EBy 2025, mental health has been declared a major national problem. The challenges facing French psychiatry are enormous, as the sector lacks resources, whether human, logistical or financial.
To start improving this situation, there are inexpensive measures that will have a direct impact on the mental health of many French people. Top on the list is the possibility for patients to obtain reimbursement for certain molecules that have not received marketing authorization (AMM) – which is a prerequisite for obtaining coverage from Health Insurance. Certain psychotropic medications are not actually reimbursed by Social Security for their use in psychiatry, despite levels of evidence as recommended worldwide.
Pramipexole is used in bipolar depression due to its dopaminergic properties, a use highlighted in 2009 by two international authorities. Thyroid hormone, which is neither sedative nor associated with weight gain, has been suggested as a cause of depression for twenty-five years by the American Psychiatric Association. Metformin has been prescribed to combat neuroleptic-induced diabetes or obesity since the early 2000s. This is the first pharmacological intervention highlighted in several international psychopharmacology recommendations for treating and preventing obesity.
Financial penalties
When, for administrative and accounting reasons, French psychiatry was unable to benefit from international scientific knowledge, the most marginalized patients were unable to access care that was sometimes the only effective treatment.
This situation is especially true for out-of-hospital treatment, where psychiatrists are significantly more likely to be controlled by the Primary Health Insurance Fund (CPAM) for off-label prescriptions, and not stated in the prescription. The socio-economic characteristics of psychiatric patients – who have complex or resistant pathology and are often the most dangerous and most frequently disabled or hospitalized – require practitioners, for ethical reasons, to do everything to ensure that they have access to effective, tolerable, safe and reimbursable treatment.
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