Dans les suites des attentats qui se sont déroulés à Paris en janvier 2015, nous avons amorcé une réflexion, au sein du centre médico-psychologique enfants et adolescents du douzième arrondissement de Paris, sur la place de notre structure dans le dispositif de soin lors de ces situations exceptionnelles.

Nous avons réalisé une enquête auprès d’autres centres médico-psychologiques de la région parisienne pour connaître leur point de vue sur les aspects organisationnels, la clinique observée et la perception du traumatisme collectif par les soignants. L’objectif était de tenter d’apporter quelques recommandations à la lumière de cette expérience.

Malgré le choc émotionnel ressenti, l’enquête ne montre un impact sur le fonctionnement des équipes qu’auprès de celles qui ont été confinées, malgré le choc émotionnel ressenti. Elle met en évidence un nombre très faible de demandes de soin auprès des centres médico-psychologiques en lien direct avec les attentats. Parmi les patients suivis, il est rapporté de rares recrudescences anxieuses, surtout chez les jeunes présentant des troubles du spectre autistique, les autres enfants et adolescents étant en demande d’explications ou apparemment indifférents. Les recommandations viseraient à : (1) protocoliser la conduite à tenir lors d’une éventuelle attaque ; (2) proposer un parcours de soins coordonné ; (3) avoir une démarche active de repérage et de prise en charge des enfants et adolescents confrontés à un trauma collectif, proposant des soins en groupe.

Ces observations invitent à une remise en cause des dispositifs actuels, avec pour objectif de mieux se préparer dans l’hypothèse où de nouveaux attentats surviendraient.

Following the terrorist attacks that occurred in Paris during January 2015, we initiated a discussion within the community mental health center (CMP) for children and adolescents of the 12th arrondissement of Paris. We wondered whether or not such proximal and free mental health institutions were adapted for such exceptional situations; and if not, what recommendations could improve the role of these structures in the means of care in case of a collective trauma.

We conducted a survey including nine other CMPs in the Paris region concerning the setting of the care plan, the number of patients referred because of the recent traumatic events, the clinical symptoms of their patients and the perception of collective traumas by caregivers. The aim was to try to make some recommendations based on this survey and also taking into account other international experiences.

Despite the emotional shock felt by the medical teams, the survey only showed an impact on the organization of the CMP from those who were confined. Also, very few young individuals sought care from the CMPs for reasons directly related to the attacks (n=10). Among the patients followed, anxious outbursts were rarely reported, and they appeared to be related to young patients with autism spectrum disorders. Most of the children and teenagers asked for explanations to make sense of their experiences. In contrast, some the other regular consultants seemed to be quite indifferent.

This low impact has at least two interpretations. On the one hand, the majority of Parisian young people were only slightly impacted due to protective factors such as the support of their families and social group, and the distance from the event. On the other hand, it is possible that they just didn’t seek help. Furthermore, it is important to take into account the fact that the caregivers themselves were more or less involved in the collective trauma, which may have influenced the way the patients sought treatment. From the available international literature, it appears that the following recommendations could help CMPs to reduce time for patients to seek treatment: (1) reflect on protocols about what to do during an attack; (2) develop a coordinated care pathway between the different actors of mental health care, and between emergency and long term intervention; (3) establish an active approach for tracking and management of children and adolescents facing a collective trauma with treatments more likely in group settings. In conclusion, the findings invite a reconsideration of the current mechanisms, with the goal to be better prepared in the event that new terrorist attacks might occur.