The advice of a psychiatrist to support the future confinement

Nicolas Franck is a psychiatrist at Le Vinatier hospital and a teacher.

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• Nicolas Franck, psychiatrist, launched in March an investigation into the consequences of confinement on the mental health of the French, via social networks.

• At the same time, he wrote an essay, completed on the eve of deconfinement, which examines the reactions, psychological disorders and resilience of isolated people.

  Whether through confinement, but also in prison, in space for astronauts, at sea for navigators.

• While the executive is preparing this Wednesday evening to announce new restrictive measures in the face of Covid, and probably new confinement, he recalls that mental health, which is sorely lacking in resources, must be one of the government's priorities.

Do you smell that scent of depression that pervades everything?

While Emmanuel Macron must announce new restrictive measures this Wednesday evening, and the latest rumors promise new national confinement, many are worried about being stuck at home for long rainy weeks ...

While waiting for the details of this new upheaval, the psychiatrist Nicolas Franck, head of the pole at the Le Vinatier hospital, and who publishes this Wednesday the

test

, alert on the mental health of the French already undermined during the first confinement.

Without forgetting to give some advice to live better in the coming months.

Why did you write this book?

From the start of confinement, I found myself disconcerted, like all French people elsewhere!

And I wondered how everyone was going to get over that.

So I launched an investigation on social networks with Frédéric Haesebaert [also a psychiatrist] on the factors that could worsen or protect the mental health of the general population from the consequences of confinement.

At the same time, I wanted to write this book to see what it is like when people are isolated.

Whether they are astronauts, speleologists, solo sailors ...

What do these various experiences teach us in terms of resilience?

Lock-up always has an impact on people's mental health.

But they live it more or less well depending on the conditions.

Astronauts, when they structure their activity and maintain social ties, are more successful in being resilient.

Note that there is a big difference between an astronaut and a confined: it is chosen and not imposed.

In these confinement experiments, preparation matters a lot: the more people know what to expect, the more involved they are, the better it goes.

You show that the confinement from March to May greatly affected the mental health of the French.

In what way?

This has resulted in a decline in overall mental well-being.

Which has not stopped decreasing over the weeks.

Containment has been a stress that has led some people to enter into pathology, anxiety or depression.

Everyone has their own threshold of vulnerability, which they can cross when subjected to persistent stress.

Knowing that there are three phases of stress: astonishment, adaptation and collapse.

Are you worried about the psychiatric services, which have for years warned that they were lacking in resources and resources, and which risk ending up with a "wave" of new patients to treat?

Obviously.

There are more French people who are going to be bad.

It is essential to put in additional resources and to reorganize the services, otherwise part of the population will remain in pain, and therefore put themselves in danger and be less productive.

The response to the Covid-19 pandemic has three main axes: resuscitation which combats the most severe effects of the epidemic, the economy that must be saved, but also mental health, which is too prone to to forget.

Are you afraid that a more or less strict re-containment, which could be announced this evening and whose outlines are still unclear, will be even more difficult to bear?

Yes, and for several reasons.

First of all, some still suffer from the after-effects of the first confinement.

Putting them back in the same conditions starts the machine again.

On the other hand, we are entering the period of lower light - we switched to winter time last weekend - conducive to seasonal depressions.

Finally, in March, there was a shorter-term perspective: two weeks first - we believed in it - then it was extended, but only to eight weeks.

We temporarily believed that the epidemic could end after spring.

There, we left for the medium or long term.

Because we realize that despite the two-month confinement, the epidemic is still as powerful as at the beginning.

In addition, we are already under strong constraints: masks, social distancing, teleworking ... What is also worrying is that in March, there was a support of the population for confinement, at least at the beginning.

This time, we feel that the French in general, and young people in particular, accept it less.

The decision was not worked on with the population.

In psychiatry, we know that it is essential to allow the appropriation of the disease and the treatment by the patient.

For example with support groups, in which people discuss their disease with former patients, workshops where we learn about the issues of the disease, the symptoms to look for when it gets worse.

Which confers mastery.

This approach should be adopted in the Covid-19 pandemic.

What should be changed compared to the first containment?

First, keep schools open, and even universities, at least in part.

This is very important because students, who are at a pivotal time in their existence and often live far from their families, are the ones who suffer the most from confinement.

If we are all confined, it is essential to maintain physical activity, to allow people to walk, run, and cycle.

People get infected in confined spaces, not outdoors.

And it is very important for physical and mental health to continue playing sports.

The other tip is to keep a regular rhythm in terms of sleep and eating.

We saw during confinement some people who confused professional and personal life and suffered burnouts, who shifted their pace, who gained a lot of weight ... Finally, last fundamental point, we must maintain social contacts.

Those who lived alone suffered the most from the confinement.

These people must be able to continue to see a person.

I think we should above all protect, confine, vulnerable people, but not necessarily the entire population.

This would be more acceptable and economically much more favorable.

You write that the stress of confinement can be increased by the lack of an end date.

Is it important, then, to set a deadline and stick to it?

It's very important psychologically to be able to project yourself beyond a specific date.

On the other hand, by breaking down the periods of restrictions, the population does not know where they are going, which is a major stressor.

If we are confined again, what can we put in place on a daily basis to better support this period psychologically?

To regain control, we can find an activity completely linked to confinement: getting into the kitchen, inventing interior, introspective activities.

For my part I wrote a book, for Bob Sinclar, it was online concerts!

It's good to find a goal that makes the situation positive and to share it with others.

It's like a retirement plan: if the person has nothing planned, after a few weeks or months, they are bored.

You can prepare for active containment depending on your interests and what is authorized.

Attention to others and solidarity can also help to feel useful and boost self-esteem.

You write that "the drawbacks of confinement could be offset by the maturity it can promote."

That is to say ?

We can get something positive for ourselves and for our relationship with the world.

For example, for the planet, confinement has had a positive impact: you don't have to be in a plane or in a car all the time.

And some have learned with this particular period to ask and question their frenetic race to consume.

* Covid-19 and psychological distress, 2020, the odyssey of containment, Odile Jacob, October 28, € 21.90.

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