Stress, depression, dark thoughts, mental burnout ... for more than a year, the Covid pandemic has had an impact on everyone’s mental health. To prevent and relieve psychological fragility and even mental disorders in young people, healthcare workers, elderly and vulnerable people, Fondation de France supports players in mental health tangibly and lastingly. We review some exemplary projects.
The pandemic is affecting French people’s mental health significantly. The CoviPrev survey carried out by Santé Publique France (National Public Health Agency) shows that the prevalence of depressive states has doubled between September and November 2020, from 11% to 23% of the population. Mental disorders – sleeping problems, stress, addiction, addiction, depression or even suicidal thoughts – spare nobody and they have been triggered or exacerbated by the pandemic. For Fondation de France, mental health is very much everyone’s business, which is why it supports long-term programs to assist and protect all those in distress.
Addressing the distress of young people
Young people, whose mental ill-health has become a topic of major concern, come first and foremost. The Observatoire de la Vie Etudiante, a review of student life published in September 2020, revealed that 31% of all students were thought to present signs of psychological distress. Isolation and a lack of social interaction, which is key to building their personality, made them particularly vulnerable. And on top of that, young people are facing increasing poverty. To support students through this ordeal, Fondation de France works alongside a number of players in the medical, psycho-social, education and non-profit fields, with a view to spotting vulnerable subjects and quickly pointing them to appropriate care. Because of the health restrictions that make therapy protocols more complicated, several remote consultation platforms have been supported. One such digital portal, developed in partnership with Lille teaching hospital is Elios (Équipe en Ligne d'Intervention et d'Orientation pour la Prévention du Suicide – On Line Team for Suicide Prevention: Guidance and Intervention), which will enable young people to contact a team of online clinicians on several social media.
Already operational since 2010, nonprofit Apsytude too offers webcam consultations to vulnerable students (Happsy Line) and also in-person ones (Happsy Hours), in a range of organizations (higher education institutions, training institutes, student social welfare, etc.). Placing a request on the website is quick and care is provided free of charge, with no time limit. Therapy is provided by a network of around 50 psychologists, each one aware of the issues specific to students and trained to identify suicidal crisis situations. Since the start of term six months ago, 6,000 calls were registered, 25% more than last year. According to Fanny Sauvade, co-founder of Apsytude: “A digital tool makes it easier to approach professionals by removing the main social, financial and geographic barriers. Young people are reassured to see that their peers are experiencing the same thing, which helps normalize the process. Many of them are suffering from anxiety and depression in varying degrees, as well as mental fatigue, which has a big impact on concentration, memory and sleep. Some of them are at risk of dropping out of their studies. Our practitioners offer ad hoc psychological support rather than therapy. On average, four sessions are usually enough to defuse a crisis. Should more serious disorders be diagnosed, the student is then directed to a specialist team for long-term care.”
Added to these online services are the more local initiatives that aim to allay the “ill-health” of young people. A few months ago, the Maison des adolescents des Ardennes (a house for teens in the north of France) welcomed a mobile psycho-social team, that travels around isolated small communities in the areas in a recreational van. On board is a team of two, an educator and a psychologist. They see young people aged 12 to 25 who want to be listened to, alone or with their parents. Establishing contact close to home or school, for example, makes it quicker to spot the difficulties young people face and helps tackle these problems with appropriate solutions.
Taking care of care providers
Having grappled with the health emergency for more than a year, healthcare workers have also been affected massively. Mental exhaustion, very tough working conditions, a feeling of helplessness and managing the distress of families have all damaged workers’ psychological state to some extent.
In the teaching hospital of Strasbourg and surrounding area, the largest regional hospital impacted by the first wave of the Covid pandemic, a mobile psychological support group was set up to assist healthcare workers. This two-stage mechanism provides collective debriefing sessions facilitated by a team of nurses and psychologists and then offers those most vulnerable individual care from a psychologist or psychiatrist.
Stress, overwork and mental fatigue have also taken over the lives of Ehpad (state-run retirement homes) staff. In order to prevent psycho-social hazards associated with this unprecedented situation, the Groupement social et médico-social Palaios, a grouping of four Ehpads in the Rodez area (in southwest France), implemented a psychological support scheme for supervising staff. Information meetings were organized in each retirement home with volunteers, to raise awareness. Two psychologists offered individual consultations to volunteers. Pierre Roux, co-director of Groupement Palaios, came up with this idea: “Our teams, overwhelmingly made up of women, were overburdened during that period. They had to cope with residents’ distress and that of their families. They invested themselves hugely with them, to address all these expectations, as well as their own personal fears. This concentration of frustration impacted them badly. It was important to help them lay down all this emotional burden at the feet of professionals who know how to listen to them and take into account the harshness of their work.” This initial personalized care will be followed up in October 2021 with a long phase of collective work based on the problems identified by psychologists, with the goal of improving their practices.
