An ordinary morning at the Edouard Herriot hospital in the city of Lyon, in the south-east of France. It’s the largest general hospital in the region and receives the highest number of patients with mental health problems.
Emmanuel Poulet is head of psychiatric emergencies. He’s in consultation with a student who tried to kill himself by overdosing on drugs.
A consumer of psychotropic drugs, the young man was in the process of detoxification. The last lockdown tipped him over.
“I felt so desperate;” the 19-year-old says. “And I said to myself, nothing matters anymore, it's no use, I'll just put an end to it all. I thought it could get me out of the stalemate. I feel like I'm stuck in something. And with the current situation, we’re literally stuck between four walls all the time, that doesn't help!”
While those already fragile before the health crisis are more exposed to stress generated by the pandemic, no one is immune, says Poulet.
“We have patients who weren't identified as having mental health problems previously,” he explains. “It’s clear. Given the set of parameters of instability and stress, whether epidemic, sociological, economical, we are entitled to think that there will be a significant increase in depressive disorders and anxiety disorders, suicidal crises too. We’ve started to see it already.”
Another sufferer greets me at his home. He had never imagined losing his grip to the point of wanting to die - as happened during the first lockdown.
“I experienced it as a feeling of deprivation of liberty, a feeling of oppression, a feeling of being locked away too,” he tells me. “There was no more meaning to life! Everything you liked was banned. It was extremely stressful for me.
“I felt physically oppressed, with pain in my stomach, tightness in my throat … And then I just lost it, and destroyed nearly everything at home.
“I was hospitalized, and I was diagnosed with delirium tremens. And it then turned out I was positive with Covid-19. This means Covid had really made my crisis worse. That's a certainty. The feeling that came back to me most often was death. Death and then the fear of dying, the fear of dying.”
It took him several months in hospital before he regained a taste for life, including a stay in the city’s Vinatier psychiatric hospital.
Benny, an assumed name, has been brought back to the Vinatier by the pandemic. The young man had already been treated for mental disorders.
He couldn’t face the latest lockdown and asked to be hospitalized.
“The first time, it didn't affect me much because I was still in psychosis,” says Benny. “When I went out of the house, there was nobody in the streets, and that reassured me. But now that I've recovered a bit, I need the support of other people, I need society to work as before.”
It’s a need shared by many. Nicolas Franck, psychiatrist and head of unit at the Vinatier hospital, is author of a book and survey on the psychological impact of lockdown. He fears the impact of the health crisis over time, as the pressures accumulate.
“You’ve the first lockdown which left traces,” says Franck. “And then another lockdown that comes in a period when there is a decrease in brightness, and winter depressions. You’ve the economic crisis that is setting in, people who are in distress, as regards their jobs or their small businesses. And on top of the effects of being shut in, you’ve the disruption of social bonds, for those who are locked down on their own, as well as fear of post-contamination side effects, fear of contamination, fear for one’s health and possibly for one’s survival.”
Mental health structures are deploying new services to respond to the population’s growing stress. At the Vinatier hospital, the LIVE hotline team has been on call seven days a week since last March. They seek to put callers in touch with teams of nurses, psychologists and doctors, to set up medical evaluations and follow-ups.
The hospital recently opened a consultation dedicated to Covid-19, in a psychological daycare service in the town centre. For many, it’s a more accessible option than hospital psychiatric wards, or private practices that are now overwhelmed with requests.
Isolation, precariousness, uncertainty about the future, fears for relatives - young and old - post-infection trauma, or bereavement, there are many triggers for distress.
“There’s a lot of sleep disorder,” says psychiatrist Elodie Zante. “People whose rhythm of life has changed, and in particular those who’ve stopped their professional activity. There are anxiety attacks, for people who didn’t use to have any. There will sometimes be social isolation with a loss of pleasure or a loss of interest in daily life activities. We also see obsessive-compulsive disorders with patients who will, for example, frantically clean their homes.
“And with this second wave, we see there are people whose symptoms worsen, and unfortunately many don’t dare have a consultation. And unfortunately, once the psychiatric pathology sets in, you have to seek professional help because over time, there’s little chance of it improving on its own.”
For Benny the lesson for others in his situation is clear.
“They shouldn’t stay in their corner,” he says. “They should always ask for help. That’s the most important thing.”
Destigmatizing mental health and increasing resources are the priorities, professionals argue, in order to overcome the next wave of the coronavirus, which they say will be psychiatric.
The 19-year-old student being treated by Emmanuel Poulet tries to stay positive.
“I want to believe that this is all going to end, because everything has an end,” he says. “And then we'll manage to move on to something else. I tell myself it's just a bad phase to get through. That said I can't imagine the future, but I want to imagine it positively. That’s what I’m holding on to.”