Do French children and adolescents have a problem with medication? In a report published on Monday, the High Council for the Family, Childhood and Age (HCFEA) warns of the explosion of prescriptions for psychotropic drugs among minors suffering from mental suffering and psychological disorders over the past ten years. According to the document, one in twenty children would now be affected, and the consumption of such drugs would simply have doubled between 2014 and 2021. The HCFEA notes, over this period, an increase of 49% in the taking of antipsychotics, of 63% for antidepressants, 78% for psychostimulants, 155% for hypnotics and sedatives.
This phenomenon concerns “tens of thousands of children”, specify the authors of the report, who are alarmed by levels of increase two to twenty times higher than those observed in the general population. How did we get here? The organization underlines a clear decline in the pediatric and child psychiatric offer. With waiting times of “6 to 18 months”, it would no longer allow minors to be accommodated “within a reasonable time”. And would encourage, in the absence of appropriate care, the use of the prescription of psychotropic drugs.
With the Express, the Secretary of State for Children Charlotte Caubel insists on the need for better care for these minors, focusing in particular on prevention “at all levels of the chain of child protection”, and a massive investment in the various structures responsible for the reception of these children and adolescents. Interview.
L’Express: The figures concerning the increase in the consumption of psychotropic drugs among children and adolescents over the past ten years are quite impressive. How to explain them?
Charlotte Caubel: These figures can be read in the context of a massive increase in the number of minors affected by mental disorders. The signals in terms of the mental health of children and young people – I also include students – are not good: the level of referrals to psychiatric emergencies is significantly higher than before the health crisis, the figures on the number of suicide attempts among these patients is alarming, eating disorders affect increasingly young audiences… The entire spectrum of mental health is affected. But it should all the same be specified that there is no French exception on the subject. Today, we are talking about 13% of children and adolescents who present at least one mental disorder in France – that is 1.6 million minors -, which roughly corresponds to the average for OECD countries.
The biggest problem that presents itself to us is to characterize all the causes of these disorders. There is of course an increase in neurodevelopmental disorders [troubles de l’attention, du spectre de l’autisme, de la communication et autres troubles de l’apprentissage]but also a more circumstantial context, which is that of the health crisis – the impact of which has been extremely strong on the mental health of young people -, the international crisis with the war in Ukraine, eco-anxiety, social generated by the omnipresence of digital technology in the daily life of young people, and the troubles obviously caused by the problems of intra-family violence.
The HCFEA report points out that these increases in the consumption of psychotropic drugs are 2 to 20 times higher than in the general population. Why in France, are children so exposed to this medication – even more so than adults?
The great awareness of young people’s mental health since 2017 has made it possible to better prevent and diagnose these disorders: there is greater involvement of all players, everyone is more attentive. France was lagging far behind in terms of diagnosis, especially on subjects with autism spectrum disorder [TSA] and neurodevelopmental disorders [TND]. We are trying to make up for this delay, in particular with the implementation since 2018 of the national strategy on ASD and TND, which aims to promote research, early diagnosis and support for the people concerned. Since more children are identified, more young patients are treated, especially with drugs.
We must nevertheless be careful, and not imply that doctors or child psychiatrists prescribe these drugs lightly, without respecting the protocols or instructions very clearly described by the High Authority for Health. [HAS] in our country. These protocols have also been redefined recently, which could also explain why doctors are prescribing more. But these are by no means comfort treatments.
According to the report, the continuous increase in prescriptions of all classes of psychotropic drugs in children and adolescents “is coupled with very high prescriptions outside of marketing authorizations and recommendations from health agencies”. The document mentions, for certain treatments, “non-diagnostic prescriptions”, “particularly long treatment times”, or even “non-compliance with the regulatory conditions of prescription and renewal by specialist doctors or specialized services”. Are there controls on the subject, should they be intensified?
The Ministry of Health, as you can imagine, analyzes this report in detail. What I can tell you is that the care pathways require comprehensive care of the child when medication is prescribed, the practices noted in the report therefore relate to specific situations. Since we are faced with a wave of patients, we are too frequently in emergency and in secondary or tertiary support. We know that when faced with such a demand, we by definition have to resort to community doctors who are not necessarily trained in these issues – a whole training plan for professionals has been put in place. . The challenge is precisely to strengthen all the links in the chain, and the vigilance of all the players on the subject.
The HCFEA is rightly concerned that the supply of care is declining, and can no longer accommodate within a reasonable time children and their families: we are talking about a 6 to 18 month wait. How to fix this problem ?
To support these patients as well as possible, it is clear that action must be taken at several levels. It is necessary to offer access to doctors and medication for the most complex situations, of course, but also to act on prevention, in order to prevent families from going directly to pediatric emergencies to try to have their children accompanied. The Mental Health Conference organized in 2021 goes in this direction: we have increased the budget of the Maisons des adolescents to the tune of 5 million euros, with the presence of such structures in each department. We have also invested 8 million euros each year for three years in medical and psychological centers [CMP] infant-juvenile to make it easier to make first appointments, almost 2 million euros in the creation of about fifteen centers specializing in the care of people suffering from psychological trauma. There was a delay on the subject, it is undeniable. It now takes time for these structures to bear fruit.
Many other projects are also being set up. The aim is to build a strong network on the territory with three levels of response: private doctors, nurses and school medicine supposed to identify the problems, the homes for adolescents who characterize these problems, and finally, child psychiatry with medical help if necessary. . Currently, we reach this third level too quickly. Especially since the sector is increasingly in tension.
On January 1, 2020, just under 600 child psychiatrists were indeed listed in France, with large territorial disparities: 17 departments would, for example, have no practitioners. How to revitalize the sector?
The entire childcare sector is affected by this problem of attractiveness: we see it for child psychiatrists, but also among social workers, teachers, nurses, educators, and even colony monitors! There is a real recruitment problem. The government is working hard to make these professions known and to create suitable sectors. There are also branch negotiations to make these professions more financially attractive, and discussions on how to improve the quality of life at work and working time in these sectors.
According to the authors of the report, the imbalance between supply and demand for psychological care in children is also explained by “the lack of coordination and clarity of the services and guardianship likely to contribute to the care and support of children”. How to restore this coordination?
This subject is absolutely fundamental. Within child welfare, one child in three suffers from a psychological problem: there is a link to be made between the family context, the consideration of psychological problems and the coordination of the different structures. . I’m not going to go into the details of all the actors who potentially surround a child, but they can be extremely numerous, and there is a real follow-up problem. We have kids who go from structure to structure, then end up in criminal justice because they were not properly supported.
It’s one of my fights. The objective is to get everyone around the table, in particular through departmental child protection committees that I recently put in place, which ensure that all child protection actors work together and ensure the coherence of their interventions.