During the confinement, people with mental disorders found themselves more isolated than ever and stopped consulting. A month later, psychiatrists and psychologists tell how their patients managed to get through the crisis. If today we are not safe from a backlash, the dreaded second wave has not yet arrived.
Patients with mental disorders, largely forgotten by the Covid epidemic? In France, 12 million people suffer from anxiety, mood, psychotic, schizophrenic and autistic disorders. During the crisis, this “fragile” population consulted much less than usual and attendance at psychiatric emergencies fell drastically throughout the country. Yes this phenomenon has caused great concernaccording to three experts interviewed by Why doctor, a month after the deconfinement, it is clear that the patients were able to mobilize enormous resources during the crisis.
“We were quite surprised to see that patients came to the emergency room less often. We finally realized that there was a rather unexpected form of resilience in patients who knew how to mobilize a lot of resources to face this exceptional context”testifies the pteacher Franck Schurhoff, psychiatrist at Henri-Mondor Hospital and professor at Paris-Est Créteil University.
“The situation was not as dramatic as expected.adds the Doctor Mehdi Zaazouapsychiatrist at the Maurice-Despinoy hospital, in Martinique. When the confinement was decreed, the patients were quite flabbergasted and everyone was seized with general confusion. Everyone’s bearings were shaken, but, after a few weeks, things naturally returned to normal”, he says. Patients who used to come to the day hospital saw their daily lives turned upside down, but a Whatsapp group was quickly set up to maintain a rhythm, daily activities and contact between patients and caregivers. For those permanently hospitalized, “it also took a little time to set up: they could no longer go out to buy their cigarettes, we no longer knew how to ensure visits with relatives… But we quickly managed to ritualise daily life in such a way as to reassure them”explains Mehdi Zaazoua.
“Obviously, the patients suffered from the lack of freedom and contact as well as from the isolation but, paradoxically, many managed to take advantage of the confinement to refocus on them. It was time to clean up, in his house and in his head. There was a sorting out between what is really important and what is less so”adds Laurent Konopinskiclinical psychologist in a private practice, who also accompanies teams in the health and social field.
“Masks can be very destabilizing for a patient”
Now, experts fear a backlash. Some poorly cared for patients could indeed decompress afterwards. “For the moment, we have not really observed any decompensation in the patients but the situation remains very stressful, and stress is a factor of decompensation. You have to be very careful”, explains Franck Schurhoff. Many psychiatrists fear in particular that their patients did not follow their treatment correctly during confinement. What’s more, for those with schizophrenia, evolving in a masked society can fuel delusions of persecution, recalls Franck Schurhoff.
A concern shared by Medhi Zaouaa. “Masks can be very destabilizing for a patient who cannot recognize the intentions of the other”, he says, deploring that the health rules have not taken better account of the particularities of patients with mental disorders. “In psychiatry, patients have a different relationship to the world. The recommendations that have been made — like wearing a mask or keeping physical distance — may apply to the general population, but in psychiatry the culture is different. In the hospital, some have felt like a rejection having to take their meals so far apart from each other. I remember a patient who decompensated for two or three days because this installation fueled her delirium.
Yet overall, since the deconfinement, for Medhi Zaouaa, things are going pretty well. “We have resumed outings and activities at a reduced pace and the patients are delighted.” Those in the day hospital were also very happy to be back to their daily lives, even if they were “anxious about being faced with a risk of Covid”. Indeed, when the deconfinement was announced, “we still didn’t know how things were going to be organized in terms of transport, contacts, activities. Here again, the uncertainty has rekindled everyone’s anxieties..
And the caregivers in all this?
If patients with mental disorders therefore seem to be doing well for the time being, Laurent Konopinski is especially worried about those who took care of them during confinement, the caregivers, who were particularly affected during the health crisis. “A lot of support work will be needed in the weeks and months to come to support the exhausted teams. It is not in the thick of the action that we have time to think about what is happening, but we have had caregivers confronted with very difficult situations and I fear attempts at decompensation afterwards. You will have to be attentive, all listening and support professionals know this.”
Fortunately, during confinement, great efforts were made by the State and within hospital structures, welcomes the specialist. “In my region, the Haut-Rhin, particularly affected during the epidemic, psychologists mobilized at the Rouffach hospital center, specializing in psychiatry, to set up a ‘resource space’ for health professionals who had taken care of mentally ill patients who had been sick with Covid.”
Great initiatives have also been put in place in generalist structures, he rejoices, citing for example the medico-psychological emergency unit of the Emile-Muller hospital, in Mulhouse, created to help overwhelmed caregivers. It is also impossible to ignore the many toll-free numbers set up to support the population, whether they are women victims of violence, people stressed by confinement or entrepreneurs who have had to liquidate their business because of the crisis.
However, now that the confinement is over and that the situation is gradually returning “to normal” in France, these efforts still need to continue on the political level. Indeed, the crisis has made it possible to update the “vulnerability of our system and a mode of management out of breathchallenges Laurent Konopinski. We had the feeling that the politician had an awareness. I am waiting to see if this will result in a real reform of the system to reorganize the hospital. It is necessary to relieve caregivers, recognize their career and give them the means to properly fulfill their mission”he concludes.
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