Monday January 15 in the morning in Créteil, temperatures are close to zero degrees, an icy wind blows on the facades of the multiple pavilions of the Albert-Chenevier hospital (AP-HP). No sirens or ambulances arriving at full speed: calm reigns inside the enclosure, which hosts ten centers of activity, including an expert center in psychiatry. These care platforms – the first of which were deployed in 2010 and which now number 53 – aim to improve the screening, diagnosis and management of psychiatric illnesses in adults: bipolar disorders, schizophrenia, resistant depression and spectrum disorders autism (ASD). We do not welcome patients in crisis, but those in medical wandering, who present complex symptoms for community medicine to understand, or whose treatment is no longer suitable.
Inside the building, the welcome from the members of Professor Antoine Pelissolo’s service is warming. Along the corridor, a few patients are preparing to be seen for consultation, after a wait of two to three years, which betrays the success of the Expert Centers as much as their lack of resources. “In the event of an emergency, the delay can be reduced to one year,” however, specifies Dr Marine Jacquelin, who has just granted an hour and a half interview to a young woman referred by her GP for possible ASD. The result was negative. Otherwise, she would have been offered a series of interviews with a multidisciplinary team, including psychiatrists, psychologists and neurologists, responsible for establishing a complete assessment as well as the most precise diagnosis and recommendations possible.
Innovative research projects
With the consent of patients, this valuable information is then recorded in order to feed the large databases necessary for cutting-edge research. “At Albert-Chenevier, for example, we have a program which aims to look for the existence of psychiatric disorders within the family circle of patients, in order to understand if certain genes explain these illnesses,” illustrates Dr Jacquelin. Other studies look at links with the microbiota – the ecosystem of bacteria that live inside our digestive tract – or inflammation. With promising results.
All this research is shared between the Expert Centers, coordinated by the FondaMental Foundation, a scientific cooperation structure dedicated to the fight against mental illness. Its goal: to achieve “precision psychiatry” capable of developing new treatments and adapting them to each patient. “The idea is to be able to say ‘you have this microbiota or this genetics, you need this drug rather than another’, which would save precious time,” explains Marine Jacquelin.
On the patient side, the support and the promises are attractive. “Of the 8,000 people who have participated in the discussion groups over the last two years, there is unanimous agreement on the merits and beneficial contribution of the Expert Centers,” assures Blandine Boussard, treasurer of the Argos association 2001, which supports patients suffering from bipolar disorder, an illness which affects a million French people and against which current treatments do not provide a cure, but a recovery, thanks to a strong reduction in symptoms and a reduction in the frequency of relapses. . “The Expert Centers appear indispensable to us,” she adds, praising the collegiality of expertise and the specialized listening provided.
“They are revolutionizing care in organizational terms, and we have shown that there is a halving of patient rehospitalizations twelve months after an assessment,” explains Marion Leboyer, general director of the FondaMental Foundation and director of the Inserm neuropsychiatry laboratory. translational (Paris-Est Créteil University). However, 80% of a patient’s direct cost is due to hospitalizations. Imagine the possible savings if we developed these centers!”
Expert center, sector psychiatry: competition or complementarity?
Despite these successes, the model is still not integrated into the healthcare system or deployed across the entire territory and is not sufficiently funded. It does not necessarily appeal to all health professionals either, while a debate between geographical sectorization and specialization runs through all of psychiatry. “There are already a lot of referral centers and I am not necessarily in favor of all initiatives focusing on these specialized sectors which can leave certain patients aside, because many do not fit into boxes and have forms intermediaries, for example between borderline disorders and autism, or bipolarity and schizophrenia”, points out Professor Nicolas Franck.
This psychiatrist at the Vinatier specialized center, in Bron (Rhône), fears that an increase in resources for expert centers will be to the detriment of sector psychiatry, which would on the contrary need “a strengthening of its resources, to promote an increase in skills. However, the two types of structures are not intended to cannibalize each other, with defenders of Expert Centers arguing that they position themselves rather as places of recourse. Unless this specialty, historically the poor relation of medicine, is finally given all the interest it deserves.
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