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Background There is growing concern about measuring patient experience with mental health care. There are currently numerous patient-reported experience measures (PREMs) available for mental health care, but there is little guidance for selecting the most suitable instruments. The objective of this systematic review was to provide an overview of the psychometric properties and the content of available PREMs. Methods A comprehensive review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines was conducted using the MEDLINE database with no date restrictions. The content of PREMs was analyzed using an inductive qualitative approach, and the methodological quality was assessed according to Pesudovs quality criteria. Results A total of 86 articles examining 75 PREMs and totaling 1932 items were included. Only four PREMs used statistical methods from item response theory (IRT). The 1932 items covered seven key mental health care domains: interpersonal relationships (22.6%), followed by respect and dignity (19.3%), access and care coordination (14.9%), drug therapy (14.1%), information (9.6%), psychological care (6.8%) and care environment (6.1%). Additionally, a few items focused on patient satisfaction (6.7%) rather than patient experience. No instrument covered the latent trait continuum of patient experience, as defined by the inductive qualitative approach, and the psychometric properties of the instruments were heterogeneous. Conclusion This work is a critical step in the creation of an item library to measure mental health care patient-reported experience that will be used in France to develop, validate, and standardize item banks and computerized adaptive testing (CAT) based on IRT. It will also provide internationally replicable measures that will allow direct comparisons of mental health care systems. Trial registration NCT02491866.

The excess cancer mortality in persons with severe mental illness (SMI) has been well documented, and research suggests that it may be influenced by care-related factors. Our objective was to assess breast cancer care pathways in women with SMI in France, using an exhaustive population-based data-linkage study with a matched case-control design. The cases were 1346 women with incident breast cancer in 2013/2014 and preexisting SMI who were matched with three controls without SMI presenting similar demographics, initial breast cancer type, and year of incidence. We compared cancer care pathways and their quality for cases and controls, using a consensual set of indicators covering diagnosis, treatment, follow-up, and mortality (until 2017). After adjusting for covariates, cases had lower odds to undergo the main diagnostic tests, lumpectomy, adjuvant chemotherapy, and radiotherapy, as well as hormone therapy, but higher odds for mastectomy. Suboptimal quality in cancer pathways was observed for both groups, but to a higher extent for cases, especially for not receiving timely care after diagnosis and post-treatment follow-up. Breast cancer mortality, considering competing risks of deaths, was significantly elevated in women with SMI. These findings highlight disparities in cancer care pathways for individuals with SMI, as well as specific aspects of the care continuum which could benefit from targeted actions to reach equity of outcomes.

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 departements 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.

Background: The objective of this study was to develop a conceptual framework to define a domain map describing the experience of patients with severe mental illnesses (SMIs) on the quality of mental health care. Methods: This study used an exploratory qualitative approach to examine the subjective experience of adult patients (18–65 years old) with SMIs, including schizophrenia (SZ), bipolar disorder (BD) and major depressive disorder (MDD). Participants were selected using a purposeful sampling method. Semistructured interviews were conducted with 37 psychiatric inpatients and outpatients recruited from the largest public hospital in southeastern France. Transcripts were subjected to an inductive analysis by using two complementary approaches (thematic analysis and computerized text analysis) to identify themes and subthemes. Results: Our analysis generated a conceptual model composed of 7 main themes, ranked from most important to least important as follows: interpersonal relationships, care environment, drug therapy, access and care coordination, respect and dignity, information and psychological care. The interpersonal relationships theme was divided into 3 subthemes: patient-staff relationships, relations with other patients and involvement of family and friends. All themes were spontaneously raised by respondents. Conclusion: This work provides a conceptual framework that will inform the subsequent development of a patient-reported experience measure to monitor and improve the performance of the mental health care system in France. The findings showed that patients with SMIs place an emphasis on the interpersonal component, which is one of the important predictors of therapeutic alliance. Trial registration: NCT02491866

