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Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review - 19/06/20

Doi : 10.1016/j.encep.2020.04.005 
A. Chevance a, , D. Gourion b, N. Hoertel c, P.-M. Llorca d, P. Thomas e, R. Bocher f, M.-R. Moro g, V. Laprévote h, A. Benyamina i, P. Fossati j, M. Masson k, E. Leaune l, M. Leboyer m, R. Gaillard n
a Université de Paris, CRESS, Inserm, INRA, 75004 Paris, France 
b Psychiatre libéral, HEC, Paris (Jouy-en-Josas), France 
c Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), Service de psychiatrie et d’addictologie de l’adulte et du sujet âgé, DMU psychiatrie et addictologie, AP-HP, Centre-Université de Paris, Inserm U1266, Institut de psychiatrie et neurosciences de Paris, France 
d CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France 
e CHU Lille, Université de Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), Lille, France 
f CHU de Nantes, Nantes, France 
g Université de Paris, Présidente du Collège National des Universitaires de Psychiatrie (CNUP), Inserm, CESP, Paris, France 
h Pôle hospitalo-universitaire de psychiatrie d’adultes et d’addictologie du Grand-Nancy, Centre Psychothérapique de Nancy, Faculté de Médecine, Université de Lorraine, Nancy, France 
i AP–HP, Hôpital Paul Brousse, Département de Psychiatrie et d’Addictologie, Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche, PSYCOMADD Université Paris Sud - AP-HP, Université Paris Saclay, 94800 Villejuif, France 
j Service de psychiatrie adultes, APHP, Sorbonne université, Groupe Hospitalier pitié Salpêtrière, ICM, Inserm U1127, Paris, France 
k Nightingale Hospitals-Paris, Clinique du Château de Garches, SHU, GHU Psychiatrie et neurosciences, Paris, France 
l Centre Hospitalier Le Vinatier, Université Lyon, Bron, Lyon, France 
m AP-HP, Université Paris Est Créteil, Inserm, Fondation FondaMental, Paris, France 
n Université de Paris, GHU Psychiatrie et neurosciences, Président de la sous-section 49-03 du Conseil National des Universités (CNU), Paris, France 

Corresponding author.

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Abstract

Objective

The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France.

Methods

The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France.

Results

We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of “COVID+ units”. These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic.

Discussion

French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.

Le texte complet de cet article est disponible en PDF.

Keywords : Coronavirus, Covid-19, SARS-CoV-2, Epidemic, Pandemic, Psychiatry, France


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© 2020  L'Encéphale, Paris. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 46 - N° 3

P. 193-201 - juin 2020 Retour au numéro
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