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HEALTH

UPDATE: How to access mental health services in France

On World Mental Health Day, we take a look at how to access mental health services in France - and what changes will come into place in 2022.

A man sits depressed during a mental health consultation. The Covid-19 pandemic has put us all under mental strain.
Accessing mental health services in France can be difficult. Read our guide on how to navigate this system and changes on the horizon. (Credit: Nik Shuliahin/Unsplash)

The Covid-19 pandemic has taken a mental toll on people around the world. France is no exception. 

According to a study conducted by French health authorities in September: 15 percent of French people are depressed (up 5 percent from pre-pandemic levels); 23 percent are anxious (up 10 percent); and 10 percent have had suicidal thoughts over the course of the year (up 5 percent). 

Accessing partially reimbursed or fully reimbursed mental healthcare in France can be difficult. Soaring demand 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. But there are ways to get help.

Accessing mental health services

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. 

READ ALSO: How to get a carte vitale in France and why you need one

If you have a carte vitale 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 conventionné secteur 1 to get the highest level of reimbursement possible.

You can read an approximate guide to current reimbursement levels HERE.

Psychologists (who are unable to prescribe drugs) are not considered doctors in France and therefore consultations with this kind of practitioner are rarely reimbursed. However, you may be able to access both psychological and psychiatric treatment if you can get an appointment in a Medical Psychology Center (centre medico psychologique – CMP). These services are free but often require a referral letter from a GP.

Counselling is another option. Generally less qualified than psychologists or psychiatrists, counsellors can provide a simple form of listening therapy. Anne Poulton, a retired professional counsellor with an NHS Community Mental Health team, set up the Counselling in France website after moving to France with her husband in 2000. It serves as a directory for English-speaking counsellors who may be able to help you. These services are not covered by social security.

READ ALSO: Health insurance in France – what you need to know about a mutuelle

Private mental healthcare will only be reimbursed if you have a private insurance (mutuelle) which specifically covers this kind of healthcare. It is however, easier to get an appointment quickly if you go down this route. 

Upcoming changes

In September, President Macron made a number of announcements that should significantly improve access to mental health services from an unspecified date in 2022. 

Psychological consultations will finally be at least partially reimbursed by the state – although you will need to have a recommendation letter from a GP to benefit from this.

For everyone with a carte vitale, the state has promised to cover ten psychological consultations at the price of €40 each. These ten consultations can be renewed once. After that, patients will continue to receive reimbursement, to the tune of €30 per session. 

READ ALSO: What your French health insurance card entitles you to

The French government intends to spend €50 million to cover these costs in 2022 and a further €100 million in 2023. 

CMPs are to employ a further 800 staff, which will help to absorb some of the demand for free mental healthcare. 

The government has also promised to invest €80 million in neuroscience research in a bid to find better treatments to the country’s mental health crisis. 

Helplines

SOS Helpline offers a telephone listening service in English – 01 46 21 46 46

The UK-based Samaritans can be accessed from France – 0044 8457 909090

If you are experiencing domestic violence you can call (English-speakers may not always be available) or report online HERE.

The British Consulate is able to advise you on various treatment options available but cannot give clinical advice on individual mental problems – 01 44 51 31 00

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HEALTH

Reader question: Do you have to pay if you call an ambulance in France?

In a medical emergency, the expense of calling an ambulance to transport you or a loved one to hospital should be the least of your concerns. Here’s what you need to know about the financials of falling ill in France.

Reader question: Do you have to pay if you call an ambulance in France?

In France, urgent emergency care is run centrally by the Service d’Aide Médicale Urgente, known to almost everyone as Le SAMU (pronounced sam-oo), which is a coordinated service to call in case of any serious medical emergency.  

Samu

You can call SAMU by dialling 15 – you should only do so in serious medical emergencies, such as loss of consciousness or chest pains.

Some operators speak English but if you’re worried about speaking French you can call the central European emergency number on 112. Although it’s not guaranteed, most of their operators speak English.  

Importantly, you should not worry about being sent away for financial reasons if you need emergency medical care – under French law, hospitals and emergency services must treat any patient in an emergency. 

You may, however, receive a bill later.

Calls to SAMU are free but you will be billed for their services, with prices for consultations and call-outs varying greatly according to the département you are in. 

