CLSM Eurométropole de Strasbourg

Addressing mental health needs among vulnerable populations in France during COVID-19

Annie Fromson-Ho

Background

Mental health has become a growing topic of discussion in the space of public health during COVID-19. Mental health is defined by the World Health Organization as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (World Health Organization). Public health departments and local organizations work to provide quality, accessible healthcare to the populations they serve. In diverse communities, it is important for these public health departments to understand how health and well-being are impacted by different factors, including the social determinants of health. In France, awareness about mental health needs among vulnerable populations has expanded during the COVID-19 pandemic. Specifically, among adolescents ages 11 to 17 years, the pandemic disproportionately affected their well-being due to school closures and home quarantine, making them a prime target for new mental health campaigns.

The Internship

During my study away, I interned at the Conseil Locaux de Santé Mentale (CLSM) Eurométropole de Strasbourg under the guidance of M. Buckel. In this internship, I conducted research on two new public health initiatives focusing on improving mental health outcomes for adolescents and vulnerable communities in Bas-Rhin, France. France is known for its comprehensive healthcare system, but vulnerable populations often face barriers that limit their access to these services. As an International Studies major with a concentration in Community and Global Health, I was able to layer my knowledge of foreign policy, international law and public/global health best practices, and language skills in French to understand how Strasbourg builds inclusive, age-appropriate and culturally-sensitive programs and services that address and reduce barriers of access to care.

During my internship, I mostly worked remotely due to the pandemic, but on occasion, I visited M. Buckel at his offices at the L'ESPAN-Strasbourg (see image below), L'EPSAN-Cronenbourg, or the CLSM Sélestat, about a one-hour train ride from Strasbourg.

CLSM Eurométropole de Strasbourg

L'ESPAN Strasbourg is the second complete mental health inpatient facility of the Public Health Establishment Alsace Nord (ESPAN).

Photo Credit: L'ESPAN Strasbourg.

The CLSM Eurométropole de Strasbourg is one of the regional offices of the Conseil Locaux Santé Mentale in France. There are, in total, 260 active CLSM centers dispersed throughout France, with the goal of strengthening local mental health needs throughout city limits across the country. The CLSM Eurométropole de Strasbourg serves the city of Strasbourg, a city known as the "bicultural crossroads of Europe" (Rick Steves). Strasbourg is located in the Alsace region of France, nestled on the Rhine across the border from Germany, and is the capital of the Bas-Rhin region.

The city is the ninth-largest metropolitan area in France, with a population of over 276.401 inhabitants. According to the Council of Europe (Conseil de l'Europe), non-nationals make up 13,66% of the total population, and the largest minority group – people from Maghreb (Algeria, Tunisia and Morocco)– represents 3,2% of the total population. Other important nationalities in the city are people from the EU (2,5%), Turkey (2,1%) and Africa (1,56%). Strasbourg's diverse population makes it necessary to address the gaps in access to quality mental health services, particularly among vulnerable populations. The added dimension of the COVID-19 pandemic warrants this topic for further research.

The Project

During my internship, I did a variety of tasks for M. Buckel, including research and starting applications for international funding for a new mental health initiative in Bas-Rhin. Known as the «Feuille de Route,» this roadmap aligns with the French national health strategy with its primary objectives of early detection and management of mental health disorders and suicide prevention (Ministère de la Santé et de la Prévention - Ministry of Health and Prevention, France). I explored avenues for international funding, only to find that a majority of global funding at this time was redirected to COVID-19 and the war in Ukraine.

When I began this internship, I initially thought I was going to be doing more hands-on research with M. Buckel to explore ways of improving access and knowledge of mental health services among adolescents in Strasbourg. However, due to the pandemic and extenuating circumstances, my research was limited to preliminary research to help M. Buckel and his team understand the scope of mental health services for adolescents during COVID-19 across other regions in France and across the globe. While M. Buckel had a firm understanding of the situation in Strasbourg, he was curious to hear how mental health is approached across borders and cultures and addressed by different governments.

My final product was a research paper discussing two initiatives on adolescent mental health, « Le Projet Territorial de Santé Mentale du Bas-Rhin » and «Mental Health de San Francisco». These two programs varied in scope and scale, as « Le Projet Territorial de Santé Mentale du Bas-Rhin » focused on the entire region of Bas-Rhin, while «Mental Health de San Francisco» only focused on the city limits of San Francisco. At the same time, the research highlighted how mental health remains stigmatized in both Strasbourg and San Francisco, indicating an overarching need for public policy to systemically reduce stigma and increase social awareness of mental health disorders and the available services and programs.

