Break in treatment, anxiety and suicidal thoughts related to confinement. While the psychiatric emergencies were neglected by the patients for a month, Dr Raphaël Gourevitch, who heads the psychiatric orientation and reception center (CPOA) *, based at the Sainte-Anne hospital in Paris, is worried to see arriving in the coming weeks a wave of patients out of treatment or particularly affected by the period we are going through.
Since the start of confinement, have you noticed an influx of patients who are struggling to manage this period?
Surprisingly, it was rather the opposite that happened. When the containment measures were announced, we were expectant; one could expect, in this context of generalized stress, a surge of patients towards psychiatric emergencies. In reality, in our country, the number of patients was reduced by two thirds in the first four weeks. Usually, we see about thirty patients every day, we turn today rather to ten. And we have similar feedback everywhere.
How do you analyze this drop?
There is relatively little hindsight, but several hypotheses could explain why the patients give up consulting. As with conventional emergencies which have seen their attendance drop outside of Covid cases, some patients are probably afraid of going to a medical environment, which they consider potentially contaminating and dangerous. The circuits of care are also disrupted, certain structures and associations which have a role of orientation had to close. On a more positive note, it can also be assumed that some patients have managed to mobilize significant resources and to set up, despite the difficult context, effective adaptation strategies.
What is the risk of this situation?
Our main fear today is to have to manage a second psychiatric wave. Confinement, the stressful news all day long on television, can lead to new pathologies or help to decompensate others. The very sharp drop in consultations makes us fear in the coming weeks an influx of patients out of treatment who risk arriving too late, in complicated conditions. To this situation could be added the arrival of new patients, hitherto unknown but who, in this anxiety-provoking context, is losing ground. This is already what is beginning to take shape elsewhere.
That is to say ? After a month of confinement, do patients start to come back?
With us, consultations are still far below our daily average, but we are not on the front line. My colleagues in the medico-psychological centers, in the emergency or hospital services are starting to feel a resumption of activity. And even if there is still relatively little hindsight, it seems that there is a significant proportion of new patients who present depressive pictures, suicidal thoughts or anxiety disorders, partly linked to the period that we are in the process of to cross. It is feared that this situation will worsen in the coming weeks and last over time. The biggest risk is that the health crisis we are going through is affecting all areas.
Are there any solutions to avoid this?
Exactly as for emergencies, you should not wait until it is too late, to be exhausted, to consult. Consultations in public centers have never stopped, some doctors have set up teleconsultation systems, we have witnessed a refocusing of care. For our part, we have set up, in conjunction with the regional health agency, a special line to listen to and guide the sick and their families.
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