If you are resident in France and either have, or have applied for, a carte vitale, the costs will be covered by state system and your complimentary health insurance (mutuelle), if you have one – in the same way as other medical costs (eg GP visit, prescription).

READ ALSO How to get a carte vitale in France and why you need one

Be aware, however, that, in France, a doctor must confirm you are really in need of an emergency ambulance service, otherwise the cost of the ambulance might not be reimbursed.

In urgent situations, prescriptions for transport costs can be written afterwards. 

If you’re visiting France you will receive the bill the same bill for the cost of the ambulance, and will then have to claim back the cost from either your EHIC or GHIC card (for EU or UK residents) or via your own health insurance or travel insurance.

Sapeurs Pompiers (fire brigade)

This takes some getting used to for new arrivals, but, in France the sapeurs pompiers (fire brigade) can also be called out (dial 18) to medical emergencies, including traffic accidents and accidents in the home.

They receive extensive medical training and are more than simply ‘first-aiders’, but if the situation is very serious the pompiers may request help from the SAMU or the SMUR – these last are highly-trained medics whose role is to provide urgent care on the ground if the patient is in a life-threatening condition.

It is free to call the French fire brigade from any number, including for visitors and tourists. But unlike SAMU, you will not be billed for their services – unless, that is, you abuse the system.  

READ ALSO What to do if you have a medical emergency in France

Firefighters will bill anyone who makes a false call anywhere between €200 and €1,000 – and there’s no option to claim this cost back from anywhere.

In hospital

If your condition is serious, either the SAMU or the pompiers may take you to the nearest hospital for treatment.

In 2022, France introduced a new flat fee of €18 for treatment at hospital emergency departments known as the forfait patient urgences (FPU). This applies whether you are taken to the emergency department by emergency services or whether you get yourself to the hospital.

It applies to most people – there are exceptions – who receives treatment at an emergency room in a French hospital who does not then need to be admitted to hospital. 

Everyone is liable, whether they are French or not, whether they’re residents or tourists.

Anyone resident in France who has a mutuelle should be covered for this fee, but it is not reimbursable via the carte vitale.

READ ALSO What you need to know about France’s fees for emergency medical treatment

If your condition is serious enough that you are admitted to the hospital for further treatment, the bill depends on what treatment you receive and how long you stay.

Transport

What if you just need transporting to hospital for non-emergency appointments? Some patients are entitled to have the cost of transport covered by social security, including public transport, taxis, or ambulance – but in this case you would need to be living in France and registered in the French system.

Each area also has its own ambulance service – in most places these are white vehicles with a blue star and the name of the local authority that they are controlled by.

You may also be able to claim back fuel costs if you use your own vehicle.

The first step, in this instance, is to get your GP to fill out a prescription converting transport costs. This should also state what means of transport you should use.

You can be reimbursed for:

  • Trips to and from hospital out-patient care;
  • Care for a recognised long-term condition if you cannot get to the appointment by yourself;
  • If you have a serious condition where you need to be under surveillance or lying down during the journey;
  • Care linked to a work accident or work-related illness.

You will need approval from your local CPAM if your medical needs require the following:

  • Long-distance transport (more than 150km each way);
  • For treatment which requires at least four trips of more than 50km each way, in a two-month period;
  • If treatment requires you to travel a flight or boat trip.

Retain all receipts to send them, with a copy of the prescription authorising transportation to your local CPAM office for reimbursement of up to 55 percent of the total cost. 

READ ALSO Prescription fees and sick notes: What’s in France’s 2024 budget

Be aware that taxis you use must be ‘conventionné’ – ie licensed to transport patients. They will have a blue ‘C’ sticker in the back window.

Full reimbursement

The full cost of transportation is covered for the following: 

  • Pregnant women (six months or more);
  • Newborns less than 30 days old;
  • People who have suffered a work accident or occupational disease;
  • People suffering from a long-term illness (Affection longue durée or ALD);
  • Children and adolescents in centres d’action médico-sociale précoce (CAMSP) and centres médico-psycho-pédagogiques (CMPP);
  • Anyone entitled to complementary health insurance (Complémentaire santé solidaire or CSS) or state medical aid (Aide médicale de l’État or AME).

READ ALSO Explained: Who has to pay France’s annual healthcare charge

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