France

Health systems in transition France 147
Palliative care capacity has steadily grown since the late 1980s. In 2011,
French hospitals included 6500 beds dedicated to palliative care; there were 420
mobile palliative care teams in activity and 110 active palliative care networks.
Nevertheless, palliative care capacity is still lower than the demand for these
services and is very heterogeneous across regions.
5.11 Mental health care
In France, services for mentally ill people are provided by both the health sector
and the social and health care sector for the disabled, with an emphasis on
community-based organization of mental health care services.
Services provided by the health sector
Services provided by the health sector take the form of both public and private
outpatient and inpatient care. Public mental health care is provided within
geographical areas of theoretically equivalent population size, called mental
health care areas. Care is organized separately for adults and children. For
each of these populations, care within each area is coordinated by a hospital
(a public hospital in more than 90% of the cases) and includes a wide range
of preventive, diagnostic and therapeutic services, which are provided in both
inpatient and outpatient settings. Psychiatric ambulatory care centres (centres
médico-psychologiques) are present in almost every mental health care area,
providing primary ambulatory mental health care, including home visits, and
directing patients towards appropriate services. In 2010, there were 857 adult
mental health care areas and 375 mental health care areas for children (Cour
des comptes, 2011a). The size and resources of mental health care areas are
quite heterogeneous.
Overall, mental health care areas account for 40% of psychiatric hospitals
and 80% of psychiatric beds. With 11 000 hospital beds, the private profitmaking
sector accounts for 70% of the remaining full-time hospitalization
capacity and is, therefore, an important actor in the field of mental health care.
Private profit-making hospitals are only marginally involved in outpatient
treatment, but they account for 20% of cases involving inpatient care. They
accept patients with psychiatric disorders on the same basis as public hospitals.
A large number of psychological disorders are also dealt with on an
outpatient basis by GPs or private psychiatrists or psychologists, some of them
practising psychotherapy and, occasionally, psychoanalysis. In 2012, there
were 12 400 psychiatrists in activity, the majority of whom (57%) were salaried