As I watched yet another person walk by me in Paris muttering to himself tonight, I was reminded of a conversation I had not long ago with a psychologist friend about the French healthcare system. Considering it has one of the most inclusive and admirable ones in the developed world, I was shocked to find out that the social security – the near-full coverage that is given to all who live in France – does not cover mental health.
A visit with a psychologist in Paris costs around 80 euros for a one-hour session. That equals out to 80 euros once a week, or 320 euros per month – about half a month’s rent. If you’re lucky enough to warrant medication and thus, a psychiatrist (read: “doctor”), you can get your bill mostly covered by the social security. But what about all the others with anxiety, mild depression, or other illnesses that can be treated – oftentimes better – without medication?
Cognitive behavioral therapy, or talk therapy, has been proven effective alongside medication but also all on its own. Talking out problems, finding constructive ways to deal with difficult situations, reversing negative thinking, and learning techniques to calm the body and mind is what CBT is all about. It’s such a shame that the French government would rather pay for someone to pop a pill than to correct what is really at the root of his or her problems.
And the government should take note. According to the NOP World Health’s Western European Depression and Anxiety Physician Study from 2004, France has the highest proportion of depressed people in Western Europe. It says:
“Many sufferers are undiagnosed, however — and even those who are diagnosed are often not treated with prescription medications. This continues to be true, in spite of the fact that many established depression and anxiety therapies are available in Europe — several in generic form or recently re-launched with new formulations.”
Of course this isn’t just a French problem. Mental health is still a hush-hush issue in the most modern countries on the planet. In Japan, where suicide rates are among the highest in the world, killing oneself is seen as an act of nobility linked back to the days of the Samurai. Japanese have even been known to join internet suicide clubs to meet and talk about their planned deaths.
One nation attempting to fade the stigma is the U.S., which has paved the way with bestselling self-help books and pop-psychology. Seeing a therapist in America is trendy and a normal topic of conversation among friends. Billboards for depression and suicide line the highways, and Dr. Phil is a regular on afternoon TV. While the Obama administration struggles to find a solution to the healthcare crisis in the U.S., mental healthcare would most likely be included in a medical insurance plan as it is now under private insurance, with perhaps a slightly higher deductible.
Back in France, the general health insurance outlook is much better. Under the national social security, patients are covered up to about 60%, which is often supplemented by a 30-euro per month mutuelle plan, bringing that coverage to 100%. One would think then, logically, that mental health would be covered by some small percentage, if not the whole 60%.
Sadly, this is not the case. My psychologist friend says that they are working on it. But I wonder, what does that mean? And what needs to happen for the social stigma of mental health to once and for all, finally wear off so that people can get the help they deserve?
Whether it’s the depressing news about mental health in France or the depression itself, I have a feeling I know why the French never smile.
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