2023-09-06 11:26:39
According to a survey carried out by the French Hospital Federation (FHF), structural bed closures are numerous and have intensified in psychiatry, massively linked to the lack of medical or paramedical staff. Figures that resonate with the recent alert from the actors.
Public psychiatry has been going through great tensions for several years. In this context, the French Hospital Federation wanted to objectify the consequences of the health crisis on these difficulties and specify the current challenges for the discipline. To this end, it carried out a major survey between April and May 2023 to which 110 establishments responded to the survey (CH, CHS, CHRU), i.e. 48% of authorized public establishments. The results were partially unveiled at a press conference on September 5, 2023.
Numerous structural closures of beds, which intensified following the health crisis
A significant increase in bed closures is recorded between 2020 and 2022. Indeed, before the 2020 health crisis, 80% of establishments had not closed any beds. As of December 31, 2022, nearly a quarter of establishments (24%) were forced to close from 10% to 30% of their capacity. They were only 5% to record such capacity closures before 2020. It should also be noted that more than half of the respondents felt that they had no prospect of reopening beds.
A large number of vacant medical and paramedical positions
Between a quarter and three quarters of doctor posts are vacant in 40% of establishments, and more than half in 8% of establishments. It is within hospitals that this vacancy is the most important. Moreover, 14% of establishments indicate that regarding a quarter of their FDI positions are vacant and 7% of them operate with more than 30% of FDI positions vacant.
In this context, unsurprisingly, all adult, child and adolescent psychiatric establishments describe “major difficulties”, and generally deplore a degraded functioning (in terms of quality and safety of care); an unsatisfactory situation in terms of public health; longer lead times; an alteration of the working conditions of the teams.
Dizzying delays in accessing care…
Almost all of the establishments consider that the waiting times for accessing inpatient and outpatient care (consultation), in adult psychiatry as well as in child and adolescent psychiatry, have deteriorated following the health crisis (regarding 90%).
In adult psychiatry, the average time to access outpatient care is 1 to 4 months for more than half of the establishments (53%). In child and adolescent psychiatry, 45% of establishments describe delays in access to day care ranging from 5 months to over a year. The average time to access hospitalization in child and adolescent psychiatry is between 1 and 4 months for 20% of establishments. 13% of establishments deplore delays in access to hospitalization of 5 months to 1 year.
Delay of several years to access medico-social
More than 90% of establishments consider that access to medico-social structures has deteriorated following the health crisis. Only 2% of establishments describe a delay in access to medico-social structures of less than or equal to one month. The majority of establishments (59%) deplore several years of delay, even ten years for 3% of them.
On the outlook side…
Faced with these difficulties, the establishments report different strategies, which relate for example to the reorganization of the supply of care (grouping of emergency rooms, transfers of units, closures, etc.) The development of alternatives to hospitalization , via for example innovative devices and/or mobile teams, is also mentioned. With regard to staff reinforcement, respondents also mention the use of temporary work and overtime and efforts to pool resources (at regional or interdepartmental level).
For the FHF, if psychiatry is “greatly affected” important prospects for development are opening up. A hundred proposals were thus formulated by the respondents to develop the psychiatric sector. They mainly concern financing, governance, territorial organization of care, coordination, human resources and the attractiveness of the sector. Links with downstream, prevention and medico-social were also discussed. Finally, streamlining the management of isolation and restraint standards was proposed by many respondents.
• According to the results of the FHF Psychiatry survey, released at a press conference on September 5, 2023.
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