After the pandemic, there is more talk of mental health, but that of children remains in the background. However, the indicators are worrying and the needs are growing. An issue that public policies struggle to grasp.
Reports for suicidal thoughts among 15-17 year-olds and anxiety disorders among 11-4 year-olds are on the rise in French emergencies, a recent report indicates. According to Inserm, the prevalence of mental disorders in children and adolescents averages 12.5%, and according to one of the latest UNICEF publications, more than one in seven adolescents aged 10-19 would live with a mental disorder mentally diagnosed globally. These data are all the more alarming as the disorders that appear in childhood have an impact on the mental health of adults. However, France is slow to grasp the subject. This is the observation of Aude Caria, director of Psycom, a national public platform that intends to refer to all information on mental disorders and psychiatric care for adults and children. According to Aude Caria, it is not only essential to establish systems of care, but above all to educate children on this transversal theme. Interview.
Children and Mental Health: What exactly are we talking about and who is concerned?
Audé Caria : When we talk about mental health, it’s really in the general health sense. All children, in elementary and middle school, have mental health the same way they have physical health. This is an important pedagogical point because mental health, mental disorders and mental illnesses are often confused. Like adults, children’s mental health evolves throughout life and can sometimes be shaken by various difficult events or conditions. Different signals can arise from this (agitation, etc.) which can sometimes go as far as diagnosed mental disorders that require treatment. Between the pandemic, the climate crisis and the war in Ukraine, children are exposed to a difficult climate, which affects their psychological balance. We must also take into account various forms of violence perpetuated against them: poor housing, cyberbullying, precariousness, incest, exposure to pornographic images or continuous news feeds… Finally, mental health is a problem at the crossroads of different policies implemented, both in terms of access to housing, justice and the regulation of social networks, sports, solidarity and global warming.
Little data to date on the mental health of children in France. How come ?
AC : France does not have a tradition of assessing children’s mental health. From an epidemiological point of view, a team of Inserm researchers proposed in 2005 to distribute questionnaires to primary school children. The goal was to evaluate and map the prevalence of the disorders to better prevent them. It was also a question of identifying the warning signs: withdrawal, appetite and sleep disorders, stress… The proposal had sparked protests from parents, student associations and National Education, reluctant to accept the idea of early diagnosis of disorders . The proposal was perceived as too invasive and gave rise to a petition to ban the distribution of the questionnaire, the petition “No 0 driving for 3 year olds! » launched by the collective Don’t drive 0. The fear was that the screening results would be stigmatizing to the children and their school records. Until recently, therefore, the culture of assessing children was non-existent. However, we note the historical presence of school psychologists in schools, and the recent birth of the Health Education Course. This program brought by National Education that “prepares students to care for themselves and others, and highlights psychosocial skills”, namely the ability to recognize their emotions, to communicate, to interact with others, to express concerns, etc. Note, however, that mental health is not mentioned as such…
Why, in France, this reluctance to talk about mental health at school?
AC : We don’t like saying the word at all, at school or elsewhere. It remains stigmatizing, taboo, shameful, frightening… It refers in the collective imagination to madness, to psychiatric hospitals. What we lack is an overview of mental health, which is difficult to see as a continuum that constantly evolves from well-being to malaise, or even mental disorders, from which we can recover. I also note the perhaps somewhat convincing legacy of the philosopher Michel Foucault (The psychiatric power, The punitive society…) which instills the imagination of the imagery of the asylum. This crosses all strata of society and produces systemic stigmatizing effects, explaining why public policies have been slow to take hold on the issue.
What changed the situation?
AC : The Covid epidemic has produced a revelation effect of the collection and the data has begun to appear. With several survey waves, Public Health France has been implementing since March 2021 an assessment of the mental health of adults, focusing in particular on anxiety, depressive disorders and suicides. As the outbreak progressed, we realized that children were affected as well, and some child psychiatrists have warned of an increase in emergency room visits for suicidal thoughts or gestures. Two investigations are currently underway. First of all, the ELFE cohort, French Longitudinal Study since Childhood: observes more than 18,000 children born in 2011 over several years and intends to study the links between social environment, nutrition and health. Then the Enabee study, for the national survey on child welfare, launched this year at the request of Adrien Taquet, former secretary of state in charge of child protection. We are awaiting the results.
England, Quebec, Australia… Children’s health has long been put there. How?
AC : For more than 30 years, massive mental health policies have been implemented, not only in the workplace but also in schools. This has given rise to a common culture of mental health, a culture still in its infancy in France. In Australia they were developed help spaces, welcoming places where children and parents can come to ask for advice, information and advice on physical and mental health. In England, the Anna Freud center has developed various forms of support and teaching (help lines, videos, etc.) for children, but above all training for teachers. Consequence: mental health education is present from an early age and included in the programmes.
To talk to children about mental health, she recommends a comparison: that of the garden… Why?
AC : We felt it was important to break the taboo and make children understand that they have mental health that they need to take care of as much as they do with their physical health. To promote this notion, we have developed an educational kit in the form of a children’s illustrator and an animation director kamishibai, a theater of images: “The garden from within”. He likens mental health to an inner garden, with its flowers and weeds, which changes with the seasons and needs tending. It is about explaining that mental health is fluctuating and attention needs to be paid. When we present the concept in class – at the request of schools, associations or town halls – we see that children are very receptive and eager for information. It’s a topic they really want and need to talk about.