Entretien avec Monsieur Brahim Hammouche, psychiatre, député, président du rapport parlementaire d’information intitulé : « Bâtir la santé mentale du 21ème siècle pour préserver l’intimité des patients et redonner la fierté aux soignants »

Abstract

ObjectivesIt is not so often that we have a psychiatrist elected to the National Assembly. How can the voices of psychiatry, psychology, and more generally care in all its dimensions be brought to the assembly in order to bring about favorable actions in the field? MethodsDoctor Brahim Hammouche, a geriatrician, but also a psychiatrist and an elected deputy for the 8th district of Moselle, France, has agreed to testify to his experience as a practitioner who has spent the past five years in the legislative universe. In addition to his comments on the dedicated parliamentary report on mental health that he chaired, our colleague shares his thoughts regarding the prospects for tomorrow's psychiatry and psychology in France. ResultsThe place of psychiatric pathology, which was once called “madness,” is still extremely difficult and painful, especially because forms of stigmatization persist. However, today there are 13 million French people confronted with psychiatric illness, i.e. one in five citizens. The life expectancy of subjects suffering from psychiatric disorders is 16 years less than that of the general public. Annual spending on mental health care accounts for almost 23 billion euros, making mental health the most expensive item in the national budget, ahead of cardiovascular disease and cancer (for a total of 237 billion euros). We should be wary of the risks of a single-headed administrative monster that proposes only “quality indicators.” Also, when an institution does not promote the liberation, the expression, and the incarnation of discourse, it enters into a system of mistreatment. Developing this speech, and facilitating its circulation among everyone -- patients, their families, caregivers, administrators -- is essential. DiscussionAs professionals of psychic life, we have to fight against decisions and orientations that claim that psychic life does not exist. Life cannot simply be reduced to communication, behaviors, or interactions. Psychic life is made up of desires, follies, fantasies, impulses -- elements that in the current state of scientific data are not scientifically demonstrable but that everyday life, proximity to patients, and the work of listening “on the ground” show to be real. Let's challenge any MRI to prove the opposite! It should be remembered that we are still in a stage of “tinkering,” which can certainly sometimes antagonize our administrations and our public health policies, but we are still in a moment of “anthropological tinkering.” We are, above all, pragmatic and we adapt our clinical practices, our toolbox, to the human person in front of us. And, if we trust freedom a little, even if we believe in free will, humanity is also capable of more than simply meeting standards. Because we are in a period where knowledge is evolving very quickly with an acceleration of time, an abundance of data, and a complexification of knowledge, there is an imperative to work as a team. At some point, when a patient needs a particular type of care, it is offered to them. In a team, we must have the ability to build different therapies and to offer a patient appropriate orientations, different but often complementary forms of care. ConclusionPsychiatric patients are not necessarily subjects that come first, neither at the parliamentary level nor at the level of the Ministry of Health. There was an appointment of a ministerial delegate, which is a step forward... perhaps one day we will have an interministerial delegate. Also, we also proposed the creation of a National Institute of Mental Health, based on the model of the National Institute of Cancer, to ensure multiannual investments and a guideline on 5- to 10-year programs. Finally, the last note of optimism, with regard to the financing of psychotherapy sessions, we started from almost nothing: what was impossible in 2017 became possible in 2022. And, now, we have included and voted it in the social security budget for spring 2022: the possibility of reimbursing 30-euro psychotherapy sessions. Regarding the terms, they will be perfected with experience.