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Experimenting locally with a stepped-care approach for the treatment of mild to moderate mental disorders in France: Challenges and opportunities

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  • Gandré, Coralie
  • Rosenberg, Sebastian
  • Coldefy, Magali
  • Or, Zeynep

Abstract

In France, publicly funded mental care services are mostly hospital-based and focused on treating severe illnesses. Mild to moderate mental disorders are typically managed by general practitioners (GP) who often lack specific training to treat these conditions. Antidepressant prescribing levels for mild to moderate conditions are inadequately high. Public reimbursement for psychotherapies provided by psychologists is generally not available. This paper presents a local experiment with a stepped-care approach for the treatment of mild to moderate mental disorders in four French départements launched in 2018. The experiment includes the introduction of a standardized assessment protocol for GPs, clear referral guidelines, and full reimbursement of visits to psychologists upon GP referral. Seemingly simple, the policy raises several issues related to the regulation, training and reimbursement of psychologists, and illustrates the need for careful preparation and workforce planning to ensure success and stakeholder support. An independent evaluation of the local experiments is planned, which provides the opportunity to fine-tune the policy before any broader rollout. The issues raised in France and the on-going debate is relevant for other countries preparing similar policies for improving mental care.

Suggested Citation

  • Gandré, Coralie & Rosenberg, Sebastian & Coldefy, Magali & Or, Zeynep, 2019. "Experimenting locally with a stepped-care approach for the treatment of mild to moderate mental disorders in France: Challenges and opportunities," Health Policy, Elsevier, vol. 123(11), pages 1021-1027.
    • Handle: RePEc:eee:hepoli:v:123:y:2019:i:11:p:1021-1027
    DOI: 10.1016/j.healthpol.2019.08.006
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    References listed on IDEAS

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    1. Irving Kirsch & Brett J Deacon & Tania B Huedo-Medina & Alan Scoboria & Thomas J Moore & Blair T Johnson, 2008. "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration," PLOS Medicine, Public Library of Science, vol. 5(2), pages 1-9, February.
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    Cited by:

    1. Kovess-Masfety, V. & Rabaté, L. & Caby, D. & Nicaise, P., 2023. "French mental health care system: Analysis of care utilisation patterns and the case for a stepped care approach," Health Policy, Elsevier, vol. 138(C).

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