Suffering children and families who no longer know where to turn for help. “Such situations have, unfortunately, become commonplace”, notes Doctor Christophe Libert, president of the Association of psychiatrists of infanto-juvenile sector (API). In question, the lack of child psychiatrists, whose numbers have been halved in ten years. In 32 departments, there is no longer a single one. And with the aging of the profession – 80% of the 730 child psychiatrists are over 60 – other departments are threatened.
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Keystone of outpatient psychiatry for minors, medical-psychological centers (CMP) and medical-psycho-educational centers (CMPP) are seeing their waiting list grow. “In these structures, we are talking about a period of six months on average. It is obviously shorter in the event of an extreme emergency, but that is where we are: sorting out the patients,” regrets Christophe Libert. And this expectation is not without consequences. “Childhood is a time of brain maturation, a time when things are changing at high speed, hence the need to take care of them as quickly as possible. Especially since the vast majority of mental disorders in adults start before the age of 15. There is always an urgent need to take care of a child. »
An old crisis
Certainly, the malaise of youth is unprecedented, “but the crisis in the profession is old and well known to the public authorities, insists the doctor. For more than twenty years, child psychiatry has been treated as a “micro-domain”, endowed with means that do not match the needs. And everything that made it possible, upstream, to take care of the children – the school environment, the PMI (Maternal and child protection, Editor’s note)the Rased (Network of specialized aid for students in difficulty, Editor’s note) – has deteriorated. »
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Another culprit: the numerus clausus, whose noose was loosened too late. “The effects will still be felt in the coming years, since it takes at least 10 years to train a child psychiatrist”, recalls Christophe Libert, who is nevertheless well aware of the lack of “historical” attractiveness of his specialty. “It’s a fact, child psychiatry is less popular than other medical and surgical specialties, and I fear that the current state of the profession is not helping matters. »“Each year, the number of positions filled is less than the number of open positions”, also deplores Professor Maurice Corcos, head of the department of adolescent and young adult psychiatry at the Institut mutualiste Montsouris (Paris).
Enough to fuel territorial inequalities. “In ten departments, there is no infant-juvenile hospital bed”, points out Professor Corcos. For lack of anything better, children and adolescents are regularly hospitalized in the adult sector.
Consequences for child development
A practice severely denounced by the defender of rights, Claire Hédon. In November 2021, its report on the mental health of children pointed to the deleterious effects of these late or poorly adapted treatments: “The lack of care for mental health disorders and the resulting breaches of rights constitute an obstacle to the proper development of the child and to his best interests. » Among its 29 recommendations, the increase in the number of CMPs and CMPPs, the creation of “children’s homes” (on the model of the homes for adolescents, which the government has planned to provide each department), but also the inclusion in the law prohibiting the admission of a minor to a psychiatric unit for adults.
An obvious thing for Christophe Libert, who emphasizes that children are not reducible to “little adults”. Beyond a “major capacity building”it is the entire architecture of the sector that this doctor calls for a review. “A device like “MonPsy” (which allows all insured persons, from the age of 3, to benefit from eight reimbursed consultations with a psychologist, Ed), is dust compared to needs. What is needed is to review the functioning of the whole field of childhood, not to add layers to the millefeuille. »