These cities that are making mental health a leading issue

Cap, wide jeans, orange sneakers, twenties and bright eyes, he is all smiles. Sitting on the sofa, Gaspard takes stock of his first half-day at the Nantes Clubhouse, aware of the benevolent listening of Jean and Françoise (the first names of the members of the association have been changed). Like him, they live with a mental disorder and have integrated this structure dedicated to the social and professional integration of people with mental disabilities: schizophrenia, bipolarity, severe depression… Here, members contribute, according to their desire and their ability to moment, to the functioning of the place, always in pairs to help each other: reception, meals, cleaning, accounting…

This morning, Gaspard chose to accompany Danielle to the market to prepare the collective lunch: “ I liked it, I feel free here, it’s a change from my five years in the hospital. I want to come back. » The clubhouse method, “based on the model of a working day, allows one in three members on average to resume professional activity”, slips Alice Aubineau, director of the Nantes branch opened two years ago, after those of Paris, Bordeaux, Lyon and Lille, soon joined by Bastia and Rennes. In Nantes, the Clubhouse is funded 50% by the private sector and 50% by the public, including a grant of 100,000 euros from the city of Nantes.

Beyond this type of targeted aid, “Nantes has been deploying a series of actions for several years. There is an emergency, even more since the Covid : the pandemic has brought to light the stigma around mental disorders and the lack of investment”, explains Rachel Bocher, head of the psychiatry department at the Nantes University Hospital, and scientific curator of the international symposium “Cities and Mental Health”, which will be held at the Cité des Congrès de Nantes the 1^er and December 2, and of which The world is a partner.

“Strong partitions”

For the World Health Organization (WHO), the psychological dimension is an integral part of health. Although mental health does not appear in the prerogatives of cities, “We are active on this subject, because we are aware that the health of the citizen does not only depend on the care, but on his living conditions in general. Qwhether it is access to housing, culture, sport, green spaces, urban mobility, we seek that all our actions include a mental health objective”, claims Sylvie Justome (Génération Ecologie), deputy mayor of Bordeaux in charge of health and safety.

The stakes are high. Each year, one in five French people is affected by a mental disorder, i.e. 13 million people. The suicide rate is above the European average, certainly more in the former, the incidence improving for several decades.

In France, “access to care is difficult: only 40 to 60% of people suffering from mental disorders are treated today, and the quality of care is very uneven”notes the Institut Montaigne in a December 2020 study. In question, “poorly distributed resources across the territory, financial barriers, very long waiting times, strong compartmentalization between somatic medicine, psychiatry and medico-social medicine, strong stigmatization”. And the medico-psychological centers, sectorized devices of free care, present everywhere on the territory, are overwhelmed.

Faced with the scale of the needs, a growing number of cities are setting up a local mental health council (CLSM) in order, in particular, to combat stigma, promote well-being and recovery and prevent disorders. “Generally chaired by a local elected official, co-facilitated by public psychiatry and giving a central place to people living with a mental disorder or to caregivers, these consultation spaces that appeared in the 2000s also bring together health professionals, social services, and any actor concerned by the subject”explains Fanny Pastant, national coordinator of CLSM.

Free listening points

The Nantes CLSM has one hundred and forty members from around sixty structures. “Having all parties around the table facilitates understanding and action”, notes Damien Durand, medical director of public health at the city of Nantes and Nantes Métropole. Thus, when the social landlord meets the psychiatrist, he understands better, for example, why the tenant who suffers from mental disorders struggles to pay his rent; he will also take another look at the occupant of the apartment suffering from Diogenes syndrome (accumulation of objects, neglect of hygiene). For his part, the psychiatrist contributes through this dialogue so that the user obtains or keeps his accommodation, a key element in the reconstruction of a stable life. “Thanks to this network of actors, in seven years, we have housed thirty-five people who would otherwise have been on the street”welcomes Damien Durand.

In Lyon, the CLSM alerted to the increase in suicides. The town hall has set up, for adults and for parents and their children, free psychological listening points, without an appointment and not labeled “mental health” so as not to frighten people. “Our system was then extended to other municipalities in the metropolis”testifies Céline De Laurens (EELV), deputy mayor of Lyon in charge of health and prevention.

In addition to the publication of practical information guides for citizens, some cities organize mental health information weeks (SISM) every year. The 33^e edition took place from October 10 to 23 on the theme “For my mental health, let’s act for our environment”. Thus, in Rennes, around ten highlights – plays, photo exhibitions, documentaries, conferences – provided an opportunity to discuss mental disorders with the general public. Newer tool: mental health first aid. Created twenty years ago in Australia, they were launched in France in 2018. “Since our arrival at the town hall, in 2020, explains Bordelaise Sylvie Justome, One hundred and twenty people, such as reception agents or key contacts in social centres, have followed a fourteen-hour first aid training course: it enables them to know how to react. »

“The local elected official, an essential link”

Despite the activism of committed cities, there is still a long way to go. Especially since” eStill too many mayors confine mental health to an exclusively health approach, and therefore consider that this subject is not their responsibility, even though it is eminently political and social”, regrets Alain Dannet, of the WHO collaborating center for research and training in mental health. As for the deployment of CLSMs, it is certainly encouraging, but “the coverage of the territory remains partial and the means insufficient: there are currently 260 active CLSMs, it would take 800 for all French people to benefit from it”notes Fanny Pastant.

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However, in this struggle, the local elected official is an essential link”, emphasizes Frank Bellivier. The Ministerial Delegate for Mental Health and Psychiatry at the Ministry of Health continues: “We note, in fact, that the CLSMs play an important role in the diagnosis of needs in their territory.. They fertilized the work carried out, at departmental level, by territorial mental health projects [PTSM]. »

Registered in the 2016 health law, “these PTSM, which bring together the main institutional, professional and associative actors, are, like the CLSM, an important part of the system initiated by the government in 2018 and reaffirmed during the Mental Health and Psychiatry Conference in September 2021, who have set the course for five years. The idea is to give a hand to local actors to develop multi-sector public policies”, puts Frank Bellivier into perspective. In this vast and complex ongoing project, cities have their place.