The Covid-19 pandemic has caused a significant deterioration in the mental health of the French, and even more severely of the most fragile populations. A finding objectified by scientific surveys and by professionals working on the front line. Mobilized since the start of the pandemic via reinforced surveillance and preventive actions with all audiences, Public Health France brings together in this issue, around thirty experts and professionals in the field. In this file, they draw up a state of knowledge and analyze the consequences that the pandemic has on the mental health of the entire population. This special issue questions in particular ethics and social and territorial inequalities in health.
Mental health: a major issue at the heart of public policy concerns
The health crisis linked to Covid-19 has highlighted mental health as a public issue that concerns the entire population, and not just “one in five people”, as generally indicated in reference to the number of people may be affected by severe psychological disorders. The crisis has acutely accentuated mental health problems but has also caused new ones. The successive confinements, the fear of catching the virus, the slowdown in the economy, the reduction of social life, the precariousness or loss of employment and many other determining factors have plunged a large part of the French into a state emotional and psychological weakened. This constitutes a turning point: the concern of mental health policies no longer only concerns the organization of psychiatric care but encompasses prevention and health promotion actions: deployment of suicide prevention systems, helplines, but also mobilization of all actors likely to intervene in favor of mental health, the social sector, housing, education (see the article Covid-19: The irruption of mental health in the public debate) .
Mobilize local resources
The actions carried out during a crisis are all the more relevant when the links between actors have already been established, such as within the framework of local mental health councils or mutual aid groups. The pandemic has severely tested the health system and revealed pre-existing weaknesses – including those in the psychiatric sector, both in hospitals and in private practice. Today, it is a matter of continuing transformations in the way of promoting mental health and better understanding its determinants, an essential prerequisite for prevention and health promotion.
The weight of social and territorial inequalities in health, accentuated by the COVID-19 crisis
The epidemic and the measures taken to contain it have revealed vulnerabilities, inequalities within the population concerning exposure to the virus, living conditions and the psychological difficulties caused. It has affected people differently depending on their accommodation and the possibility of continuing their professional activity or not. The impact of the crisis varied greatly depending on the financial, relational and social resources of individuals, their access to basic necessities, leisure or healthcare. This issue explores the effects of the crisis on the mental health of different populations: caregivers, the elderly, students, the disabled, etc., living and working in different living environments (retirement homes, hospitals in particular psychiatric services, etc. .).
The ethical issues raised
Many ethical questions have been raised throughout the outbreak. These include possible tensions between protecting health and respecting rights; priorities and interdependencies between physical health and mental health – even between health and other collective issues (such as the economy or education) or between individual and collective protection. From an ethical point of view, as an academic analyzes, “the crisis has also revealed the stigmatization of people with mental disorders”.
The case of children and adolescents
In the face of COVID-19, children show resilience if they are accompanied by their family, school or professionals. As a child psychiatrist deciphers, the mental health of children and adolescents has been and continues to be affected by the Covid-19 epidemic. In the fall of 2020, child psychiatry professionals saw children arriving in their departments in acute crisis states (generalized anxiety, suicidal crisis, etc.). These professionals point out that children are particularly sensitive to the anxiety of their loved ones and warn once morest the effects of family in camera during confinement (with an increase in intra-family violence); once morest altered schooling conditions (cancellation of school activities, restricted access to playgrounds, etc.) and once morest changing health protocols that cause strong tensions. These measures have been the subject of ethical and political debates on the balance between benefits and risks for children.
Definitions and concepts of mental health
This issue reviews the definitions and concepts of mental health and specifies its scope, in particular to better understand the associated intervention logics. The High Council for Public Health presents its opinion on the consequences of Covid-19 on mental health and the World Health Organization issues its recommendations to improve the mental health of populations in times of pandemic. A team of researchers summarizes all the repercussions of the pandemic on the mental health of the French. A psychiatrist presents a set of operational measures allowing part of the population to develop a kind of resilience in the face of the stress created by the pandemic. In this respect, the lessons learned can, in his view, be extrapolated to any difficult situation.
