data transmitted to the Court by the College of Physicians.
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