Lyon, France – In Lyon, the medico-psychological centers (CMP) are suffering. The shortage of caregivers is worsening and patient queues are lengthening. The Le Vinatier hospital center – which oversees the Rhône CMPs – is trying to remedy this. On the program: establishment of telephone reception platforms and reorganization of support in large centers. Solutions criticized by caregivers, who denounce the sorting of patients and the remoteness of care centers from where they live.
Rhone CMPs overwhelmed
Treat as close as possible to patients. This was the doctrine in the early 1960s when the medico-psychological centers (CMP) were created.
Thus, the Rhône department was divided into 28 sectors divided between two public hospitals, Le Vinatier and Saint-Cyr-au-Mont-d’Or, and a private health establishment of collective interest (Saint-Jean-de -God). Le Vinatier manages around fifteen CMPs for adults and the elderly and a dozen CMPs for children and adolescents. It thus covers the 793,656 inhabitants of the Metropolis, or 46.4% of the Rhône population.
The patients received in the CMP are generally in a precarious situation and do not have the means to turn to private caregivers. However, not all of them can be taken care of. “The inclusion criteria for the CMP are serious disorders: schizophrenia, bipolar disorder, psychosis, severe personality disorder. For everything else, for example for depression, we guide in liberal or in other structures ”, confides Ali Karauzum, psychologist at the Villeurbanne CMP (Rhône) and CGT delegate.
The metropolis of Lyon watched over by psychiatric deserts
Places are scarce, because all CMPs share a bitter observation: the shortage of caregivers awaits them. At Vinatier, 30 doctor positions are vacant. The causes are numerous: work overload, demands for profitability, etc. Some practitioners prefer to turn to the liberal in the hope of more favorable wages and working conditions. The numerus clausus slows down the renewal of nursing staff to meet retirements … As for young professionals, when they do not throw in the towel, the trying working conditions of CMPs are struggling to convince them to apply. “A lot of nurses change jobs, including young people who are just starting out. There are attractiveness problems, ”sighs Valerie Blanchard, nurse at the part-time therapeutic reception center (CATTP) in Vaulx-en-Velin (Rhône). Added to this is the return to a balanced budget for Vinatier, which has “concentrated working time, exhausted the teams and conveyed a very pessimistic climate in the hospital”, points out the Dr Natalie Giloux, psychiatrist and head of department of the CMP of the East pole (Villeurbanne, Bron, Décines). “We must always do more, but with less resources. The staff feel compressed and additional missions are constantly being added. We are faced with accounting logic and this creates an experience of staff dissatisfaction and loss of meaning, ”she notes. These deficiencies are self-sustaining: the shortage of caregivers leads to the deterioration of working conditions … which keep potential future professionals away.
At Vinatier, 30 doctor positions are vacant.
Longer waits for patients
Psychologists are not spared by this crisis. “When I arrived in 2016, there were 2.2 full-time equivalents (FTEs). From now on, we are 1 FTE, for 160,000 inhabitants. The wait has been extended from 3 months to 1 year ”, denounces Ali Karauzum. “From now on, I am asked not to take any more new patients”, he continues indignantly. However, the patients in his sector are particularly fragile. “In Villeurbanne, we have a lot of comorbidities which add up, social difficulties, drug consumption, violence, which complicate the care”. As a result, “liberal psychologists have no financial interest in accepting these patients,” he believes. “It is not profitable for them, or it would cost too much for patients who do not have the means to pay”, laments the psychologist.
A complicated ambulatory shift
In addition to this shortage of professionals, there is a policy of reducing hospital beds and a redirection to extra-hospital. “The health crisis has accelerated the closure of beds at Vinatier. There have been 150 deletions of beds since 2020 in intra-hospital “, observes Nathalie Gramaje, social worker at Vinatier and CGT secretary. This reduction policy is accompanied by a desire to further develop extra-hospital care, the famous “ambulatory shift” advocated by the public authorities. “There is pressure to reduce the average length of stay in hospital as much as possible and to relay as quickly as possible to day hospitals and CMPs,” notes Dr. Natalie Giloux.
There have been 150 bed deletions since 2020 in intra-hospital.
But in reality, outpatient care structures do not have the means to keep up with the increase in demand. “At the Villeurbanne CMP, we have an active queue of 3,000 patients for 3 FTEs of doctors. We receive around 100 support requests per month. We can only take about a quarter of it, ”she explains.
Poles created to bring together structures
Despite this congestion, the management of Vinatier has closed several day hospitals and wishes to reduce the number of CMP by merging patients from large geographical areas. She started restructuring with child psychiatry. “The current sectoral model with local CMPs coupled with a day hospital and a CATTP has lived”, judges the Pr Nicolas Georgieff, child psychiatrist and head of the Child and Adolescent Psychiatry (PEA) pole at the Vinatier hospital in Lyon (see also “Child psychiatry is a popular but damaged specialty”). “Today, a CMP with a team of ten people and 18 months of waiting does not facilitate access to care. It is inevitable that there will be larger technical platforms, including different care lines and different age groups. We need a lot of staff and they need to be trained ”. For child psychiatry, the Vinatier project is to create four departments, in 4 or 5 CMP, instead of the 16 small existing systems. Problem: this restructuring is currently being carried out on a constant perimeter in terms of human resources. “We were short of doctors and they didn’t recruit more. Some even left because they did not find themselves in this reorganization ”, points Laure venet, social worker at CMP Montplaisir, in Lyon 8th district.
For caregivers, this polarization plan risks weakening their link with patients. “On CMPs, we welcome people as close as possible to home. We don’t want that to change, ”said Dr Natalie Giloux, who fought with her teams to keep the CMP in Bron. Some patients find it difficult to move around. “There are patients who are unable to take the bus and most of them do not have a vehicle. However, from Vaulx-en-Velin to Rillieux-la-Pape, it’s more than an hour’s journey by public transport. I fear that some people will give up care, ”says Valérie Blanchard.
Reception and referral platforms for patients
Another point of friction between management and caregivers: the establishment of reception and orientation platforms for patients. “Our waiting period is currently 5 weeks, but everything will change with the establishment of the CADEO (reception and diagnostic unit, assessment and orientation). Now the instructions are to refer to general practitioners if there are not enough doctors on the CMP ”, explains Chantal Legroz, psychiatric nurse at the CMP de Perrache, in Lyon, and FO delegate.
Now the instructions are to refer to general practitioners if there are not enough doctors on the CMP.
In addition to this physical reception, the Vinatier has created a telephone platform to respond to the first requests, called LIVE, available in the child psychiatry center under the acronym POP (Platform of Orientation in Child and Adolescent Psychiatry). But this telephone reception saddens the caregivers. “I don’t see how we can assess patients over the phone. We do not see the facial expressions, the tears, the clothes … Many factors escape us to guide them as well as possible “, fears Ali Karauzum. “There will be a screening of patients. In January, a student will no longer be able to come to us because his problem will not be psychiatric, points out Chantal Legroz. We find ourselves facing situations that are not very human. We end up losing our professional soul. “
Ali Karauzum apprehends the consequences: “the hospitalizations, in the long term, will be units of crisis. We tend towards a psychiatry that just treats the psychiatric crisis, but everything else must depend on the medico-social. What I sense, and is already happening, is that there will be more untreated people and we will only see them when they are going to explode. “