At least one in five people in France suffer from a mental health condition. The issue has been named a priority for the government in 2025, which hopes to tackle a wide range of conditions, from mild symptoms to severe and chronic illnesses. Every day, psychiatric emergency departments in hospitals treat patients in distress, while operating in increasingly difficult conditions. To find out more, we spent time with the Ville-Evrard psychiatric unit of the Delafontaine Hospital in Saint-Denis, north of Paris.

Fayçal Mouaffak is a psychiatrist who heads up the Emergency Psychiatric Services unit of Ville-Evrard in Seine-Saint-Denis. When he arrives at work, four patients are already waiting for him on stretchers in the emergency room corridors. All of them have spent the night there and one 18-year-old girl has already been there for three days. The hustle and bustle and noise of the ward often aggravates their symptoms. The author of "Diary of a Psychiatrist on the Frontline in Seine-Saint-Denis" starts his working day at breakneck speed, trying to find beds for them as quickly as possible while also providing the necessary medical care.

A lack of space and staff shortages

Finding beds for patients is a daily struggle for the psychiatrists. They spend a good part of their day making phone calls to get patients transferred. In 2023, there were 566,000 visits to emergency rooms for psychiatric reasons, an increase of 21 percent compared to 2019. At the same time, 8,800 beds have been cut in public hospital psychiatric wards over the past 15 years.

These shortages are partly due to a lack of staff. Psychiatry is one of the least popular specialties among medical students.

The CRUP, a solution to overwhelmed emergency rooms

Stereotypes go some way to explaining this lack of interest. There are many assumptions about the patients. "People think psychiatry is a violent sector, but that's because they don't know any better. There is no more violence than anywhere else," says Nadia Cheffi, psychiatrist and head of the secure psychiatric emergency unit (known as CRUP in French) at Ville-Evrard. Psychiatry was her first choice for specialisation in medical school and she "has no regrets". Misconceptions also exist among healthcare professionals. "In discussions with our colleagues (...) we often see the old stereotypes come up: that psychiatry isn't really medicine," laments Dr. Mouaffak. However, he insists, "there are effective treatments, medical protocols (...) research is advancing rapidly (...) and there are also physiological factors involved in these illnesses."

Dr Mouaffak was one of the initiators of this secure psychiatric facility (CRUP), a response to seeing patients waiting far too long in the emergency rooms of hospitals without specialised care. The CRUP opened two years ago within the Delafontaine Hospital. Patients have their own rooms, receive treatment in a much calmer atmosphere, and can stay for up to 72 hours. This gives doctors the time to stabilise their condition before they return home. Alternatively, they can be transferred to other wards for longer stays in hospital. Both the patients and their caregivers say it’s a real relief: "It makes what I do meaningful again," says Hakima, an emergency room nurse.

Dr Mouaffak hopes to see this model adopted more widely. The Emergency Psychiatric Services unit of Ville-Evrard is set to open another CRUP within the Avicenne Hospital in Bobigny – also located in the greater Paris region – in the near future.