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Accueil arrow L'actualité de la CSMF arrow Derniers communiqués arrow Rapport Couty : des propositions en trompe l'oeil
Rapport Couty : des propositions en trompe l'oeil Version imprimable

La CSMF, premier syndicat médical français, qui représentait les médecins libéraux dans la commission COUTY, a pris connaissance avec beaucoup d’attention du rapport sur l’organisation des soins en psychiatrie.

Trois points méritent d’être soulignés :

1. l’état du malade doit être pris en considération :

  • plus le patient est gravement malade, moins il est en mesure de demander des soins,
  • la prise en charge de ces patients doit être globale, elle dépasse largement le champ du soin.

2. le désinvestissement des médecins psychiatres hospitaliers de secteur et le manque d’attractivité de leur exercice, entraîne une pénurie importante de ces professionnels.
3. la pédo-psychiatrie connait une situation dramatique.

La CSMF approuve les recommandations sur la reconnaissance et l’accompagnement des patients et de leur famille, de même que  l’articulation de la santé mentale se fasse dans le champ de la santé publique.

En revanche, en termes d’organisation des soins, les réponses apportées par ce rapport sont vouées à l’échec :

<!--[if !supportLists]-->1. Depuis plus de 15 ans, à travers les SROS, les Autorités Sanitaires proposent une organisation des soins graduée. Cette approche a toujours conduit à une concentration des moyens médicaux humains et techniques vers les niveaux très spécialisés et à un désengagement humain sur les niveaux 2 et 1.<!--[endif]-->

Ce schéma organisationnel aggrave encore la pénurie et le manque d’attractivité de la psychiatrie de secteur, et s’accompagne d’une concentration de la psychiatrie libérale dans les grandes métropoles.

2. Le rapport propose une organisation de premier recours structurée autour d’un Groupement Coopératif local. La CSMF est favorables aux Comités locaux de santé mentale car elle approuve une approche territoriale de la réponse aux besoins de la population.

Cependant la CSMF propose la mise en place de groupements de professionnels de santé au-delà de leur spécialité. Par exemple, des psychiatres exerçant sur un territoire associés aux médecins généralistes qui pourraient organiser entre eux une régulation professionnelle et mettre en œuvre des pratiques coopératives. Ces groupements de professionnels pourraient contracter avec l’ARS.

La CSMF ne pense pas qu’une structure placée sous l’autorité d’un directeur administratif nommé par l’ARS puisse réponde aux problèmes posés et soit attractive pour les psychiatres libéraux qui perdraient leur statut libéral pour retrouver un statut précaire.

De plus, cette structure serait une pénalisation inutile et désobligeante pour les psychiatres hospitaliers de secteur qui seraient réduits à une fonction d’officiers de santé  

<!--[endif]-->3. En dehors du niveau très spécialisé, ce rapport n’apporte aucune réponse aux difficultés de  la pédo-psychiatrie.

La CSMF ne peut se satisfaire de l’échec annoncé de l’organisation proposée qui s’inscrit d’ailleurs en cohérence avec la Loi HSPT, et qui n’aborde à aucun moment, malgré ses demandes répétées, le problème de l’articulation entre la médecine générale de premier recours et la médecine spécialisée de proximité.

Les représentants des malades et des familles nous ont sensibilisés sur l’urgence d’apporter des réponses au problème de l’accompagnement des patients n’exprimant pas de demande particulière.

L’UMESPE-CSMF, le Syndicat des Psychiatres Français et l’UNOF-CSMF ont engagé une réflexion commune avec le Président de l’UNAFAM.

Dans le cadre de formation sur le terrain, Il apparait nécessaire d’organiser des rencontres avec les représentants départementaux de l’UNAFAM, les médecins généralistes et les psychiatres quel que soit leur exercice, pour répondre à deux objectifs :

  • Organiser des échanges réguliers entre les acteurs
  • <!--[if !supportLists]-->Organiser une disponibilité des psychiatres

Il est bien évident que ces réponses ne seront possibles que si des moyens financiers sont mis à disposition et bien identifiés.

Enfin, le problème de la démographie des psychiatres est abordé dans ce rapport. Comme la CSMF ne cesse de le souligner, la démographie des médecins spécialistes est un réel problème car si rien n’est fait, des déserts de médecins spécialistes apparaitront dans les 10 ans, que ce soit dans les hôpitaux généraux ou en ville dans les cités de moins de 30 000 habitants.