Child psychiatry: no to triage of children!

Tribune. The report was already unanimous and the deterioration of the health system recognized. Following the restrictions that have hit the hospital for ages, it was common knowledge that psychiatry was shipwrecked … It had often served as an adjustment variable to overly blind managerial policies. Within it, the most glaring shortcomings concerned child psychiatry, “deprived among the disinherited”.

The pandemic has passed there, with its deregulation of our confined lives. It has highlighted, by exacerbating them, all the pitfalls that so many young people may encounter, caught in new, uncertain and anxiety-provoking contexts. Psychiatry teams are familiar with these difficulties: in overcrowded structures, they welcome them every day and see their increasing incidence.

Moderate but also severe anxiety disorders, phobias (including school phobia), the most diverse addictions, eating disorders, learning difficulties populate our waiting rooms.

For several years, we have noted the multiplication of depressions, hitherto rare, in young children (underlined by the WHO) and the increasingly early appearance of signs of what could become serious adult psychoses, schizophrenia or bipolar disorder.

It is also towards psychiatry, health as well as medico-social, that the children followed by social services (ASE) are oriented, taken in chaotic existential paths alternating various institutions, homes of life and foster families and who present severe attachment and personality disorders.

All of these complications encountered by young people confront the teams responsible for receiving them in CMP as in CMPP (1) with more than tense situations in which professionals try, despite the small size of their means, to prioritize the most more urgent while ensuring medical and psychological care for all.

Cascade out of care

It is in this context of shortage, that the Regional Health Agency (ARS) of Nouvelle-Aquitaine is currently presenting a plan to reconvert its 29 CMPPs into platforms for early diagnosis for autism.

We know that, in this type of disorder, the earlier the diagnosis, the greater the possibilities of help. It is essential to start care early to relieve loved ones and initiate a life course as acceptable as possible for these children. That this requires a real effort on the part of the State, despite the always relative successes of autism plans for fifteen years, is obvious.

The fact remains that this project was developed by the ARS without any consultation either with the professionals or with the populations of the territories concerned and their elected representatives. The brutality of the approach is unprecedented and will cause breaks in cascading care: some teams have been “summoned” to end the treatment of their current patients within three months!

What do we do with the 60,000 children followed for psychological and psychological difficulties and who had, across the region, multidisciplinary local treatments, accessible to all and covered by health insurance? What will be done with those, just as numerous, who are awaiting the start of treatment?

In the “specifications” imposed on the CMPPs, the ARS evacuates the question, taxing them without further form of “Light cases” and referring them either to an almost nonexistent liberal sector, or to the school aid structures (Rased) dismantled for several years and unsuited to this type of care.

One of the CMPP in the region is even closed and its resources redeployed to other places, to diagnose other pathologies and another population … local families will appreciate.

We thus monopolize a system recognized as efficient for many categories of young people, even if it means knowingly abandoning these children when they are not less threatened psychologically, academically and socially than those for whom we fear an autistic development.

Young people who have become invisible

All children deserve our care! How can we explain that a majority of children find themselves abandoned in this way, in favor of other young people, who are in the minority, but who carry more “targeted” disorders? The answer is probably to be found in their lack of legibility for public authorities. By the wide variety of pathologies concerned, by the lack of collective action supporting them, young people with psychologically debilitating disorders have become invisible, especially in the eyes of the State Secretariat for the Disabled.

On the other hand, the families of autistic people, well constituted in solid associations (some can contest their methods, but certainly not their pugnacity and their legitimacy), are very influential there. It is up to the Republic not to discriminate between its children, especially when they need its active support.

It is the mission of the State and its representatives, in concert with professionals, associations, populations and elected officials not to undress some to try to clothe the others, and in the last resort to leave none “on the tile”.

(1) CMP: medico-psychological center (hospital management), registered in the health sector. CMPP: medico-psycho-pedagogical center (associative management), registered in the medico-social sector.

Signatories: Patrick Belamich, child psychiatrist, president of the FD CMPP, Sarah Bydlowski, child psychiatrist, psychoanalyst, HDR teacher-researcher, University of Paris, deputy director of the XIII Mental Health Associatione district of Paris, Brahim Hammouche, psychiatrist, deputy of the 8e riding of Moselle, Richard Horowitz, child psychiatrist, former president of the FD CMPP, Arnold Munnich, pediatrician geneticist, former head of genetic service at Necker hospital.



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