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MENTAL HEALTH FRANCE

Why France has such a high rate of suicides

Alarming figures released this week revealed that France has a much higher suicide rate than the European average, and double that of the UK and Spain. One expert in the field tells The Local the problem stems from France's history and economic model.

Why France has such a high rate of suicides
France's suicide rate is well above the European average. Photo: Stavros/flickr

Every day in France an average of 21 men and eight women take their own lives and around 700 attempt it.

Stories about many of these suicides, some of them particularly shocking such as the despairing unemployed man who set himself on fire outside a job centre recently, end up in the French press on a regular basis.

And the latest figures published this week to coincide with World Suicide Prevention Day on Tuesday, revealed that France does have an acute problem with suicide, and charities are demanding the government gives the issue its full attention.

The figures from statistics agencies INSEE and Eurostat, published by the National Association for the Prevention of Suicide, show that the number of people who commit suicide in France is worryingly well above the European average.

Every year around 220,000 people in France attempt to take their own life and 10,000 of those die as a result. These alarming statistics mean that the number of suicides in France is more than double that of the UK and Spain.

Statistics for 2009 show the European Union average for the number of suicides per 100,000 inhabitants stood at 16.8 for men and 4.4 for women. However in France the number of suicides stood at 23.5 and 7.5 respectively.

So why does France suffer from a phenomenon that has, in the past at least, been more associated with Scandinavian countries?

Bodies dragged through the streets

Jean-Claude Delgenes, the director of Technologia, a company which works with highlighting safety concerns for workers, said that  historically, from before the revolution up to the present day, France has never shown a good example of how to deal with the issue.

“Until the revolution, people who took their own lives had their bodies mutilated, dragged through the streets and buried outside town, because it was considered a shameful act,” Delgenes told The Local.

“Another explanation is the historical influence of Catholicism in France. For the church, committing suicide was a big sin and it was a question that was dealt with from a moral point of view rather than a scientific one” he said, which prevented mental health problems from being treated seriously.

For Delgenes, France has also been left lagging behind its European neighbours when it comes to trying to prevent suicide.

“For a lot of issues, whether its suicide, asbestos or cancer, France was left behind when it came to creating programmes and policies geared towards prevention.

“In the UK the first plan to help prevent suicide was laid out in 1950, in France it was in the year 2000.  

Statistics show that the majority of people who kill themselves in France are aged between 35 and 64, and the rate increases with age.

Certain areas of rural France are also worse affected than others, with Brittany and Poitou-Charentes in the west and Nord Pas-de-Calais in the north of the country particularly affected.

The lack of access to services in rural areas of France is considered a reason for this trend.

As might be expected, a person’s financial situation can aggravate the risk, with the suicide rate among job-seekers twice as high as among those with jobs.

In France people have a different relationship with their jobs

In recent months France has witnessed a number of shocking incidents in which several despairing unemployed people have set themselves on fire in front of job centres.

But it is not always those out of work in France who are propelled to take their own lives.

For Delgenes the traditional economic model in France, which has had many huge state-run companies where employees have worked for almost all their lives, can also help explain a high suicide rate, especially during the ongoing economic crisis.

“Work normally protects people from thinking about suicide as it's normally those whose are unemployed or living in poverty who are most at risk, but in recent years, in some cases work has actually been a cause to push people to take such extreme action.

In 2009, former state-run company France Telecom hit the news after a wave of staff suicides which saw 20 workers take their lives in 19 months.

“A lot of people, perhaps some who have worked for state-run companies, often find themselves lost with the pace of change. They cannot find their feet and are being asked to do different jobs which they may never have been trained for and cannot cope with.

“In Anglo countries people don’t have the same relationship with work. They change jobs more often and try new careers but in France people really identify themselves with a job, especially if they have trained for it and it’s hard for them to change, especially in a time of high unemployment.”

National Observatory set up

Earlier this year a study was published which revealed that more and French people are living lonely lives. Odile de Laurens from the charity Fondation de France explained the reason was partly to do with modern life and the loss of traditional French family values.

Delgenes and numerous charities in the field have long been calling on French lawmakers to take action to deal with the issue.

On Tuesday, to mark World Suicide Prevention Day, the government finally heeded the calls of various charities and experts and set up a National Observatory on Suicide Risks.

The Observatory was launched by Health Minister Marisol Touraine and will have three main missions: to gather information on suicide from various sources, conduct additional studies that are deemed necessary and to propose action to prevent suicide.

For Delgenes and other charities who have worked in the field, the project is late, but it's better than never. 

“By opting for a proactive and consistent policy we can bring down the mortality rate, as has been the case with the number of road deaths,” he added.

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PSYCHIATRIST

EXPLAINED: How to access mental health services in France

Latest research shows that one in five of the population in France are dealing with mental health issues as 18 months of the pandemic take their toll - but how can foreigners in France access support if they need it?

EXPLAINED: How to access mental health services in France
Illustration photo: Jeff Pachoud/ AFP

According to the fifth edition of the Observatoire-Place de la Santé de la Mutualité française, published in June, some 13 million people in France are dealing with mental health issues – that’s one in five of the population. 

It said that 64 percent of French people have dealt with ‘mental suffering’, a figure that rises to 75 percent among those under 35.

Moving countries brings with it its own challenges even in normal times, and repeated lockdowns and restrictions on travel have been particularly difficult for those with families in other countries – but for foreigners in France accessing mental health services can be a challenge.

Helpline

“We definitely had more new calls – and from younger callers, mainly students,” a spokesperson for  SOS Help, a charitable anglophone telephone listening service in France, told The Local.

