Covid-19 and Psychiatry: The Ongoing Emergency

Author

Head of the Psychiatry and Addictology Unit at Hôpitaux Universitaires Henri Mondor, director of Fondation FondaMental

Covid-19 and the lockdown have had serious psychological consequences on the population. It is increasingly obvious that mental health has been a collateral victim of this pandemic. Psychiatry is facing a major, yet largely underestimated challenge. Professor Marion Leboyer, psychiatrist and director of Fondation FondaMental, which gathers a nation-wide network of more than 70 research laboratories and 40 university hospitals, answered our questions and presented the Foundation’s action plan towards the urgent need to support and reform mental health care in France.

Covid-19 has revealed the strengths and weaknesses of the French healthcare system. What did it reveal about psychiatry and what innovations have emerged during this time?

First of all, I don't think we should talk about Covid-19 in the past tense, for the pandemic itself has not ended. We are just beginning to understand how serious its socio-economic consequences will be. This unprecedented health crisis has certainly been highly instructive, but there are still many lessons to be learned. It made the general French public suddenly aware of the weaknesses of our healthcare system. At the same time, while the system was falling apart at the seams, medical teams showed great resilience and adaptability, avoiding potential disasters.

Like all medical specialists, psychiatrists made themselves entirely available for their patients, whether they were affected by Covid-19 or not, by staying in touch with them, offering reassurance, and giving them the support they needed. The teams were resourceful and reactive. They broke down historical barriers, developed highly operational applications and platforms in just a few days and implemented new practices. Telemedicine was the most visible, but certainly not the only one.

Unfortunately, psychiatry still remains neglected by public policy.

Unfortunately, psychiatry still remains neglected by public policy, and much more needs to be done. While all hospitals were mobilized as early as March 6, following the launch of the "plan blanc" (the French emergency response to the sudden increase of activity in hospitals), it was not until March 23 that instructions were drawn up for psychiatric institutions, without providing any concrete means for their implementation. Psychiatry is in a permanent state of emergency. The only way out is that it be given the place it deserves.

This is not about seeking a special treatment for psychiatry, but rather about placing it on an equal footing with other disciplines, and ending the disadvantages it has endured for decades. This was the objective of the Manifesto we wrote at the end of May, the title of which, Avec l’urgence sanitaire, l’urgence psychiatrique (With a health emergency comes a psychiatric emergency) summarizes our analysis of both the situation created by Covid-19 and the challenges that remain.

You launched the CovidEcoute platform: what results have you had so far?

Less than a month after the beginning of the lockdown, FondaMental brought together partners and sponsors to launch CovidEcoute. The aim was to provide, free of charge, a highly professional response to the needs of those for whom Covid-19 and the lockdown induced suffering, anxiety, sadness, stress and even suicidal thoughts, as we found in 10% of cases.

After answering a short questionnaire to assess their level of stress, anxiety or sadness, users were offered advice and resources, such as access to various online mediation tools, depending on the difficulties encountered, to sites or content on subjects such as the functioning of the brain, self-help tools for mental health, etc. When necessary, they were also offered a 45-minute teleconsultation provided by a pro bono psychologist or psychiatrist, trained to support people suffering from post-traumatic stress. A file was opened for each teleconsultation A report of each teleconsultation was sent to the user, who could then, if necessary, contact the same professional again.

At a time when digital solutions have developed at high speed, a secure platform, the length of the teleconsultations, the very professional nature of the response and the possibility to stay in touch with the same healthcare professional are what have made CovidEcoute original and successful. The service has received a score of 4.5 out of 5 from its users.

In 6 weeks, more than 5,000 people reported on their mental state through the platform, with more than 1,500 teleconsultations involving individuals who had never consulted a psychiatrist or a psychologist before. The callers were 39 years old on average, and 69% of them were women.

The top three reasons for using CovidEcoute were sadness from being separated from loved ones (43%), aggravation of a psychological condition that already existed before Covid-19 (42%) and the lockdown (41%). These were followed by sleeping problems (37%) and difficulties related to overworking and managing daily life (20%). These results confirmed the urgent nature of the issue and the need for mental health professionals.

By providing immediate help and tackling the systemic response, CovidEcoute highlighted the urgent necessity to organize and improve assistance for people who are unaware of the warning signals or uninformed about the mental healthcare system, and who could thus neglect a serious, or even disabling pathology.

What are the challenges faced by psychiatry, following the lifting of the lockdown and its consequences?

Whatever the quality of healthcare professionals and the performance of organizations, they cannot be truly and sustainably effective if they cannot count on excellent research teams. However, in the field of research, psychiatry is not treated like other disciplines, as is revealed by the low level of public funding allocated to psychiatry-related biomedical research. It is significantly insufficient to say the least. This disadvantage is all the more unjustified given the high quality of academic teams that are available. Moreover, industrial actors are also beginning to get involved in the field.

Each year, 20% of the population suffers from a mental disorder. Recognition of psychiatry as a major health and social issue is thus essential.

At Fondation FondaMental, we contributed to a major European project entitled "ROAMER - A Roadmap for Mental Research in Europe". We had worked to show that European funding for mental health research was two times lower than for research in neurology (including neurodegenerative diseases). Nonetheless, the epidemiological burden of mental illness is estimated to be 2.7 times higher than that of neurological diseases, while its economic burden is estimated to be 2.1 times higher.

This is an enormous challenge which can be met by recognizing the importance of the health, economic and social challenges of psychiatry on a national level. Each year, 20% of the population suffers from a mental disorder. Recognition of psychiatry as a major health and social issue is thus essential. It is clear that mental health issues, as important as they are, do not receive the attention and resources needed to develop the solutions and responses that patients and their families expect.

The mental health consequences will be heavy for the millions of patients who were receiving psychiatric help before Covid-19. The same goes for those who did not have psychiatric antecedents, but who saw their mental health deteriorate during the first wave of the pandemic, during and after the lockdown. In order to measure and qualify these consequences, FondaMental is already carrying out research on the consequences of the lockdown on patients diagnosed with mental health issues prior to the Covid-19 crisis.

Copyrigth : Philippe LOPEZ / AFP