Taboo, scary, shameful? Mental health remains a difficult subject to discuss, both in society and in family circles. And the stigma persists, even if speech is gradually being freed. Particularly since the Covid pandemic which, if it has accentuated the deterioration of mental health – particularly among young people -, has also had the merit of highlighting this subject. And that’s good, because it’s urgent. Every year, nearly thirteen million French people are affected by a psychological disorder and 9,000 people commit suicide. Tuesday October 8, a new survey, this time carried out by Ipsos for AXA Prévention, confirms the extent of psychiatric illnesses. According to this work, 36% of the 2,000 participants are in a state of psychological distress – including 54% of those under 35 and 56% of those under 25. And 60% of participants believe it is better not to reveal their mental health problem so as not to be ostracized.
Tuesday October 1, Prime Minister Michel Barnier announced that mental health will be the “great national cause” of the year 2025. This system makes it possible to highlight a cause thanks to the free broadcast of spots on public television and radio for the benefit of non-profit organizations and associations. A decision requested for month by the collective “mental health, great national cause 2025”which brings together 23 players representing more than 3,000 structures working in the field of mental health (psychiatry, medico-social, research, etc.). But given the scale of the needs, many voices hope that in addition to free media coverage, means and solutions commensurate with the problem will also be implemented.
In the meantime, three representatives of the “mental health great national cause” collective interviewed by L’Express, Angèle Malâtre-Lansac, general delegate of Alliance for Mental Health, Aude Caria, director of Psycom-Santé Mental Info as well as Jean-Philippe Cavroy, general delegate of the Fédération Santé Mentale France, are counting on this label to break taboos and best inform the population.
The Express. What are we talking about when we talk about “mental health”? The term seems catch-all: why not talk directly about mental illnesses?
Small mental health issues can seem insignificant in the face of serious mental illnesses, with persistent symptoms. However, we must understand that there is a continuum between well-being, psychological suffering and disorders that may require care. Our mental health can be disrupted little by little, until we reach a state of psychiatric diagnosis: depression, bipolar disorders, anxiety disorders, etc.
It is also in movement throughout our lives, with ups, downs and the possibility of recovery. This implies not having a vision focused solely on the disorder and care, but also on the importance of information, prevention and taking into account social, economic and environmental determinants. In short, everything we can do to prevent mental health from being disrupted to the point that it manifests itself in severe and persistent disorders.
Why should we pay more attention to mental health issues today?
Because the situation is urgent. Society must tackle the problem head on. We also want to break taboos. No one is ashamed of having cancer anymore, because it is not dishonorable. This is unfortunately still the case for a mental illness, even for a “mild” depressive episode. A major information campaign can help free up speech. And we think society is ready to have this discussion. The need for information is also very strong. In France, we are seriously behind. Other countries, such as Canada, Australia, England, organized the first major awareness campaigns more than 30 years ago.
You say that society is finally ready to break certain taboos, why?
The word has become clearer in recent years, particularly since the Covid-19 pandemic during which almost the world was affected. Since then, our various structures have received more and more questions every day from teachers, elected officials, judicial protection, etc. who want to better understand this subject. There has also been, over the past fifteen years, the emergence of the voices of caregivers who no longer want to accept certain things, such as the fact that those affected are sometimes no longer considered full citizens. In the business environment too, we see the emergence of subjects linked to stress and burn-out. Mental health is also the leading cause of long-term sick leave. Some companies are looking for solutions.
Given the scale of the problems, doesn’t the label Mental Health, a major national cause, act like a plaster on a gaping wound?
It’s going to be miraculous (laughing)! More seriously, having a spotlight on this subject is already very important. Yes, the great national cause “only” offers free communication space. But it is a lever for three clear objectives: inform, prevent and destigmatize. It’s a good start. This does not make us forget that the overall response will be in the long term.
This label could also help implement a prevention policy, for example by improving early detection. If we succeed, there will be a concrete impact in improving the lives of people with disorders. Finally, public actors will be able to take up the subject and put it at the top of the priority pile. This can be an opportunity for us to continue to raise it loud and clear, so that the government can help us find solutions.
Doesn’t the waltz of Health Ministers over the past two years worry you?
Despite these changes, there remains continuity in public policies. And this is the first time we have heard a Prime Minister commit in this way publicly. The Minister of Health Geneviève Darrieussecq also took a position on these issues as soon as she took office. For example, she suggested opening the ministerial delegation which deals with mental health and psychiatry in order to make it an interministerial delegation. This decision has been requested for a long time by all partners because we know that mental health is not only a problem of disorders or illnesses, but that it is linked to education and housing policy. , the organization of work, the fight against violence or against pollution (hearing for example), etc.
The fact remains that a communication campaign worth a few million euros will not be able to solve all the problems. How much money would it take to start making things happen?
It is practically impossible to give a figure. We nevertheless know that the total cost of caring for people diagnosed with a psychiatric disorder and all psychotropic treatments is estimated at 25 billion euros. This is the first item of expenditure for Health Insurance. And even then, this only concerns a small part of “mental health”. The OECD indicates, more generally, that the sum of direct and indirect costs of mental health corresponds to around 4% of GDP.
But money is not the only answer or the only problem. For example, there are open and funded positions for psychiatrists and child psychiatrists which are not finding any takers. One in three psychiatrist positions is not filled. One in two child psychiatrists are missing. There is therefore a concern for the attractiveness of the profession and working conditions. Why and how to make them more attractive? Some countries have succeeded in doing this, such as Australia, which has moved psychiatry into the top five specialties chosen by medical students (it is the last choice in France).
We can also wonder how to rely on emerging professions or organizations, such as advanced practice nurses. [NDLR, IPA, des infirmiers expérimentés aux responsabilités élargies]mobile teams [NDLR, qui se déplacent au domicile des patients]. Studies show, for example, that health mediators can have positive effects. It is also about questioning care practices, which may evolve. We believe we have reached the end of the psychiatric response. We will only be able to get out of this by involving all spheres of society which can alleviate suffering in psychiatry.
Mental health is precisely one of the first targets of unconventional treatmentsmethods that are not scientifically proven and/or criticized, such as psychoanalysis, or even sectarian excesses…
The members of the collective are “evidence-based medicine” oriented, with people who have strong scientific rigor. We have in the collective organizations whose mission is to produce reliable, accessible and independent information, such as Psycom, whose information sheets systematically indicate whether a therapy is based on evidence. [NDLR, des preuves scientifiques] or not. And we inform about the risks sectarian excesses linked to certain practices.
But this rigor does not mean that we exclude open-mindedness because, to help people with disorders or illnesses, many aspects of their lives must be taken into account. This can be physical activity, the quest for meaning, hope, self-esteem or spirituality. We must, of course, remain vigilant on these subjects, without distorting reality. But what guides us is determining how to respect the person while serving their recovery.
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