2023-08-23 02:01:23
Stress, depression, ADHD, phobia, bipolarity, dyslexia, dementia, autism, trauma, anorexia, Alzheimer’s… Today, we know almost all of these terms.
We regularly hear regarding it and many people in the media do not hesitate to announce that they have suffered from “suicidal thoughts” and that they had to be hospitalized to get out of it. This is called “primary” prevention in mental health, according to child psychiatrist, epidemiologist and public health professor Bruno Falissard. “Psychiatric disorders have been much less stigmatized over the past thirty years. “The arrival of social networks has largely contributed to a greater dissemination of information concerning mental health,” adds Caroline Delannoy, neuropsychologist and clinical psychologist in Paris.
Indeed, prevention in mental health has been developing since the beginning of the 21st century in France, admittedly with a delay compared to other countries, such as Canada. But the first results are there “and can already be seen, even if few scientific studies have yet evaluated them, so much hindsight and large groups of participants are necessary for this kind of analysis”, comments Bruno Falissard.
Prevent, detect and treat
However, the teen suicide rate between 2004 and 2018 has been shown to have dropped by 40%. The simple fact of de-stigmatizing the occurrence of such an act in a family contributed to this decline. Similarly, since the models in magazines or on social networks are no longer all extremely thin, psychiatrists have noticed a decrease in the number of adolescents suffering from anorexia nervosa or eating disorders. All this contributes to primary prevention.
But there is more than just one line of defense once morest mental illness. “In reality, we must speak of ‘preventions’, primary, secondary and tertiary, specifies the epidemiologist. Primary prevention consists of preventing the onset of the disease by acting on avoidable risk factors, as is done with vaccination once morest viruses. The secondary aims to detect and diagnose the disorder at the first symptoms or even before they are visible, to reduce the harmful consequences, as when practicing a mammogram once morest breast cancer. The tertiary applies to treat and take charge of the disease, when it is installed and chronic, so that it has the least impact on the daily life of the patient and his entourage. »
The word is free
In our country, these three areas of prevention exist in mental health. Thus, the movements and demonstrations of the populations, in the streets, once morest sexual and family violence make it possible, among other things, to fight once morest trauma. Even if, in France, the first avoidable risk factor in mental health remains violence, in particular vis-à-vis children. But here too, we talk regarding it more and prevention is progressing.
In principle, the French healthcare system is adapted to screening for mental disorders. But it still doesn’t work well…”
Bruno Falissard, child psychiatrist and epidemiologist
In addition, helplines and discussion lines have been set up, and many associations provide the necessary social support. The latter is a major lever for primary prevention, not only once morest violence, but also to prevent anxiety-depressive disorders and suicides. “When someone around you is not well, and it lasts, it’s not regarding letting them down. You have to try to go to him, to talk to him regarding it. This is the best prevention,” insists Bruno Falissard.
Second part: screening. It is clear that far too many mental disorders are still diagnosed far too late. However, “in principle, the French healthcare system is adapted to secondary prevention. If you are not well, you will see your GP who is trained to diagnose a mental difficulty and to take care of you. But it doesn’t really work. Many people don’t realize that they are in trouble; the duration of a consultation is too short to make this type of diagnosis; many people do not have a primary care physician; access to psychotherapies is complicated… But that is changing. For example, for the past two years, Health Insurance has reimbursed sessions with a psychotherapist, with the Mon Parcours Psy system. » And websites for making appointments online, such as Doctoliballow you to find consultations with a shrink, according to your specialty, in video, fairly quickly, and face-to-face.
The paradox of false positives
“However, it must be admitted that secondary prevention is more complicated than in other medical specialties,” adds the child psychiatrist. Who to screen? At what point in its development? “Imagine imposing screening for autism spectrum disorders
in kindergarten in France because, with research advancing rapidly, we know that warning signs are visible very early. When a toddler shows symptoms, it will be announced to his family and the monitoring and care system will be launched. Indeed, today, we know that psychotherapies adapted from an early age are effective. But what if that child is a false positive on the screening test? A little one can also have a slight developmental delay without it being pathological… Beware, therefore, of the risk of stigmatization. “Preventing” sometimes has undesirable effects. »
The American Academy of Pediatrics has just given an unfavorable opinion on systematic screening for autism, partly for these reasons. “Recent progress in neuropsychology research, the multidisciplinary nature of its teams and those of caregivers, as well as new treatment techniques implemented by trained practitioners, have greatly improved prevention in mental health. But, for each person, it is a question of carefully evaluating the benefits and the risks”, adds Caroline Delannoy.
The same goes for screening for attention deficit disorder with or without hyperactivity, or ADHD. We know that many hyperactive people are not “detected”, or not early enough, and suffer from it. In France, scientists have proposed that screening questionnaires be introduced in all elementary schools to find “the one who moves a little too much”… But if the child is also a false positive? The risk is then to prescribe drugs that act on the psyche to too many people. For the moment, the French High Authority for Health therefore refuses the device.
“Secondary prevention is therefore complicated in mental health”, summarizes Bruno Falissard. As is the tertiary sector, namely the care of patients and their families. The supply of care is lower than the demand, and the doctors, nurses, educators, shrinks are not always trained, often for lack of time and financial means, in new screenings or treatments, or do not necessarily know where and who to contact someone when necessary. A lack of training and communication that should be taken into consideration.
teaching psychology
Be that as it may, the “queen” prevention, to avoid the disease, takes off. “And it would take off even better if we taught, in college for example, psychology and neuroscience, as we explain sexual reproduction, concludes Caroline Delannoy. People are now realizing that mental health “is health” period. And it is better to understand it a minimum to maintain it. Especially with the health, environmental and societal crises that we are going through…”.
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