When the thermometer panics, we first think of infants, the elderly or the chronically ill. Much less for patients followed in psychiatry. However, during a heatwave, this population is among the most vulnerable, not because we should look at it separately, but because the heat hits head-on with vulnerabilities already present: isolation, interruption of follow-up, cessation of treatments, confusion or brutal disorganization.
The topic arose after a listener’s question about “decompensation”, before being placed in the context of mental health in times of extreme temperatures. Head of emergency and doctor confronted with these situations at the hospital, Mathias Wargon describes a reality far from the most hackneyed summer advice. For him, the heatwave acts as an accelerator on an already saturated psychiatric system, and on patients whose balance can become fragile very quickly.
Why the heatwave further weakens people under psychiatric care
For Mathias Wargon, we must first start from a very concrete observation: “In reality, in fact, psychiatry is in crisis all year round (…) with a shortage of space, a shortage of reception, patients who stay for days in the emergency room. The most serious patients stay for days in the emergency room waiting for space in the sectors and particularly in the isolation rooms..
In this already tense context, a heat wave never hits neutral ground. It can disrupt daily life, increase fatigue, complicate sleep, promote isolation and make it even more difficult to maintain regular monitoring. This is precisely what Mathias Wargon sees in the emergency room: “With each heat wave, we find ourselves with patients who lose contact with their psychiatrist, who sometimes stop taking their medication.”.
In other words, heat alone does not create a psychiatric disorder, but it can worsen an already unstable situation. A fragile person may no longer respond to their doctor, skip appointments, stop treatment, eat less, drink too little, withdraw or, on the contrary, become unusually agitated. It is these ruptures that are worrying, because they can upset a precarious balance.
Neuroleptics, heat, interruption of treatment: what worries emergencies
Among the elements of vigilance, Mathias Wargon cites antipsychotic treatments: “Patients taking neuroleptics have thermal dysregulation. So they can heat up faster“.
Put more simply, certain treatments can disrupt the way the body manages heat. This does not mean that you should stop taking a medication on your own initiative, quite the contrary. The real risk is precisely the sudden stopping, repeated forgetting, irregular intake or lack of contact with the doctor who is following the person. During heatwaves, this point becomes central: psychiatric treatment does not change alone, especially when the general condition begins to change.
What the head of emergency describes is therefore a sometimes formidable sequence: intense heat, poor sleep, exhaustion, disorganization, interrupted or poorly taken treatment, then worsening of the psychological state. And the hospital then recovers these situations at a time when they have already gone a long way. “And so, yes, we will end up with a lot of psychiatric patients, like after each crisis. And crises are all year round.. His observation is harsh, almost worn out by repetition: “I feel like I deal with crises all year long. It’s getting a little tiring.”.
Nearby: the signals that should alert you during the heatwave
For families and those around them, the issue is not to monitor a loved one like a child, but to not trivialize certain changes under the pretext that “it’s hot”. A person under psychiatric care should not be left alone if their condition changes significantly during a heatwave, especially if they are isolated, fragile or under treatment.
The signals that should trigger a reaction are quite concrete: unusual confusion, incoherent comments, extreme drowsiness, sudden very agitated behavior, discomfort, stopping treatment, a sudden break with the psychiatrist or doctor, or even a person who no longer responds even though they are usually reachable. You also need to be attentive to someone who withdraws completely, no longer goes out, no longer eats or seems to lose track of what is happening around them.
The right reflex, in these moments, is to maintain the link with the treating doctor, the psychiatrist or the care team as soon as something changes. And if the person shows discomfort, significant confusion, a major change in behavior or a state that seems frankly worrying to you, you should not wait: you must call 15. In a heatwave, mental health does not come second to the rest. For some patients, it is even one of the most sensitive fronts.