After the emotion the time of questions in France after the death Monday, May 22 of a nurse in Reims, killed in hospital by a patient suffering from psychiatric disorders. A tragedy that brings to the forefront the catastrophic situation of the psychiatric sector for several decades.

The murder "immediately raises the question of the catastrophic situation of the care of the mentally ill in our psychiatric institutions," responded Tuesday Force Ouvrière Santé, after the announcement of the death of a 37-year-old nurse, stabbed Monday at the University Hospital of Reims.

According to the first elements of the investigation, the aggressor, a 59-year-old man under curatorship, suffered from severe psychiatric disorders and had already been violent on several occasions.

Even if it is not possible at this stage to determine what precise role his pathology played - the nature of which is unknown - questions are already being raised about the psychiatric follow-up to which he was subjected.

"The patient had not been taking his treatment for more than a year," a local union source told AFP on condition of anonymity.

Several actors in the hospital world therefore see in this drama a new illustration of the difficulties of French psychiatry, a sector plunged into a deep crisis for several decades.

"We will live tense moments in terms of psychiatry" in the coming years, acknowledged Tuesday on RTL Arnaud Robinet, president of the Hospital Federation of France (FHF), also mayor of Reims and member of the presidential majority (Horizons).

He used a term ubiquitous among observers of the sector: psychiatry is the "poor relation" of the French health system.

In recent months, the main organizations of psychiatrists at the hospital have repeatedly denounced the "advanced dilapidation" of the sector and the "great contempt of the government".

Desperately looking for psychiatrists

Psychiatry has problems common to the entire hospital, but amplified by the specificities of mental disorders: the latter often require long-term follow-up and drug treatments must generally be accompanied by psychotherapies, which involve long consultations.

To respond to this, the resources of the public hospital appear inadequate, which translates for many patients, especially children and adolescents, into the impossibility of finding an appointment for many months and then benefiting from a sufficiently regular follow-up.

One figure shows that this trend goes back a long way: between 1997 and 2021, the number of psychiatric inpatient beds fell by about a fifth, from almost 100,000 to just over 80,000.

This decline is not easy to absorb because it reflects a lack of caregivers - psychiatrists and specialized nurses - due to a lack of income and satisfactory working conditions in hospitals.

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These conditions can have disastrous consequences for hospitalized patients. In 2021, several dozen psychiatrists denounced, in the newspaper Le Parisien, an excessive use of imprisonment, seeing it as the "shame" of their discipline because of excessive pressure on caregivers.

Known for a long time, the crisis of psychiatry returned to the political field Tuesday: the leader of the Republicans, Eric Ciotti, called for a "great psychiatry plan", a concern until then rarely expressed on the right.

But "it is not by snapping our fingers that we will have more doctors tomorrow, we will have to wait 10 years," warned the Minister of Health, François Braun, at the National Assembly, also defending the "sharing of skills with specialized nurses".

As he recalled, the government has taken several measures since the beginning of Emmanuel Macron's presidency. But, among the actors of psychiatry, they are still considered very insufficient.

The most emblematic is to offer the reimbursement of several consultations with a psychologist for "mild to moderate" disorders.

But the amounts reimbursed are considered too low by psychologists, the number of consultations often insufficient for effective therapy. In addition, many patients are left behind, their disorders being considered too heavy for such a journey but not serious enough for hospitalization.

With AFP

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