The panicked 22-year-old is led to Consultation Room No. 2, with its easy-to-mop floor and honeycomb pattern over the window. Behind her, the heavy double doors of the psychiatric emergency room – open only with a staff member’s key – slam shut.
With fearful taps of her white sneakers, she confides in an on-duty psychiatrist how the loneliness of the coronavirus blockage and the fear of not finding work in the pandemic-torn job market contribute to her maelstrom of fears. She’s nervous that she’s starting to become obsessed with knives, worried her sanity might collapse.
“The lockdown – let’s not pretend otherwise – worries me,” explains the young woman through her surgical mask, while the psychiatrist, Irene Facello, listens intently.
“I want to be reassured,” says the woman, “that I’m not going mad.”
Forcing millions of people to stay home again – cutting them off from families and friends, shutting down businesses they’ve invested in, college classes that fueled their minds and places to hangout where they socialized – has yet to reverse the renewed wave of coronavirus. France pushing it past the bleak milestone of 52,000 deaths in November.
But the costs to mental health have been significant. With the number of French COVID-19 patients in intensive care declining, psychiatrists are facing a follow-up wave of mental health problems. Health authority surveys indicate an increase in depression, most acute among those out of work, those with financial difficulties and young adults.
The Rouvray Hospital Center in the Normandy city of Rouen is one of the places where psychiatrists are at the forefront of the pandemic’s effects on mental health. They fear that a growing crisis of depression, anxiety and worse could be on the horizon as more livelihoods, futures and hope are lost in the pandemic. Associated Press (AP) journalists spent 10 hours in the sprawling 535-bed facility, the day after French President Emmanuel Macron drafted a blueprint that stretched into mid-January for the gradual lifting of lockdown restrictions.
In the emergency room, as Facello sends the 22-year-old home with a prescription for anti-anxiety drugs and an appointment to see her again in two weeks, the double doors swing open again.
It is another young woman of 25 years old, a linguistics student. She is sent to consultation room No. 1, where she sits quietly in the darkness at nightfall.
On the ward’s whiteboard, which lists the names and details of the patients, an abbreviated initial diagnosis written by hand on a piece of paper uses acronyms to indicate how closely she has handled the irretrievable. For the past week, it says, she suffered from ‘IDS’ – suicidal thoughts – and was thinking about ‘IMV’, or taking medication voluntarily.
Sandrine Elias, the department’s head psychiatrist, gently teases out of the student how the lockdown has left her completely alone, and classes are put on hold.
It’s not the only cause of her malaise. Elias discovers that the young woman has had a difficult puberty, with suicide attempts. Isolation during the epidemic only added to the student’s suffering. In a soft voice she tells Elias that it “confronts us with ourselves.”
“I’m a stay-at-home person, but this absolute limitation is a real weight,” she says.
Elias promptly decides to hospitalize her. Guarded rest and medication, Elias says, can help her through it.
“You need a framework to be taken care of. You can’t do that all alone, in your studio apartment, ”says the psychiatrist. “It is very good that you came here.”
Not all clients have a previous psychiatric history. Mental health professionals say lockdowns and curfews have also destabilized people who, in less difficult times, have overcome difficulties by talking to family and friends rather than ending up in psychiatric wards.
“Being alone between four walls is terrible,” says Elias. When life grinds to a halt like this, it reverberates off people. It is not good.”
Nathan, a 22-year-old college student, came through the emergency room two days earlier. The log shows that he was admitted at 5:20 PM and transferred to a longer-stay unit that evening.
There, in room 14, he told psychiatrist Olivier Guillin that he had sought emergency help “because I felt my morale deteriorating very quickly, that I was about to fall, with suicidal thoughts.”
Similar thoughts had first defeated him in the summer, after the initial closure of France from March to May. They struck again when the country was imprisoned for a second time from October 30. His university was closed. His political science classes became virtual. Rather than being alone in his college dorm, he moved back to Rouen with his parents, disconnected from his support network and brooding over his uncertain future.
“The first lockdown didn’t really affect me,” he tells Guillin, but the second “really sinked me.”
“Being locked up again, always having to stay in a limited perimeter, not being able to see my friends as often as usual, it made me desperate,” he says.
The safety of hospitalization and medication quickly began to stabilize him. On his bedside table was a Rubik’s Cube that he had solved.
Guillin, who runs several departments of the hospital and oversees 200 medical staff, says the number of young adults seeking help for anxiety, depression, addiction and other difficulties is on the rise. He’s bracing for more.
“We will very likely see the peak of the wave in the coming months,” he says.
The pandemic has also had other mental health consequences that are less obvious but no less devastating.
Guillin still denounces the death of a patient who committed suicide during the initial lockdown, 48 hours after what turned out to be their last appointment. She wore a mask during that meeting to protect against the virus. It interfered with reading the depth of her grief, he says.
“She was a very expressive lady and there, with the mask, I misjudged things,” he says. “In retrospect, I say to myself that without the mask I might have been more alert and done more.”
Patients have also been hurt by diverting resources from mental health to the fight against COVID-19.
The electroconvulsive therapy that helped Laura, a college student, get out of her severe depression, was confused when anesthesiologists – who needed to put her to sleep with electrical current running through her brain – were requisitioned to care for virus patients.
“My morale went downhill shortly after, and the suicide ideas came back,” she tells Guillin.
Laura says the therapy is “as urgent as COVID-19.” She says prioritizing virus patients is “a bit silly and mean.” Instead of being released from the hospital in mid-November, as she’d hoped, Laura had to stay.
In the emergency room, for the third time in two hours, another young woman enters through the double doors, dressed in black, with a hollow appearance. With room 1 already occupied by the 25-year-old, the 18-year-old high school student is allowed into room 2. After her first interview with a nurse and a caregiver, she curls up in her chair.
The nurse, Sébastien Lormelet, and the caregiver, Anita Delarue, exchange notes in the teachers’ room where the teen’s name and the admission time, 5:02 PM, are written on the board in black marker.
“The lockdown has a lot to do with it, because she says the first was difficult. With the second, now, if she could slip out, she would, ” says Delarue.
“She wouldn’t resist a third.”