Keeping a link with those most at risk
People suffering from chronic psychiatric conditions – another particularly vulnerable group – were rather left out of emergency health provision during the first Covid lockdown and their situation deteriorated significantly. For those diagnosed with schizophrenia, on the bipolar spectrum or living with addictions, the subsequent repeated lockdowns and restrictions worsened their already fragile mental state. Confused by the closure of medical-psychological day hospitals and the cancellation of many leisure activities that gave meaning to their lives, many people found themselves with no therapy. In Lyon, the Vinatier Hospital and the Association Francophone de Remédiation Cognitive (Francophone Association for Cognitive Remediation) set up a mobile psychiatry team to mitigate the lack of care and its consequences. Operational since September 2020 and with two teams already, this project has provided care for more than a hundred patients in their own home, in the Lyon area. “Avoiding a gap in care is critical, as it represents one of the main reasons people return to hospital,” explains psychiatrist Nicolas Franck, head of this project. The work carried out by the mobile group means it can maintain a link with at-risk patients very proactively. It can also provide comprehensive psychiatric care.”
With the same approach of protecting the most vulnerable, the nonprofit Case de Santé, a healthcare center based in Toulouse, guides and cares for at-risk people with psychosocial disorders (chronically ill, homeless or isolated people, women victims of violence, etc.). Faced with the pandemic, there has been a complete reorganization at Case de santé so that it can continue to help people in distress. Whereas many services were closed, the medical-social center supported by Fondation de France maintained a physical presence and even broadened the scope of its assistance by setting up a personalized phone call system for those who were particularly at risk. “Everything we put in place turned out to be pretty effective and we managed to keep a lid on the most critical situations,” says Fabien Maguin, the administrative coordinator of Case de santé. “That way, nobody was left behind without any support or treatment during lockdown. But it was a very tough period, and we had to cope with an influx of new patients from other networks who no longer had anywhere to stay. We set up phone calls, in French and Arabic, to stay in touch with the most isolated people, defuse their anxiety and sometimes just explain the health restrictions.”
Being there, whatever the circumstances
Because mental health problems can happen to anyone, and each individual can find themself confronted with them at a particular point in their life, other projects were launched to provide occasional help. At the Lille teaching hospital, during the first wave of deaths linked to Covid, a psychological support system was developed for grieving families. The numerous health restrictions introduced because of the pandemic prevented loved ones from spending time with the deceased, prohibited traditional funeral rites and celebrations for large numbers. As a result, many people found it impossible to embark on a more serene grieving process. Doctor Axel Bastien, who coordinated the project, believed that this was a critical point: “We realized that there was a missing link in the hospital care pathway and we couldn’t just let grieving people cope by themselves. Which is why we decided to systematically and proactively offer support from a psychologist. Each family member or friend was contacted by phone to review their mental state and consider whether ongoing care was required. Out of the 450 people contacted, more than a third of them accepted help.The project had a real impact on families’ grieving process and feedback from funeral home professionals confirmed that it was helpful.” In fact, this exemplary approach is to be extended to other hospitals in the north of France, and to other departments also concerned by the after-effects of traumatizing death (death of a child, violent death, or requiring forensic input).
The pandemic increased the prevalence of mental disorders, but it’s important to be properly equipped to cope with it. How can we approach, identify and help people affected by these conditions? Awareness raising is everyone’s business and it happens to be the hobby horse of nonprofit Premiers Secours en Santé Mentale (PSSM – First-Aid in Mental Health). It offers first-aid training to learn how to recognize potentially risky mental disorders (panic attack, depression, suicidal state among other issues). It also provides solutions to help people or guide them towards appropriate care. Two-day training programs for the general public have been developed since 2019. Training is provided throughout France, including in overseas territories Martinique and La Réunion, thanks to a network of 176 trainers. “We’ve seen an increase in demand since 2020,” says Caroline Jeanpierre, coordinator of PSSM for France. “Many requests came from companies and universities, which shows that the issue is gaining ground, everyone wants to get to grips with it. This year, more than 7,500 first-aiders will be trained and in 2022, fresh support will help us roll-out our training programs on an even greater scale, with the aim of reaching 25,000 people each year. The issue of mental health is gradually becoming less taboo, which is a very encouraging sign.”