The Disparities in Mental Healthcare in France

One in four people in France struggle with mental health disorders at least once in their lifetime, says a report from Fondation de France. Mental health advocates have spread the message of taking care of their bodies both physically and mentally. In France, mental pathologies present significant morbidity and mortality and therefore require an understanding of the various social factors that impact one's mental state. It has been known that socio-demographic characteristics (such as age, gender, education level, personal wealth, and insurance coverage) influenced both the decision to use hospital services (including emergency rooms) and the degree of use once that decision was made [1].


Many different socio-economic factors can affect an individual’s access to mental healthcare as well. For example, one in six individuals without a residence in France are found to have higher rates of post-traumatic stress disorder (PTSD) [2]. People without a residence permit face deplorable housing circumstances, clandestinity-related stress, and, lastly, difficulty accessing the AME (the medical aid given by the state) [2]. In addition, there are high rates of depression and PTSD in mothers and emotional and behavioral difficulties in children from homeless families [3]. Except for alcohol and tobacco misuse, women are at higher risk for numerous markers of mental health and have a higher prevalence of the classic risk factors for mental health disorders [4]. These many elements have been linked to mental health illnesses and various socioeconomic indicators, with the most disadvantaged social groups being the most affected.


Furthermore, social factors can affect an individual’s help-seeking attitude, or one’s ability to vigorously search for assistance from healthcare providers or trusted community members. There was an inverse association between education and personal stigma and help-seeking attitudes, with higher levels of education and personal stigma being linked to more unfavorable help-seeking attitudes [5]. Help-seeking attitudes are driven by a person's own beliefs about mental illness and behavioral health, rather than what a person thinks others think about mental illness and behavioral health [5]. As a result, focusing on an individual's personal views about mental illness and behavioral health has the potential to enhance help-seeking attitudes and reduce behavioral health inequities.


Reducing behavioral health inequities is particularly important because inequities in the realm of mental health resources have been more pronounced than ever due to the pandemic. Four critical vulnerabilities in persons with mental illnesses were found during the pandemic: (1) medical comorbidities, which are more common in people with mental illnesses (cardiovascular and pulmonary ailments, diabetes, obesity, etc.) and are a major risk factor for fatal diseases, such as COVID-19-related disease; (2) age (coronavirus is more common in older persons); (3) cognitive and behavioral impairments, which may make it difficult to comply with containment and sanitary precautions; and, finally, (4) psychological susceptibility because of stigma [6]. The pandemic has proved the importance of maintaining a system where mental health is accessible across demographic groups, especially to those that are socio-economically underprivileged.


References


1. Loubière, S., et al. “Determinants of Healthcare Use by Homeless People with Schizophrenia or Bipolar Disorder: Results from the French Housing First Study.” Public Health, vol. 185, Aug. 2020, pp. 224–31. EBSCOhost, doi.org/10.1016/j.puhe.2020.05.019.

2. Prieur, Constance. “Une Personne sans Titre De Séjour Sur Six Souffre De Troubles De Stress Post-Traumatique En France.” Irdes, https://www.irdes.fr/.

3. Roze, M., et al. “Santé Mentale Des Mères Et Des Enfants De Familles sans Logement En Île-De-France. Résultats De L'enquête ENFAMS.” Neuropsychiatrie De L'Enfance Et De L'Adolescence, Elsevier Masson, 23 Aug. 2019, https://www.sciencedirect.com/science/article/pii/S0222961719300777?via%3Dihub#bibl0005.

4. Murcia, Marie, et al. "Social Inequalities in Mental Health among Employees: Results of the Samotrace Study (France)", Santé Publique, vol. , no. HS, 2011, pp. 59-73.

5. Benuto, L.T., Casas, J., Gonzalez, F. et al. The Behavioral Model of Health: Education, Behavioral Health Factors, and Stigma as Predictors of Help-Seeking Attitudes. Community Ment Health J 56, 1275–1283 (2020). https://doi.org/10.1007/s10597-020-00601-y

6. Chevance, A et al. “Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review.” L'Encephale vol. 46,3 (2020): 193-201. doi:10.1016/j.encep.2020.04.005



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