[HILLY: The silent injury experienced by families of intensive care patients]

Admission to the intensive care unit represents a profound psychological ordeal for patients' family members. Far beyond the initial shock related to the severity of the illness, the hospital experience exposes families to a cumulative burden of stress, including prolonged uncertainty, confrontation with medical technology, physical exhaustion, loneliness, opaque medical language, and a sense of helplessness. Numerous studies show that during the months following an ICU stay, up to 70% of relatives experience symptoms of anxiety, 35% symptoms of depression, and nearly one third symptoms consistent with post-traumatic stress disorder. To name this specific burden, we propose the concept of HILLY (healthcare-associated family mental injury). HILLY does not pathologize families' experiences nor does it assign individual blame; rather, it highlights the often-unintentional role of certain care-delivery and organizational practices in the emergence of an avoidable trauma, which adds to that of critical illness itself. Restricted visiting policies, fragmented or jargon-laden communication, lack of dedicated spaces for listening, and insufficient recognition of the role of relatives all contribute to exacerbating this injury. The COVID-19 pandemic starkly illustrated the consequences of family exclusion, leading to complicated grief and heightened psychological symptoms among both relatives and healthcare professionals. Preventing HILLY requires a systemic approach: acknowledging this injury, training teams in communication skills, integrating family mental health into quality indicators, valuing relational time, and organizing structured follow-up after ICU discharge. Thinking HILLY means broadening the ethical framework of care to include those who accompany patients, and recognizing that caring for a patient also means caring for their family.