Article by Francine Aizicovici, François Béguin, Sandrine Cabut, Alexis Delcambre, Alexandre Piquard, Anne Rodier and Catherine Vincent - LE MONDE:
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Psychologists at the bedside of a shocked France

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First and foremost, the survivors had to be taken care of. Those who had found themselves at the heart of the attacks, wounded or within bullet range, in the street or in the hell of the Bataclan, those who had seen loved ones fall, friends die. For all of these, medico-psychological support was essential and will perhaps remain so for a long time. But they won't be the only ones who need help. Just hours after the shootings, the medics who provided first aid were left in horror. And for them, too, nothing has been quite the same since the evening of November 13.

“Everyone is groggy, stunned. There is a heaviness, a heaviness which will take a long time to be evacuated”, recognizes doctor Jean-Paul Fontaine, head of the emergency department at Saint-Louis hospital, in the 10th arrondissement of Paris, who has treated 27 victims that night. Here, the proximity of several attacked sites creates a special relationship with terrorist acts. There are those who, too tired this Friday evening, had given up at the last minute on going for a drink at the Carillon. Those who heard the shots finishing their shift, those who came back on foot, by bike, by car as soon as they heard... For the team manager, what happened that evening is " unprecedented, unimaginable”. Even for caregivers who have "a certain proximity to death".

"We're going to let things go"

How to handle the shock? On Thursday, November 19, a first “debriefing” meeting was to be held at the end of the afternoon, open to all service personnel, medical and non-medical, but without a psychologist. “We are going to let things slip away so that people can freely tell what they have experienced, that they analyze all that, that they say where they are,” explains Doctor Fontaine. At the direction of the Assistance Publique-Hôpitaux de Paris (AP-HP), it is specified that this type of collective meeting, in the hospitals which were at the forefront of the care of the victims, was the "first request caregivers”.

To provide psychological support for its staff, the AP-HP has set up three systems. First, a specific consultation, organized in the psychiatry department of the Hôtel-Dieu, in the center of the capital, where caregivers can be welcomed individually by psychiatrists, psychologists or occupational physicians. Wednesday evening, “about forty calls had been received for appointments”, specifies its manager, Doctor Nicolas Dantchev. At the same time, each hospital site that received major emergencies during the attacks has a crisis unit for its staff. Finally, adds the psychiatrist, the teams who request it can benefit from a collective debriefing under the aegis of doctor Thierry Baudet, head of the medico-psychological emergency unit (CUMP) of Seine-Saint-Denis (93).

“Even more necessary than after the January attacks”

Another professional category located in the epicenter of the violence: the media. The Vivendi group paid a particularly heavy price, since two employees of Universal Music and two collaborators of its television channels were killed during the attacks. From Saturday, psychological cells were made available to their colleagues. A usual approach for the i-Télé news channel, where consultations are open for reporters returning from a war zone. But this time, given the potential crowds, the occupational physician was supported by workers from the Labor Clinic and the Preventis cabinet. Also at BFM-TV, in a special edition since the evening of November 13, all employees have been offered the services of the cabinet of psychologists that accompanies the channel. “It is even more necessary than after the January attacks. This time, many knew victims, directly or indirectly, because they frequent these places and these districts, ”says the editorial director, Hervé Béroud.

More generally, many companies have organized themselves since the beginning of the week to give their employees the possibility of psychological support. At La Poste, the listening cell has recorded a hundred calls since the attacks - twice as many as usual -, while occupational doctors treat EDF employees, in shock after the loss from one of their colleagues. The majority of large groups have an internal support system or in partnership with private firms, which they have activated in recent days. The law makes the employer responsible for ensuring the health – physical and mental – of employees. A duty reinforced since the wave of suicides at France Telecom in 2008, which marked the beginning of the development of psychological support cells.

112 trips to the emergency room for stress

Whether they come from private practices or mutual insurance companies, all have recorded an increase in requests since November 13. As was the case in January, after the attack on Charlie Hebdo. “Half of our clients had called us on Saturday to find out how to react to their employees,” says Xavier Alas Luquetas, president of the Eleas firm. Assessment of the first week after the attacks, the cabinet Psya, for its part, brought in its twenty or so employed psychologists. But it also had to, given the demands, call on external professionals.

Audiens, a press, entertainment and communication mutual, has just opened a support system for Bataclan employees. Since the attacks, it has received "a request for psychological support from around sixty employees and intervention by psychologists on site from eight companies", indicates its manager of corporate customer relations, Stéphane Lecoq, who recalls that “40 of the 129 deaths due to the attacks affected cultural professions”.

After the terrorist acts that have bereaved her, will France find herself on a psychological infusion? Beyond immediate support, will all these systems be able to provide long-term follow-up for those who need it? Will there be enough shrinks for everyone? The only certainty: according to the preliminary figures provided, Thursday, November 19, by the Health Watch Institute (InVS), the number of people going to the emergency room of a hospital because of stress has increased significantly in the Paris region since attacks, particularly among 25-35 year olds. "During the single day of Saturday, 112 visits to the emergency room for stress were observed against fifteen the day before in Ile-de-France", specified doctor Thierry Cardoso, who does not exclude "a rebound effect" after the police operation carried out on Wednesday in Saint-Denis.