Mental healthcare in France

France has a lauded history of investing in its citizens’ physical health. However, mental health in France is treated completely differently, which can make it complicated for new arrivals in the country to access the appropriate services.

Finding help as an expat is especially difficult when it comes to specific issues – essentially, help gears more towards locals. While it’s not particularly intuitive for an expat to get help, it is possible.

This article cuts through the red tape as much as possible and cover the following:

Overview of mental health in France

The healthcare system in France offers mental health services that patients can access for free or, they can at least access using subsidies. According to recent studies, around one in five French people suffer from mental health problems. According to Foundation de France, around three million people in France suffer from a serious mental illness.

However, in recent years, there has been growing concern that services in the country can’t cope with demand. Indeed, in January 2019, 100 French psychiatrists sent a letter to the French health minister expressing concern over the level of mental healthcare provision. Coronavirus has catalyzed many mental health issues such as sleep disorders, anxiety, and depression in France. A survey showed that people suffering from depression has increased from 15.5% on October 21, 2020, to 22.6% on November 25, 2020.

According to statistics from the French public health authorities, more than 7% of the French population – that’s about three million people – admitted having considered ending their lives in 2017. Nearly 5% had thought about committing suicide in the previous twelve months. 0.4% had actually attempted to kill themselves. These stark figures show that mental health was an issue in France long before coronavirus was around.

Mental healthcare services in France

Much of the mental healthcare in France is provided through Medical Psychological Centers (click the link and you’ll find a list of hospitals, centre médico-psychologique – CMPs, are attached to these). These centers – which you can find attached to any hospital in France – provide mostly free services covered by state health insurance.

Some specialist services involve partial payment. Practitioners such as psychiatrists, psychologists, nurses, social workers, occupational therapists, and speech therapists run these centers. However, bear in mind that most of these services are given by French speakers, so you may want to brush up on your French language skills beforehand.

President Macron recently announced changes to the mental health system, due to take effect in 2022. For example, psychological consultations will be partially reimbursed by the state, though you will need to have a recommendation letter from your doctor to benefit from this.

Accessing partially reimbursed or fully reimbursed mental healthcare in France can be difficult. Be warned, the unfortunate nature of soaring demands, coupled with a lack of staffing (close to a third of positions in public mental health hospitals are unfilled) means that waiting lists can be long.

How to access mental health services in France

You will need a referral from your doctor for most treatments in a CMP. If you see a psychiatrist or psychologist outside of a CMP, you will be reimbursed at the same rate as for GP services. This applies if it’s a state-provided treatment, you’ll need to clarify this with your GP if you fall into this category. You will not get a reimbursement for the cost of private services and treatments unless you have private health insurance.

Your local mairie (town hall) should also have details of local mental health services, especially if you need help urgently. In cases of psychiatric emergencies, you should head to your nearest hospital.

Insurance for mental healthcare in France

All legal residents who meet the requirements can benefit from the healthcare system and health insurance scheme in France. This applies to anyone who has lived in France for three months with the intention of for another three. Healthcare costs are paid for by both the state and the individual.

Private health insurance is a good option for those with chronic illnesses. The state will not cover chiropractors, osteopaths, or psychologist consultations. Private insurance is also beneficial for some types of prescription medication. The state will only cover a percentage of what they consider “essential” medication. Prescription medication can be quite pricey, therefore, private insurance is recommended. Private health insurance providers in France include:

• Allianz Care
• APRIL International
• Cigna Global

If you’re an EU/EEA citizen, you should get a free European Health Insurance Card (EHIC) before you arrive in France. If you already have an EHIC it will still be valid as long as it remains in date. The GHIC or EHIC entitles you to state-provided medical treatment. These treatments include visits to a psychologist or psychiatrist when referred by your doctor.

Psychologists, psychiatrists, and therapists in France

If you have a carte vitale the card to prove your insurance is all in order, it is possible to have partial or full reimbursement for psychiatric treatment in France. If booking an appointment online, be sure to check whether the doctor is classified as ‘conventionné secteur 1’ to get the highest level of reimbursement possible.

The easiest way to book an appointment with a psychiatrist is through the Doctolib website. It is possible to filter your search for English-speaking clinicians. We would always suggest visiting your doctor first for advice and even a referral. However, you can bypass this process if you’re happy to pay – this will cut down on waiting times.

Psychologists are not considered doctors in France. Note, too, that they are unable to prescribe drugs. Therefore, consultations with this kind of practitioner are rarely reimbursed. This may change in 2022 with the government announcing new changes to tackle mental health. These changes mean psychology consultations will be free. For now, though, it’s difficult to get help for free. You may be able to access both psychological and psychiatric treatment if you can get an appointment in a CMP. These services are free but often require a referral letter from a GP.

Counseling is another option. Counselors can provide a simple form of listening therapy. Anne Poulton, a retired professional counselor with an NHS Community Mental Health Team in the neighboring UK, set up the Counselling in France website. It serves as a directory for English-speaking counselors in the country, who may be able to help you.

