Psychiatry Reinvestment: A Health Crisis, A Democratic Challenge

One in three people will experience a mental disorder during their lifetime. About two million French people are treated in psychiatry every year. Despite the importance of this topic in the field of public health, we are witnessing a structural crisis whose duration is depleting players, a general sense of powerlessness and leading in the end to collective apathy. This report is no longer about an overview of the state of affairs, but about proposing ways to enable a transformation of the field.

Boris Nicolle is thus engaged in a forward-looking exercise to reflect on the re-establishment of a genuine public psychiatric service, open to society, organized around the user with a view to recovery and characterized by a culture of collaboration, multidisciplinary and evaluation.



20 proposals to reinvest psychiatry


Territory, Psychiatry, Politics
A mental health framework law
A clear framework for an ambitious reform of psychiatry
The Four Functions of Psychiatry
For a legible, democratic and operational territorial organization
Articulation with the regional level
Integrative and coherent national management

Psychiatry versus society: the urgency of dialogue
Redefining the relationship between psychiatry and society: a necessary democratic dialogue
The participation of users and their relatives, a transversal necessity
Media and psychiatry: a shared responsibility in the face of challenges
School, Mental Health and Psychiatry
Psychiatry and justice: several links need to be reorganized
A well-ordered dialogue starts with yourself

Dignity and effective care for everyone
Restore as Compass
Leaving the hospital
For relevant and graded care
How to reduce the use of insulation and restraint?
Save Child Psychiatry

The question of meaning: thinking about functions, redefining professions
The functions to be developed in the care teams
The opportunity for new professions
What does a psychiatrist do?
Where are the health managers?
Psychiatric nurse: from the role of ‘patient traceability officer’ to that of healthcare provider
Psychologists and psychiatry: the great haze

Reinvesting research in psychiatry
Strengthening the links between complementary disciplines
Open and protect research activities
Create common spaces with shared priorities
Invest financially to meet the challenges



The author:
Boris Nicole is a psychiatrist, general practitioner in the psychosocial rehabilitation department of the Pyrénées hospital center, Pau (64); national coordinator and New-Aquitaine sponsor of the Association of Young Psychiatrists and Young Addicts (AJPJA).

Michael Laforcadeformer director-general of ARS Nouvelle-Aquitaine,
author of the October 2016 Mental Health Report

“I am young, it is true, but for good-born souls courage does not wait for years. How comforting it is to read so many pertinent observations and finely chiseled proposals from the pen of a very young psychiatrist. Would he have understood more than others? ?Would he have? duende as they say of an artistic bullfighter or a flamenco singer? Would it simply be driven by the desire to understand and re-understand… without taboos, without systemic mind and with as much freedom as possible?

In any case, the result is stunningly beautiful. This text contains the almost complete arsenal of what deserves to be analyzed and proposed for a complete overhaul of mental health and psychiatry: the necessary political strategy in the form of a mental health framework law that represents a major national cause, ethics and values ​​would become what are so many “small” bets of Pascal on the path of professionals: recovery as a new compass, elusive power of action of users, openness, collaboration, multidisciplinarity dear to Edgar Morin, the goal – utopian or not? – the removal of limitations, the place of life of the patient that becomes the center of gravity of the hospital action, this beautiful image of “going to” that will oblige professionals to go metaphorically, physically, semantically to where the person is in difficulty.

All this outlines the contours of a new, ambitious, sometimes far-reaching and therefore realistic policy. The needs are immense, all the more reason to have a panoptic view of the subject: a gradual and seamless progression of care and support, the emergence of new professions (coordination, partnership, medical management, nurses in advanced practice, peer helpers), the new place of psychologists in this logic of pathways, the school that will eventually become an actor in the promotion of the mental health of young people, the necessary collaboration with the media to avoid too safe or emotional treatment, the attractiveness of the professions of psychiatrists and nurses is being revalued.

Some measures are absolutely urgent, for example increasing resources, especially for research or for child psychiatry, a disaster-ridden discipline. Others, more radical, are just as popular: the need to re-examine the paternalistic medical model or the ARS, which would delegate its power to allocate resources to the actors and citizens of the territorial health project. After all, why not?

Mental health and psychiatry are of rare complexity. Scientifically documented good practices are less numerous than in other disciplines. The human dimension is omnipresent there with its pains, its fears, its images, its dreams, its denial and perhaps its misunderstood geniuses. It is one of the rare disciplines where everyone can find themselves: who does not see a part of themselves in the pathology of the other? This is why it fascinates us and why we love it so much. She deserved the talent of Boris Nicolle.

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