Get psychiatric help in France
How the mental health services work, how much is reimbursed, and the different types of help available
MENTAL health services in France usually involve a visit to a psychiatre or psychologue - both sometimes referred to as un psy.
It is important to note the difference - only a psychiatre (psychiatrist) is a doctor and while his or her bills are state reimbursed a psychologue’s may not be, unless you consult them in a hospital context.
If you see a psychologue en ville - that is at their own premises - their fees are not reimbursed.
A psychiatrist’s fees, if you go via your médecin traitant, are €37 if they have a set tariff (of which you are state reimbursed €24.90). Some are honoraires libres which means that you will be reimbursed but must also pay for the part that exceeds the basic reimbursement level.
If you have a mutuelle (top-up insurance) check to see what cover, if any, it gives for this.
It is always advisable to go via your médecin traitant first, though there is no reimbursement penalty for not doing so if you are aged 16 - 25.
While a psychiatrist is trained in therapeutic techniques including both talking therapies and prescribing medicines, a clinical psychologist does not prescribe.
They typically offer talking therapies (which may be informed by a specific theoretical background), whether one-to-one, couple or group, and psychological tests.
A psychologist has a degree in psychology plus postgraduate training as a clinician, a “clinical” psychologist being one who works with patients as opposed to doing research.
Dr Claude Leroy, honorary president of the Ligue Française pour la Santé Mentale (LFSM), said: “Seeing a psychologist might be suitable for most neuroses [depression, anxiety etc.], if they are not too bad, but if you suffer from a psychosis - a disturbance of your perception of reality like manic-depression or schizophrenia - there is a strong organic component which must be treated with drugs.”
You will come across other “psy” words like psychanalyste, psychothérapeute, or even psychosomatothérapeute or psychorelaxologue.
These are not regulated titles though psychiatrists or psychologists may in practice also be psychotherapists (offering a talking therapy to work through a problem) and psychoanalysts (offering traditional in-depth, long-term analysis in the tradition started by Freud).
Ask the person you are considering seeing if they are a psychiatre or psychologue - you can also check with the DDASS (direction départmentale des affaires sanitaires et sociales) or ask them for their ADELI number (given by the DDASS).
The government’s Mission interministérielle de vigilance et de lutte contre les dérives sectaires warns that some psychotherapists have links with cults.
It reports there are several hundred forms of therapy in France and only about half of psychotherapists are doctors or psychologists.
One way to get free mental healthcare is to go to a Centre Médico-Psychologique (CMP) attached to a hospital, either directly or via your doctor or a school nurse.
They cover people living in a specific geographical area and are completely free, whichever professional you see. They often have waiting lists of several months apart from emergencies.
They exist both for adults and children. A psychiatrist specialising in children is a pédopsychiatre.
There are centres médico-psycho-pédagogique (CMPP), run by associations and offering free care for children experiencing difficulties affecting their schoolwork such as developmental problems or dyslexia. It can take several months for an appointment.
Your child’s teacher or médecin traitant should know local children’s services (or check the yellow pages).
Whether for an adult or child, your mairie should also have details of mental health services in your area, especially if you need help urgently.
Dr Leroy said: “A lot of people are reluctant to seek mental healthcare and admit their brain is not working well. However the French are more used to the idea for children.
“Sometimes it turns out problems have simple answers - actually the child needs glasses or a hearing aid...”
Some associations have funding to help certain sectors of the population for free. Dr Leroy said, for example, the LFSM ran services for an association helping unemployed managers.
He added: “Prevention is also very important, stopping psychological problems from getting worse - because there are not enough psychiatrists in France - for example where there is violence or neglect in families.
“We have a centre at Beauvais which aims for this. An individual can contact them or mairies or social workers flag problems up - it often involves couple or group therapy.”
One LFSM psychologist, Eric Verdier, said: “Associations fill in the gaps in mental health care in France - and there are a lot of gaps.”
Dr Leroy said that the idea of going to a counsellor - a simple form of talking therapy where the professional listens to your problems and helps you find your own solutions (conseil psychologique) - is not well-known or regulated in France and there was a risk of “cult problems.”
“Your best bet for this kind of help would be to see a psychologist. Our association can offer counselling with a psychologist in Paris.”
Otherwise for basic listening support there are services such as the helpline SOS Amitié, he said.
Dr Leroy said it would often be possible to find a professional with good English if necessary.
A spokeswoman for the CMP for Paris 8th said: “People do sometimes ask and we help them find a therapist who speaks English - as long as they are from our area.”
Find English-speaking counsellors at www.counsellinginfrance.com (their qualifications may be British - in Britain the job of counsellor is more regulated than France and British counsellors are usually not psychologists). A partner for the UK’s Samaritans in France is www.soshelpline.org (tel: 01 46 21 46 46).