“The suicide of a patient is the caregiver’s greatest fear”

Olivier Bonnot is a university professor, hospital practitioner in child and adolescent psychiatry at the Nantes University Hospital, and secretary general of the National College of University Psychiatry.

What are the lessons to be learned from the suicide of this teenage girl on January 26 at Ambroise-Paré hospital in Boulogne-Billancourt (Hauts-de-Seine)?

First of all, we must not forget the figures for depression in adolescents, of the order of 10%. It is an endemic pathology whose knowledge remains rather poor, both in society and in the medical community. We do not talk enough about depression, there is never a prime-time campaign to say to consult if you have suicidal thoughts, when there is to screen for colorectal cancer.

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In addition, you should know that it is not because we ask the question of suicidal thoughts to someone that they will take action. Talking about it does not trigger them; on the contrary, it can provide relief. Nobody fakes when they talk about it.

Are there protocols for managing the suicide crisis in the hospital?

Yes, there is training provided, especially for nurses. They are told, for example, that answering “you have everything to be happy” is guilty and useless in the face of someone in depression. It is therefore a question of talking about it, then of evaluating the seriousness, the force, the level of precedence of the suicidal ideas. It is not the same thing to say “I can’t take it anymore I want to die”, and to have thought about how to buy a rope, where to hang it, and the fact that there was no nurse on the ward between 6:30 a.m. and 7 a.m. to be able to do that quietly.

But the risk of suicide is inherent in the treatment of mental illnesses. Suicides are prevented every day in all psychiatric services in France. All caregivers live with this idea in mind all the time, it is our greatest fear, that of a patient left unattended, or that we have let out, because places are also lacking. Sometimes I have to make trade-offs, be a little worried that I haven’t been able to hospitalize a patient, and I’m relieved to have him on the phone the next day.

Does the chronic lack of beds in child and adolescent psychiatry have consequences for pediatrics?

The pediatric departments are aware of these issues, but the environment is not necessarily very suitable: meals are served in the room, there are no therapeutic activities, not the same supervision. Anyway, we have no choice, there is such a lack of child psychiatrists! We are about to lose half of it in ten years. It’s not even a question of money anymore, but of people. And it takes ten years to train a doctor …

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