Drug and alcohol services in France

in 2019, President Emmanuel Macron admitted that the country was losing the fight against drugs. Specifically, in neighborhoods such as Marseille’s 14th District and the banlieues in Paris. Increasing numbers of French people have been experimenting with drugs.

There is a specialized addiction treatment system and a general care system in France. Most of the 100 sub-regional administrative areas in France have at least one Centres de Soin, d’Accompagnement et de Prévention en Addictologie (CSAPA). These centers provide both pharmacologically-assisted and psychosocial treatments. To access one, speak to your doctor to get a referral.

Services dealing with eating disorders in France

France has long been associated with dangerously thin models gracing the catwalk. The country has no doubt had an uneasy relationship with what’s considered healthy when it comes to how one should look and the eating habits that inform that.

Thankfully, there are changing public perceptions around the issue, culminating in action from the government. Namely, the introduction of new legislation in 2017 banning “unhealthy” models. This may seem immaterial to the larger public concern, but considering how reflective the tradition of fashion and modeling is of French culture, the move by the government was certainly considered a positive one.

Is the changing culture reflective of the services available? Not if you don’t speak French. If that’s the case, you’ll have to engage with the private sector and get in touch with a clinic such as this one in Paris.

With regards to the public sector, there are specialist centers, carers, and doctors you can engage with. Again, like most specialist services in France, you have to go through a middle-man by way of your GP. A psychologist or psychiatrist will often refer you for specialist treatment.

Healthcare for people with severe mental health problems in France

The best route for people with a recurring or severe mental health issue is to visit a Centre Médico-Psychologique (CMP) attached to a hospital, either directly or via your doctor.

They cover people living in a specific geographical area and are free. Unfortunately, the waiting lists can be several months. If the problem is deemed severe enough or an emergency, they will see you sooner.

Mental healthcare for children and young people in France

France has a good healthcare system for children. The first stop for any child or young person suffering from mental health issues should be their school nurse. Like a GP, they have the power to refer students to the nearest centre médico-psychologique (CMP). Here, they can receive specialist, government-funded treatment from a psychiatrist specializing in children – a pédopsychiatre.

There are also centres médico-psycho-pédagogique (CMPP), run by associations offering free care for children experiencing difficulties. This applies mainly to issues affecting their schoolwork such as developmental problems or dyslexia. Note that it can take several months for an appointment.

Your child’s teacher or médecin traitant (primary care physician) should be able to share information on some local children’s services. Alternatively, speak to other parents you may know or search online forums for local services.

Mental healthcare for special groups in France

Early in 2021, the French government announced new aid to guarantee the rights of people with intellectual disabilities to access help and services.

The government will extend the Handicap Compensation Benefit (Prestation de Compensation du Handicap, PCH) scheme. The PCH will now be open to people with psychological or mental health problems. The PCH also applies to those with a cognitive disorder or a neurodevelopmental disorder.

Until these changes are fully implemented, people living with severe mental illnesses can receive services from the health and social care sector – The Caisse Nationale de Solidarité pour l’Autonomie, handicap.fr and L’Arche are good resources. Many organizations for the disabled offer a wide range of services to mentally ill patients. These include housing, health care treatment, professional training, schooling for children, professional education, and sheltered workshops. You can access these services via your doctor or by visiting a CMP.

Emergency support and crisis lines

There are a number of support services for those with mental health problems living in France. However, be aware that the vast majority of these services will only be available in French. That said, there are some English-speaking options. Should you need services in other languages, be sure to check online and with other local expats for more information.

• The British Consulate can advise you on various treatment options available, but can’t give clinical advice on individual mental problems – 01 44 51 31 00
• SOS Helpline offering a telephone listening service in English – 01 46 21 46 46
• The UK-based Samaritans (accessible from France) – 0044 8457 909090
• If you are experiencing domestic violence you can report it online here
• Alcohol hotline: Écoute Alcool, confidential advice, and help in French. Open daily 14:00-02:00 = Tel: 0811 91 30 30
• Cannabis hotline: Écoute Cannabis, confidential advice and help in French Tel: 0811 91 20 20
• Drug abuse helpline: Drogues Info Service, confidential advice and help in French. Open daily 08:00-02:00 Tel: 0800 23 13 13 Tel: 01 70 23 13 13  

Useful resources

• French Ministry of Social Affairs and Health ((Ministere des Solidarites et de la Sante);
• ZAVA – access online doctor consultations throughout France
• Complementary Solidarity Health Fund (complementaire sante solidaire) – information about accessing healthcare for those on a low income;
• Ameli – website with healthcare information and advice. There is also an English-speaking advice line for information about French healthcare insurance: call 3646 from within France; +33 811 70 36 46 from abroad;
• Cleiss (Centre des Liasons Européennes et Internationales de Sécurité Sociale) provides information about healthcare in France and the social security system;
• National Federation of Health Centers (Federation Nationale des Centres de Sante) – find a local health center near you;