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21 March 2023
Communication to the Social Affairs Committee of the National Assembly
Access to and provision of care to be reorganised
In the member countries of the Organisation for Economic Co-operation and Development
(OECD), about 13% of children and adolescents have at least one mental disorder, i.e. a
condition that affects mental health and can take many different forms and expressions.
Although the lack of data on the French situation makes it difficult to estimate the numbers
involved, it can nevertheless be estimated that around 1.6 million children and adolescents
suffer from a mental disorder. As in other OECD countries, the Covid-19 epidemic has
resulted in a significant increase in mental health problems in children aged 10 and over and
in adolescents. The report published today by the Court of Accounts aims to quantify the
need for child and adolescent mental healthcare by assessing the prevalence of disorders
and the available provision, and to analyse the organisation of the supply of care, its
distribution over the territory and its cost to public finances.
Psychological care provision not adapted to the needs of young people
Between 750,000 and 850,000 children and adolescents receive child psychiatric care from
specialised professionals each year in different ways (outpatient, partial and full
hospitalisation). However, the Court notes that in the current state of the organisation of care,
and in particular in the child and adolescent medical-psychological centres (CMP-IJ), some of
the patients followed only suffer from mild disorders, to the detriment of the care of children
suffering from more severe disorders. In terms of the supply of facilities, both outpatient and
inpatient, France is in the middle of the pack among European countries and is marked by high
regional inequalities. Furthermore, the crisis in medical demography, with the number of child
psychiatrists falling by 34% between 2010 and 2022, makes access to child and adolescent
psychological care even more difficult. Expenditure dedicated to their care in healthcare
institutions in 2019 is estimated at €1.8 billion and is concentrated in the public sector.
An insufficiently graded care pathway and a saturated supply
The child psychiatry care pathway is based on a supply organised in child and adolescent
"sectors", whose assigned tasks are very broad. Upstream of the process, the public authorities
have tried to develop an approach to preventing psychological disorders in mothers and infants
with the "1,000 first days" national project. But this effort is not as strongly pursued in schools
- national education psychologists are often referred to school counselling. In towns and cities,
private professionals are still too unfamiliar with the characteristics of psychological disorders
in children and adolescents and therefore do not play their role sufficiently as the gateway to
care. In particular, the Court recommends that their training be improved. On the other hand,
psychologists and advanced practice nurses, in large and growing numbers, are destined to
gradually take their place in the care pathway. In this context, the CMP-IJs have been
progressively overwhelmed by various requests, ranging from mild to severe disorders, making
it difficult to fully carry out their task of monitoring the most severe psychological disorders.
In addition to the existing structures, an experiment with children's and young people's centres
could help to ensure more effective front-line care. In this renewed landscape, the CMP-IJs
could thus devote themselves to the monitoring of moderate to severe disorders, to the
coordination of pathways and fully assume their role as centres of expertise. Lastly, in order to
anticipate and limit the use of emergency services when a patient is in crisis, mobile and liaison
teams should become a basic facility in each reference territory.
A clear desire to improve the organisation of child and adolescent mental healthcare, but
governance that is not very operational
The Ministry of Health has shown a willingness to strengthen access to child and adolescent
mental healthcare since 2018, notably with the adoption of the mental health roadmap.
However, the latter does not set clear objectives or a timetable for implementation. Moreover,
although the establishment of a ministerial delegate for mental health and psychiatry (DMSMP)
has improved the legibility of the policy, its role and place must be extended to child psychiatry
and brought to an interministerial level. The regional administrative organisation of child
psychiatry also suffers from a lack of operational vision. The financing of child psychiatry is
subject to the same regime as that of psychiatry, but the allocations renewed each year do not
take into account the evolution of activity and are little adapted to the local specificities of
institutions, with the exception of new measures and calls for projects.
The need to enhance the attractiveness of child and adolescent care professions
There are still shortcomings in the provision of child psychiatry care, both in terms of quantity
and quality. The entire sector must therefore be revitalised, in particular by making child and
adolescent mental healthcare professions more attractive. This is based on enhancing the value
of hospital and university courses, supporting French research in the field and improving the
recognition of clinical practice in institutions and private practice. Lastly, the Court
recommends that the child's doctors and paediatricians be placed at the heart of the reception
and referral of patients, in order to improve the care pathway and its gradation.
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Julie Poissier
Head of Press Relations
+33 (0)1 42 98 97 43
+33 (0)6 87 36 52 21
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