“There was a proportional rise as we had to halve our hours during the first confinement. We also noticed a higher level of anxiety.”

Among the most common reasons for people calling the service were loneliness and isolation during the periods of confinement and restrictions on travel.

SOS Help does not claim expertise in the mental health field, but its volunteers often find themselves at the sharp end of a rising problem, answering the phone to people in need of urgent support some 5,000 times a year. 

“Our listeners offer emotional support by telephone to anyone in France who prefers to speak English,” the spokesperson said. “We listen in confidence and anonymously – our aim is to alleviate anxiety and prevent suicide.”

Younger demographic

The experiences of SOS Helpline are backed up by national research in France into the impact on young people of the pandemic.

Nearly a third of children and adolescents had more difficulty falling asleep after the first confinement — 30 percent of 13-18 year olds and 27.2 percent of 9-12 year olds questioned talked about an increase in these difficulties in a survey examining the mental health of children and adolescents during the first related confinement to Covid-19, published by Santé publique France.

To the government’s credit, it has recognised the Covid-caused mental health crisis among young people. President Emmanuel Macron announced in April that children would be eligible for free therapy sessions.

For more details on the ‘chèque psy‘ scheme, click here.

But the mounting case load in France – which has been described as ‘the other health crisis’, one that is spreading in the shadow of the pandemic – is not confined to young people. Mid-career adults, too, have suffered more over the past 18 months. 

“The pandemic has created an emergency,” Daniel Havis, deputy vice-president of Mutualité Française, told Novethic. “The question of mental health [for employers], of its prevention, of its treatment, has resurfaced.”

Accessing mental health services

As with many things in France, working out where to look for appropriate mental healthcare and what to do can be confusing. 

“There are many mental health services but access is not always clear and often not well known,” Carmen Delavaloire, director of the Ile-de-France mental healthcare body Céapsy, explained.

“This is one of the reasons why Céapsy was created to facilitate the understanding and access to these different services, to raise awareness in mental health, to destigmatise.”

Having a health professional in your corner is an important first step. “People in difficulty need help to suffer less and to have a diagnosis of their situation,” Delavaloire said. 

“Mental health issues are very anxiety-provoking, people need to be accompanied to understand what is happening to them and to have a hope of getting better.”

And she recommended anyone with concerns over their mental health should first visit their GP – a routine point of first contact with the medical profession.

“Access to care through the general practitioner is a good way to be reassured, to understand that there are services adapted to their needs,” she said.

A town’s mairie should also have details of local mental health services, especially if you need help urgently – otherwise in cases of psychiatric emergencies  you should head to hospital. 

“Some CMPs receive people urgently but this is not systematic,” Delavaloire added.

It is not, however, necessary to make an appointment via your GP. You can go directly to a specialist if you prefer, though this may reduce or cut completely any reimbursement on fees. 

“People can also go directly to specialists, such as centres médicaux psychologiques (CMP) or to a psychiatrist or psychologist.”

The advantage, however, with visiting your GP first is that they are better placed to point you in the direction appropriate to your needs – including helping find an English-speaking professional if necessary.

One psy or another

Once you’re in the system, mental health services in France usually involve a visit to a psychiatre or psychologue — both sometimes referred to as un psy.

There is a long tradition of psychoanalysis in France – where Freud and Jung, Lacan and Dolto have long been heavy hitters.  

Jacques Lacan and Françoise Dolto are leading 20th century psychoanalysts. Dolto, a household name, was also a pediatrician, and her books on child rearing are still commonly given to French women when they first have children. 

ALSO READ: France’s problem with autism – and its roots in psychoanalysis

According to a 2017 YouGov poll, one third of French people have consulted a psy.

The good news, therefore, is that there are a lot of registered practitioners so you are unlikely to be waiting a long time to get an appointment, although provision can be more patchy in rural areas. According to 2015 statistics from the EU, France has 84 psychologists per 100,000 inhabitants which is nearly three times more than the UK which has 32.

Costs

Going to a psy in France isn’t cheap with a consultation costing upwards of €50 on average – and you are unlikely to be reimbursed in all but certain specific circumstances.

As mentioned above, young people suffering mental health problems related to the pandemic are entitled to the chèque psy, which gives a certain number of free sessions depending on the situation.

Last year, in a bid to cut the number of anti-depressants consumed in France, health authorities introduced a measure in parts of the country which allows patients with light or moderate mental health problems to get up to 20 consultations for free.

The four-year pilot is being tested in four départments (Landes, Morbihan, Bouches-du-Rhône and Haute-Garonne) and could be rolled out to the rest of France if it is successful.

Counselling

There are other avenues, however. Counselling – a simple form of therapy in which a professional listens to your problems and helps you find your own solutions (conseil psychologique) – is not well-known or regulated in France. But it exists.

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 lists dozens of English-speaking therapists, psychotherapists, counsellors and psychologists, by areas of expertise.

“From what I have heard, it is very difficult for people to get referred for counselling by French GPs as they tend to be sent down the psychiatric route,” she said.  

“Counselling isn’t recognised as a therapeutic term in France, there are only conseillers in banks or travel agencies, but getting psychotherapy is more usual, although rarely in English.”

The site routinely has between 800 and 900 unique visitors per month rising to more than 1,000 ‘at difficult times’, she said.

When she worked with the NHS, “the waiting lists were about 18 months for counselling then, so I felt that there must be a need for counselling for expats when they moved to France.”

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.

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