2023-05-07 04:00:00
“8,000 forced hospitalizations per year”
You have just written two books. How to summarize the first, “Well in my head”?
“During the Covid, we all felt concerned by this question of anxiety, imbalance, chronic stress, the impression of no longer being in tune with one’s values… I found that we talked a lot about helplessness and few solutions. I wanted to share the tools I knew because I couldn’t receive everyone for consultation. Obviously, I am aware that the advice is less individualized. I do not deliver miracle recipes. »
An example ?
“Cardiac coherence calmed me down. I do it several times a day. I practiced it even when I played tennis matches to reduce my stress level. I did a lot of work on reconnecting to emotions and to the body. I have been meditating since I was 18. I am also talking about EMDR, the kundalini yoga model… this book can help you awaken your faculties of self-healing. »
The second book, “I stop doing too much”, raises the question of perfectionism?
“Perfectionism can cause suffering for people. It is also good to regularly carry out an inventory, an upgrade of one’s perfectionism so as not to fall into a negative spiral. »
How do we recognize it?
“The need to control, to do too much, to say yes to everything too often. Not knowing when to stop. These situations, in which we put ourselves, can cause health problems and lead to stress, depression, burnout, and even impostor syndrome. »
On a daily basis, you treat patients in great difficulty:
“I have been the head of the observation service (MEO) since 2009. We have a law in Belgium which makes it possible to order a placement under observation (MEO), that is to say hospitalization under duress in psychiatry, for a maximum period of 40 days. Services are overwhelmed. We currently have 8,000 observations per year in Belgium. This represents 10% of psychiatric hospitalizations. In our services, we have 400 hospitalizations per year, more than one per day. »
What is an MEO more precisely?
“This request can be made by a doctor if he considers that there may be a danger for you or for others. A justice of the peace may find that it is better for your safety and that of others that you be followed by a medical team within a specialized establishment. »
How to explain this increase?
“Since the Covid, different reasons explain the situation: delays in care, dropouts, people who are impoverished… Every day, I am in discussion with patients and families on the risk of suicide, the risk of transition to act, the question of treatment, of drug interactions… So it’s intense. »
V.Li.
“The patient can become an actor of his health”
How do you do when a patient comes to see you?
“My commitment is to offer the most individualized care possible. I have always had a concern for humanism and humanity in meetings. I don’t want to reduce patients to pathologies, symptoms and boxes… even if it is necessary to make diagnostic hypotheses in order to be able to give treatments. »
For you, the patient can be an actor of his mental health?
“The patient can once again become an actor in his health, in his mental health. This is important because when a person feels helpless, it increases their distress. I put the patient in a process of being more responsible for his health. Obviously, this doesn’t work with everyone. Some patients are too distressed and depressed. These people cannot be told to go and meditate. On the other hand, it can be a next step, when it is possible to reduce the treatment. I seek through my medical practice what is right for the person at the right time. I am aware that on a daily basis, it is not always easy because psychiatrists today are overwhelmed and understaffed. »
Are patients not sometimes tempted by alternative medicines or approaches?
“Socially, people have realized that the medicine of omnipotence must evolve. They sometimes turn to alternative medicines that have more or less quality with more or less trained people. The quality of the therapist is essential in each approach. »
How do you know who is competent and well-trained?
“The authorities do not know how to regulate everything. Do not hesitate to ask the question of training to the healthcare professional in front of you. If it is a doctor, a clinical psychologist, we can know it more easily of course. The patient should not be afraid to ask the question of diploma and training to his therapist. I don’t mind when people ask me the question. He must also ask the question of reimbursement of care, which is very important. »
What is the difference between a psychologist and a psychiatrist?
“The psychologist completes 5 years of study. This professional cannot prescribe medication. He is not qualified to be able to make a differential diagnosis. A psychiatrist is first and foremost a doctor, with a specialization in psychiatry. That is 11 years of study. He can prescribe medication and complementary examinations, and also request differential diagnoses for a patient. Psychologists and psychiatrists are complementary. »
“Each patient is unique”
In mental health, more than ever, do we need to provide individualized care?
“Each patient is unique in mental health. That’s what’s great about my job. We must meet the patient with our knowledge, our expertise, but without prejudice. We must listen to the patient and see the best care adapted to him. »
An example ?
“I’ll take an example: when, in an appointment, we treat a person who is not well and who has difficulty living alone in his apartment, we can sometimes say to him: “you, what you need, it’s a psychiatric care home.” Theoretically, that’s true. But if he doesn’t want it, and he wants his autonomy, it will never work because he will defeat this project. He could run away and refuse treatment. We can then think about setting up a mobile team that comes to your home. It takes a little time. We trust the patient. If that doesn’t work, we review the process with him. The patient must be involved in the process whenever possible to find lasting solutions. »
Also find better compliance?
“The same approach can be applied to psychiatric treatments, which are very effective treatments (there is still 30% resistance to psychiatric treatment) but which have side effects. These must be taken into account because they can cause the patient to stop treatment. We must talk about the side effects to adapt the doses or the treatments. We will then have a better follow-up treatment, even if it may not be optimal. The dose will perhaps be a little less strong but better bearable by the patient who follows it. »
In today’s fast and hyper-connected world, you are asked to listen and take time, isn’t that paradoxical?
“It is indeed the paradoxical injunctions to which we are subjected in a profession where we are not always given the time to do our job well. It’s difficult. »
Do your colleagues also call you for help?
“Many doctors called me to tell me that they were also close to burnout and that they needed to breathe or have means to escape. We have the right as caregivers to take care of ourselves! It is essential and fundamental. This makes it possible to get out of denial: the carer is supposed to always be strong… When he is not well, there is a feeling of shame, we must not know it… We must speak, otherwise the caregiver can, like the patient, turn to self-medication, alcohol, and also suffer…”
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#explosion #demand #mental #health #followup