Society. Child Protection: Minors in Place, the First Victims of a Failing Health System

Three figures are enough to understand the scale of the crisis: 50% of children in child welfare services (ASE) suffer from at least one mental health disorder. 90% do not receive appropriate medical care. And 50% of adolescents hospitalized in psychiatric care come from ASE.

Mental health among young people is a major issue, especially among these minors who have had turbulent lives. Due to the abuse they suffered prior to their placement, most of these vulnerable children, who experience a strong sense of abandonment, suffer from post-traumatic stress disorder. This is compounded by "institutional violence," marked by frequent changes in foster families or even violence endured within the reception centers themselves.

More than one in two children placed in care have been victims of sexual violence, before or during their placement, reveals a study by the Union for Children, published on April 2. "Often, the child who is the perpetrator and the victim of this violence remain in the same establishment due to lack of space," says Lyes Louffok, a children's rights activist. These young people, who are highly impulsive, express this distress through verbal and physical violence, running away, and even suicide attempts.

Today, nearly 400,000 minors are in child protection, a figure that is constantly increasing. Their medical care is clearly lacking. "The 2016 law requires departments to conduct a complete health assessment of children, but this is never done," denounces Lyes Louffok.

Medical-psychological centers (CMP) are overwhelmed. Waiting times to see a specialist can last many months. The number of child psychiatrists has plummeted, dropping from 1,235 in 2007 to 593 in 2017. This is forcing these young people to resort, as a last resort, to emergency psychiatric services at the hospital.

To alleviate the crises and calm these often agitated children, they are administered – sometimes even without a prescription – large doses of anxiolytics. "These medications are often administered somewhat by default, because it's the quickest and easiest way. But it's also a sign of medicalization that comes too late," confirms Professor Guillaume Bronsard, a specialist in child and adolescent psychiatry at the Brest Regional University Hospital, according to whom "psychological monitoring and support for educators should have been initiated much earlier and over the long term."

This overmedication is not harmless and can have consequences in adulthood. Lyes Louffok, a former ASE employee, explains that he has become an insomniac as a result.

To provide a framework for the child, professionals guarantee that the most suitable model remains the foster family, even if it may not be suitable for all adolescents. Today, there are 36,000 family assistants in France, compared to 40,000 five years ago. "There are retirements without replacements, but also those who decide to stop given the scale of the task," explains Bruno Roy, president of the National Association of Childminders, Assistants and Family Welcoming Families (Anamaaf).

How can these young people, who are starved for love, rebuild their lives? "To avoid separation pain, foster families were warned not to become attached to these children," recalls ^Professor Guillaume Bronsard. However, for the child psychiatrist, this attachment is "desirable and absolutely essential": "The child develops in the eyes of the adult, he develops because he believes he matters to someone.

"If he doesn't have that certainty, he doesn't develop," quoting the psychiatrist Spitz, who in the 1930s developed the theory of hospitalism: "When you left a small child in the hospital, without the people he loved, he would completely devolve, refuse to eat, and fall into a very serious depression."

In the absence of love and a framework, it is difficult for these children, who are often stigmatized, to build their lives peacefully. Some even turn to delinquency. More than 41% of male prisoners and 37% of female prisoners received an educational assistance measure in childhood, according to a December 2022 study cited by the Economic, Social and Environmental Committee (CESE). "The fact that they are much more emotionally impulsive, and that their educational and identification frameworks are much more fragile, produces a higher rate of juvenile delinquency," analyzes ^Professor Bronsard.

In 2018, Alain and Marie Christine Marmignon paid a heavy price. Their granddaughter Léa was brutally murdered with 22 stab wounds by a 14-year-old boy who was living with them. Today, the teenager has been released. The family continues its fight, both legally and politically, to prevent such a tragedy from happening again.

However, Lyes Louffok is keen to point out that "ASE saves lives" by allowing abused children to be removed from their families. Moreover, 3,300 children at risk are waiting to be placed in care due to a lack of places...