Solidarity with Mayotte: taking action on access to healthcare and mental health

The impact of Cyclone Chido highlighted the major difficulties in the health system. The hospital centre is overwhelmed, there are not enough doctors and the population faces multiple financial, logistical and administrative obstacles in accessing healthcare. In this context, mental health is a major issue: the needs are immense, particularly among young people. Interview with Sophie Lasserre, head of health and mental health at Fondation de France's Emergency unit.

What are the priority challenges in meeting the health and mental health needs of the population?

The healthcare system in Mayotte is extremely fragile. When we visited the hospital at the end of June, we saw that only two of the five operating theatres were operational and that there was a severe shortage of professionals, often on short-term contracts. Access to healthcare is limited by the fact that many residents are unable to pay medical expenses upfront, the lack of public transport and, for some, the fear of being arrested when visiting a clinic. Remember, there is no state medical aid in Mayotte. The particularly poor living conditions on the archipelago (a high proportion of substandard housing, poor hygiene, air pollution, lack of access to running water for a large proportion of the population, etc.) have a major impact on the health of the people of Mayotte. In particular, there has been a sharp rise in chronic diseases (cardiovascular conditions, cancer, diabetes, etc.). In addition, the cyclone caused interruptions in treatments for several weeks.

Mental health is particularly neglected: adult psychiatric services are virtually non-existent and access to private practice psychologists remains limited, too expensive and faces cultural barriers. Yet the needs are considerable: many young people suffer from isolation, anxiety disorders, addictive behaviour or trauma reactivated by the cyclone. Young people's health is another major issue. Mayotte has almost 10,000 births a year, the equivalent of a school class every day, with an infant mortality rate twice as high as in mainland France. Early pregnancies are still very common. Many young people grow up in an environment marked by poor living conditions, insecurity and lack of access to drinking water, further undermining their physical and psychological health.

What are Fondation de France's priorities in this field?

We have chosen to place a priority on the health of young people, who are particularly vulnerable. The Terra Psy association  organises discussion groups in schools. School psychologists are in short supply, and it was vital to be able to support pupils when schools reopened after the cyclone at the start of the year. Terra Psy also runs psychological outreach to support out-of-school children and their families. The Play International association  has set up sports sessions led by mental health professionals for children in various neighbourhoods. For the start of the new school year, it is offering these sessions in schools and is working with professionals from the French education system to enable them to run these sessions. Meanwhile, the EPSM association provides somatic and psychological care for students at the University of Mayotte, the agricultural college in Coconi and the rural family centres, which will be continued at these establishments. We have also focused on outreach projects to reach vulnerable and isolated people who are not or are no longer able to go out for treatment.  

Why is cooperation between the various stakeholders essential?

Mobile initiatives enable us to reach people who do not go to health centres for fear of being arrested, a lack of resources or who have withdrawn following the cyclone. But these systems are still fragile: uncertainty about the capacity of the hospital and outpatient facilities sometimes limits the possibilities for referrals after screening. That's why we're working with the Regional Health Agency to strengthen coordination between health, social and community actors, in order to pool resources, share practices and provide a more coherent collective response.

This effort is particularly necessary in the area of mental health, which is still the neglected part of the healthcare system. Anxiety disorders, addictive behaviours and post-traumatic syndromes, which are very prevalent among young people following Cyclone Chido, require a concerted and coherent response. There is still a strong stigma attached to psychological counselling, which is often seen as a sign of weakness. Offering clearer and more appropriate care pathways also helps to reduce the stigma attached to mental health in society.

We also pay close attention to the care of victims of gender-based and sexual violence, which also affects young people. Associations working in the field have identified many situations, made worse by the destruction of homes and overcrowding, but lack secure facilities to host and protect victims. The development of coordinated systems, bringing together healthcare professionals, voluntary organisations and institutions, is essential if we are to offer comprehensive support.

Can you give some examples of the projects you have supported?

Our priority is still to support the most vulnerable. The Mayotte Autisme association has refurbished its therapeutic garden to continue its support for people with autism spectrum disorders. Located in Mamoudzou, the Groupe d'Entraide Mutuelle Vivre Ensemble, which supports people with mental health problems and has seen a sharp increase in demand for its services, has replaced its destroyed equipment and increased its capacity. We also supported a day of reflection on the psychological consequences of the cyclone, organised by and for healthcare professionals, with the aim of making mental health a reality and a priority for everyone.

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