Already witnesses this winter of difficulties in pediatric services, the French will be faced with a “major shortage” of child psychiatrists “in the short term”, warns the Court of Auditors in a report published on Tuesday. Some 1.6 million children and adolescents suffer from a mental disorder, including 600,000 to 800,000 from “more severe disorders”, estimates the Court.
However, between 2010 and 2022, the number of child psychiatrists decreased by more than a third, to fall to nearly 2,040 people note the financial magistrates. “The decline in the number of child psychiatrists […] makes access to care very difficult,” said the first president of the Court of Auditors, Pierre Moscovici, heard by deputies on Tuesday.
Worse, while alerts on the mental health of children and adolescents have multiplied since the Covid pandemic, “the demographic crisis of the discipline promises to be even more acute in the years to come”.
Nearly 40% of “active retirees”
Because today, care is largely provided by child psychiatrists who are in a situation of accumulation employment-retirement. These “active retirees” represent approximately 37% of competent doctors in the discipline and they are on average… 72 years old.
Suffice to say that the blow will be hard when these doctors have completely retired. Especially since 47% of working people are already over 60 years old… “Without targeted measures” warns the Court of Auditors, France could have “less than 1,000 practitioners” by 2035.
“To compensate for future retirements, it would be necessary to at least double the number of students trained in child and adolescent psychiatry for the next fifteen years”, insists the Court of Auditors.
Improve the supervision rate
To achieve this, she calls for “strong attractiveness measures” to encourage students to choose to specialize in child and adolescent mental health. Admittedly, there is a risk of undressing Pierre to dress Paul, but the demographic crisis is “more striking” as far as child psychiatry is concerned than adult psychiatry.
Among the measures likely to enhance attractiveness, the magistrates recommend improving the student supervision rate. Knowing that the ratio of supervisors is low compared to other medical specialties (1 teacher for 17 interns in child psychiatry). The Court also proposes to increase the number of lecturers or to support French research in the discipline.
Reinforcing the role of “shrinks”
Beyond targeted measures on the attractiveness of psychiatry, the magistrates recommend strengthening the place of psychologists and nurses in advanced practice. Especially since, according to the Court, the care is not “graduated enough”. Some of the patients followed in specialized centers are for mild disorders, sometimes to the detriment of the treatment of victims of severe disorders.
This logic of sharing with other health professionals is reminiscent of the strategy displayed by the Ministry of Health to deal with the lack of general practitioners.