Overview of Regional Care for Adolescents Over the Age of 15 With a Mental State at Risk in France

Early detection and intervention in psychotic disorders are public health issues that have led to the creation of specific care systems in France, the visibility of which is still debated. Moreover, these services are often concentrated in adult rather than child psychiatry, which may increase the duration of untreated psychosis.

The main objective of this study was to take stock of the care provided in the adolescent unit of the Candélie hospital (Lot-et-Garonne, France) in 2023 and the proportion of adolescents aged over 15 diagnosed with a mental health risk who were followed up. The second objective was to propose an experimental approach to improving care for this group of patients by introducing an 'advanced practice nurse'.

Activity data for 2022 were collected by the IT department of the Candélie hospital. At risk mental state adolescents were identified according to the COGDIS and COPER criteria.

The results of the retrospective study carried out in 2022 show that staffing levels and care units in adolescent medicine are saturated. Depending on the system, between 19% and 39% of the patients are considered to have an at risk mental state. The construction of an Ishikawa diagram highlights three major issues on which the advanced nurse practitioner could intervene: support the system under pressure, delegate part of the medical activities given the shortage of doctors, and coordinate the transition of child and adolescent mental health care to adult mental health care.

Restructuring existing health care systems by including initial consultation and monitoring of adolescents and their families by advanced practice nurses would allow earlier intervention with these adolescents.