Takeaways

During this internship, I was able to explore how public policy and public health go hand in hand. In addition, I learned firsthand the challenges of maneuvering the French public health system as both an individual and intern in a large multilayered organization. This project was not directly related to practices of public health, and I did not complete qualitative research on how French public health programs affect the livelihoods of adolescents in Strasbourg and, more broadly, Bas-Rhin. That said, through various multimedia presentations and in-person conferences, I discovered how complex the implementation of projects like « Feuille de route : Santé mentale et psychiatrie » can be across local health departments. During this project, I honed my desk research skills and learned to work independently under limited supervision and guidance. While I finished this internship without gaining hands-on skills in public health, this experience allowed me to observe aspects of public health policy implementation, furthering my interest in public health.

Since my internship at the CLSM Eurométrople de Strasbourg, I have continued to remain engaged in advancements in public health policy in France. As of March 2023, the Ministry of Health and Prevention in France published the latest progress report of « Feuille de route : Santé mentale et psychiatrie, » demonstrating its commitment to public transparency about public health initiatives. Additionally, I have applied the skills and knowledge of public mental health campaigns in France to my current position on Macalester's campus as a Health Promotion Assistant (HPA) with Health Promotion. In this role, I have had the opportunity to gain first-hand knowledge of public health concerns among Macalester students and gain practical skills through first-year presentations, collaborations with the Counseling staff, social media, and qualitative data analysis.

Overall, during my experience at the CLSM Eurométropole de Strasbourg, I was able to apply the research and communication skills I’ve gained through my Macalester courses. My liberal arts education at Macalester College has challenged me to approach all fields of study from an interdisciplinary approach, pushing my understanding and knowledge of the communities within my coursework and interconnections of my lived experiences. Specifically, courses like International Public Health, Building Trust - Education through a Global Perspective, and Adolescent Sexual Reproductive Health have helped me become more knowledgeable about global healthcare systems and the importance of having age-appropriate strategies and involving local voices in developing and implementing health initiatives.

Annie Fromson-Ho (she/her)

My name is Annie, and I am a senior majoring in International Studies with a minor in Asian Studies and a concentration in Community and Global Health. I am from the San Francisco Bay Area, and after graduation, I plan on returning home to be closer to family and pursue career opportunities before applying to graduate school.

References

Petit, Véronique et Wang, Simeng (2018). « Éditorial : La santé mentale en migrations internationales », Revue européenne des migrations internationales [En ligne], vol. 34 - n°2 et 3, DOI : https://doi.org/10.4000/remi.10489
Steves, Rick. Strasbourg: The Bicultural Crossroads of Europe, https://www.ricksteves.com/watch-read-listen/read/articles/strasbourg-france-bicultural-crossroads-of-europe
CLSM & Politique de la ville : Dynamique de déploiement - Etat des lieux au 1er janvier 2020, CLSM France, https://ressources-clsm.org/les-conseils-locaux-de-sante-mentale/clsm-et-quartiers-politiques-de-la-ville/
CLSM Eurométropole de Strasbourg, https://ressources-clsm.org/clsm/strasbourg-metropole/
Strasbourg, France - Intercultural City, Council of Europe (Conseil de l'Europe), https://www.coe.int/en/web/interculturalcities/strasbourg
(2014). Strasbourg: Results of the Intercultural Cities Index, Council of Europe Intercultural Cities, https://rm.coe.int/CoERMPublicCommonSearchServices/DisplayDCTMContent?documentId=090000168048352e
City of Strasbourg Intercultural Profile, Council of Europe Intercultural Cities, https://rm.coe.int/CoERMPublicCommonSearchServices/DisplayDCTMContent?documentId=0900001680488f96
Santé Mentale, Santé Publique France, https://www.santepubliquefrance.fr/maladies-et-traumatismes/sante-mentale
(2022). Santé mentale des enfants et adolescents : un suivi renforcé et une prévention sur-mesure, Santé Publique France, https://www.santepubliquefrance.fr/les-actualites/2022/sante-mentale-des-enfants-et-adolescents-un-suivi-renforce-et-une-prevention-sur-mesure
(2022). Évaluation de la campagne santé mentale adolescents : « J’en parle à »., Santé Publique France, https://www.santepubliquefrance.fr/content/download/419451/document_file/2022_LePointSur_sante_mentale_ados_140322.pdf?version=1
(2018). «Feuille de route: Santé mentale et psychiatrie », Ministère de la Santé et de la Prévention, https://sante.gouv.fr/IMG/pdf/180628_-_dossier_de_presse_-_comite_strategie_sante_mentale.pdf
(2023) « Feuille de route Santé mentale et Pyschiatire - Etat d'avancement au 1er mars 2023», Ministère de la Santé et de la Prévention, https://sante.gouv.fr/IMG/pdf/dp_cssmp_bilan_fdr_01.03_2023_-_dmsmp.pdf
(2019) « Le Projet Territorial de Santé Mentale du Bas-Rhin » Ministère de la Santé et de la Prévention, https://sante.gouv.fr/IMG/pdf/ptsm_bas-rhin_-_diagnostic_et_feuille_de_route.pdf

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