Available online 14 November 2023, 104945

Author links open overlay panel, , , AbstractContext

: In France, spending on mental health and psychiatric care, in proportion to GDP, is close to the EU average. However, there are complaints that the French system is overwhelmed and potentially underfunded.

Objective

: To describe the utilisation of psychiatric and mental health care in different settings to consider the appropriateness of care provision and resource allocation.

Methods

: For the year 2018, several national databases on the use of all type of psychiatric care provision (full and part-time hospitalisations, private and public, public ambulatory care, private office-based psychiatrists) were cross-tabulated with diagnosis categories for different age groups and illness severity in order to assess the use of resources and evaluate the appropriateness of resource allocation.

Results

: A sizable proportion of patients with mild and moderate mental disorders are treated in psychiatric care whilst there is insufficient continuity of care for patients with severe disorders, who are not adequately followed up after discharge from hospitals. This contributes to increase the rate of re-hospitalisations, the use of emergency departments, and longer stays in hospitals.

Conclusion

: The several components of the French mental health care system are used inappropriately, not only in geographical terms but also in terms of service use. We argue that strengthening the access to affordable psychotherapy and the implementation of a stepped-care approach could contribute to solve this issue.

Section snippetsBackground

Mental disorders are an underestimated burden [1]. They affect both psychiatric and non-psychiatric health systems, as well as many other national resources through their numerous societal consequences. A study found that the total cost of brain disorders in Europe was €798 billion in 2010, of which the share of direct health care costs was 37%, the share of direct non-medical costs was 23%, and the share of indirect costs was 40%. The average cost per inhabitant was €5,550 [2]. The scope of

The burden of long stays in hospitals

In 2018, 19,185,771 full-time hospitalisation days, corresponding to 328,463 patients, were recorded by ATIH: 3.5% of the hospitalisation days concerned children and adolescents, 73.2% concerned adults up to 64 years, and 23.2% concerned older people. The main diagnoses associated with these hospitalisation days varied greatly between age categories. In children and adolescents, 23.6% of hospital days were related to behavioural disorders and 15.3% were related to psychological developmental

Discussion

The examination of the different sources of data available indicated that more than a third of hospital stays were very long (longer than 272 days in a year), and about half of these long stays concerned people with psychotic disorders. In some age categories, a significant proportion of hospital stays were for undefined disorders. Nearly 40% of the patients were hospitalised following a visit to an emergency department or short-stay crisis centre and a quarter were admitted involuntary. These

Conclusions

According to the stepped-care model recommended for the organisation of mental health care systems by the WHO, the most specialised resources should be directed towards the most severe cases, while primary care should be able to cover the needs of people with mild and moderate disorders. The French mental health care system, however, is not following such approach. The linkage of the allocation of resources, measured using financial data, with diagnosis groups, provides a global picture of

Declaration of Competing Interest

The authors declared no conflicts of interest

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (33)WHO WHOMental Health Action Plan 2013-2020

(2013)

M Lambert et al.Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER)

BMJ Open

(2020)

Making Mental Health Count: The Social and Economic Costs of Neglecting Mental Health Care

(2014)

européenne U. Health at a Glance: Europe

(2018)

OECD. OECD logoA New Benchmark for Mental Health Systems : Tackling the Social and Economic Costs of Mental Ill-Health...P. Coldefy MLF et al.Cinquante ans de sectorisation psychiatrique en France : des inégalités persistantes de moyens et d'organisation

Questions d’économie de la santé

(2009)

View full text

© 2023 Elsevier B.V. All rights reserved.