As the French government launches a new mental health campaign that includes reimbursing the cost of therapy sessions, psychiatric professionals are examining a sector that they say has gone from “pioneering and innovative” to faltering, and that US hegemony is partly to blame for French decline.
“The state of French psychiatry is catastrophic,” says Marie-José Durieux, a child psychiatrist at a Paris hospital, bluntly. It’s a diagnosis shared by many others in their profession, and one of the reasons the French government held a two-day conference on mental health and psychiatry this week with industry professionals (l’Assises de la santé mentale et de la psychiatrie) in an attempt to rejuvenate a failed branch of the French medical establishment.
“Just 30 years ago, psychiatry was practiced with great interest and enthusiasm,” says Durieux. “We associate psychiatry with imaginative sciences such as philosophy, psychoanalysis, sociology, and literature, and we push the field further.”
Later the use of drugs was introduced in the sector. “They have brought undeniable progress, but medication alone is not enough to solve existential problems,” he says.
“In the 1980s, American ways of thinking and treatment methods were adopted in France. French psychiatry, which was world renowned, innovative and pioneering, little by little began to go downhill due to the influence of the United States ”.
At the heart of this tug of war between French and American practices is the profession’s Bible: the “Diagnostic and Statistical Manual of Mental Disorders” or DSM. This manual, compiled by the American Psychiatric Association, lists psychiatric disorders, diagnoses, and statistics, and began to be used in France in the 1980s. “Over time, the standards described in this book took hold of what previously it had been the standard in French psychiatry, ”says Durieux.
The reference manual, used in the United States by physicians, researchers, and governing bodies, as well as insurance and pharmaceutical companies, is regularly updated with new data. But its latest update in 2013 drew pushback from French mental health professionals, many of whom believe that the manual’s classification systems, while extensive, did not leave enough room for subjectivity in a diagnosis.
Many also believe that the manual increasingly pushes professionals to turn to medication and brainwashes early career psychiatrists. “Human beings are born with a search for meaning that cannot be suppressed by an injection of antipsychotics or some antidepressants,” says Durieux.
But a heavy-handed approach to medication is not just an American phenomenon: French doctors are known to freely prescribe. France has the highest per capita antibiotic consumption rate in Europe. A recent study showed that French doctors prescribed too many medications for children, and half of the children under the age of 2 had taken more than nine medications a year. When it comes to prescribing drugs for psychiatric disorders, a 2014 study showed that one in three people in France took psychotropic medications, including antidepressants. In fact, France is regularly among the world’s leading consumers of antidepressants.
An aging profession, abandoned by young professionals
So are the American diagnoses to blame? Durieux says French health authorities are also responsible for the decline in this sector.
“Several decades ago, we began to remove patients with mental health problems from hospital wards. That was a great thing because they shouldn’t have all been there. Now specialized psychiatric wards have gradually disappeared from hospitals, but they have not been replaced by outpatient services or follow-up care, ”Durieux laments.
French public authorities have repeatedly cut funding for the psychiatric sector. As a result, tight budgets have led to lower salaries and key job vacancies. When the latest round of junior physicians in the country chose their specializations, 71 psychiatric positions were left unfilled. Durieux says that even those in the psychiatric profession itself are to blame because there is a lack of energy and innovation in the sector. The “average age of psychiatrists is quite high and many will be retiring soon. In just 40 years, the profession has lost 40 percent of its workers, ”says Durieux.
These problems are clearly visible in health centers across the country. Patients face a one-year waiting period before a first consultation at a psychological health center. That trend is even more apparent in rural France or in densely populated areas like the suburbs of Paris, where there are simply not enough qualified healthcare staff to meet the growing demand. According to the latest data from an ongoing government survey on mental health during the Covid-19 pandemic, 15 percent of French people show signs of depression (a five-point increase compared to before the pandemic), 23 percent shows signs of anxiety and 10 percent have had suicidal thoughts in the past year (twice the pre-pandemic levels).
While it is promising that the French are increasingly turning to psychologists and psychiatrists for help when struggling with mental health, we must be serious about providing the necessary funding for the sector, Durieux says.
That is exactly what the government is trying to do. French President Emmanuel Macron announced a series of measures designed to boost the sick sector, including reimbursing the cost of consultations with psychologists, creating 800 jobs in psychological health centers, and additional funding and support for research. . But unions have responded by saying that these measures are not only insufficient, but threaten the independence of the sector.
One aspect of the new measures has particularly irritated psychologists: Patients must be referred by their GP to take advantage of reimbursed consultations with a psychologist.
“It is scandalous. It shows total disregard for our profession and for the population, ”says Patrick-Ange Raoult, general secretary of the National Union of Psychologists (SNP).
Christine Manuel, also from the SNP, told the French news agency AFP that the reforms were decided without consulting health professionals. “We would like to be involved and we are not. They decide everything without our participation, with the doctors. ”
The French Hospital Federation has responded more positively to the announcements. In a press release, he said the reform was “indispensable to end the historic underfunding” of public psychiatry.
“These measures are going in the right direction,” says Durieux. “But Macron alone will not be able to fix the industry. Health professionals must also re-interest themselves in psychiatry and breathe new life into the sector so that France can stand out again ”.
This article was adapted from the original in French.