Background For patients with multiple and complex health needs, such as those suffering from mental health disorders, outcomes are determined by the combined actions of the care providers they visit and their interactions. Care coordination is therefore essential. However, little is known on links between hospitals providing psychiatric care and community-based care providers which could serve as a basis for the creation of formal mental care networks supported by recent policies. In this context, we first aimed to identify and characterize existing types of healthcare provider patient-sharing networks for severe mental health disorders in one French region. Second, we aimed to analyse the association between their characteristics and the quality of the care they provide. Methods Patient flows among healthcare providers involved in treating severe mental health disorders in the Provence-Alpes-Côte-d’Azur region were extracted from the French national health data system, which contains all billing records from the social health insurance. Healthcare provider networks that have developed around public and private non-profit hospitals were identified based on shared patients with other providers (hospitals, community-based psychiatrists, general practitioners and nurses). Hierarchical clustering was conducted to create a typology of the networks. Indicators of quality of care, encompassing multiple complementary dimensions, were calculated across these networks and linked to their characteristics using multivariable methods. Results Three main types of existing healthcare provider networks were identified. They were either networks strongly organized around the main hospital providing psychiatric care; scattered networks involving numerous and diverse healthcare providers; or medically-oriented networks involving mainly physician providers. Few significant associations between the structure and composition of healthcare provider networks and indicators of quality of care were found. Conclusions Our findings provide a basis to develop explicit structuring of mental care based on pre-existing working relationships but suggest that healthcare providers’ patient-sharing patterns were not the main driver of optimal care provision in the context explored. The shift towards a stronger integration of health and social care in the mental health field might impact these results but is currently not observable in the administrative data available for research purpose which should evolve to include social care.

Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have been insufficiently documented so far. In this context, our objective was to explore patterns of general somatic healthcare use of individuals treated for SMI in comparison to those of the general population in France using national health administrative data and a matched case-control study. Differences in the use of general and specific somatic preventive care services, primary care, routine specialized somatic care and admissions to non-psychiatric hospital departments for somatic causes were described between cases and controls after adjustment on differing clinical needs, socio-economic status, and living environment. Our results show a lower use of general preventive care services and of routine specialized somatic care in the SMI population, despite more frequent comorbidities, and a higher occurrence of avoidable hospitalizations, despite higher contacts with primary care physicians. These findings suggest that the health system fails to address the specific needs of this vulnerable population and support the development of measures aimed at reducing this gap.

Organization of mental health care: the role of general practitioners. In the evaluation of the National French Psychiatry / Mental Health plan 2011-2015, as carried out by the High Public Health Council, some points concern the role of general practitioners and the difficulties they encounter regarding their patients suffering from psychiatric disorders ; are mentioned access to urgent or planned specialized psychiatric care, their role in the management of the physical health of their patients suffering from psychiatric disorders, the vigilance that they must exercise with regard to the over prescription of psychotropic drugs, the announcement of an experiment in the reimbursement of psychotherapies conducted by psychologists and the importance of initial and continuing training of general practitioners in adult and infant-juvenile psychiatry. The regard on psychiatric patients must be changed and the role of general practitioners in this change is important.Organisation des soins en santé mentale : le rôle des médecins traitants. Dans l’évaluation du Plan psychiatrie santé mentale 2011- 2015, tel qu’il a été réalisé par le Haut Conseil à la santé publique, certains points concernent le rôle des médecins généralistes et les difficultés qu’ils rencontrent concernant leurs patients souffrant de troubles psychiatriques ; sont évoqués l’accès aux soins spécialisés de psychiatrie, urgents ou programmés, leur rôle dans la prise en charge de la santé physique de leurs patients souffrant de troubles psychiatriques, la vigilance qu’ils doivent exercer vis-à-vis de la sur-prescription de psychotropes et l’annonce d’une expérimentation de prise en charge de psychothérapies conduites par des psychologues, ainsi que l’importance d’une formation initiale et continue des médecins généralistes en psychiatrie adulte et infanto-juvénile. Il est nécessaire de changer le regard porté sur les patients psychiatriques et le rôle des médecins générales dans ce changement est important.

En France, 71 000 personnes ont ete hospitalisees sans leur consentement en psychiatrie, en 2010. Le taux de recours a l’hospitalisation sans consentement varie fortement geographiquement, a la fois entre pays et a l’interieur d’un pays. Si la contrainte aux soins est une exception psychiatrique, le soin librement consenti reste privilegie et majoritaire. Necessaire dans certains cas, elle pose des questions en termes d’atteinte aux libertes des personnes et constitue une problematique majeure pour les equipes soignantes et les personnes concernees. A partir de l’exploitation des donnees du recueil d’informations medicalisees en psychiatrie, la presente etude propose de decrire cette population, de mesurer la variabilite geographique du recours aux soins sans consentement, et d’explorer le role de l’environnement geographique, socio-economique et sanitaire dans les disparites observees. Elle conclut au role preponderant du contexte social et economique pour expliquer cette variabilite.

International audience; Objective: To explore the socioeconomic and health resource characteristics associated with geographical variations of lithium and clozapine dispensing rates in France.Method: The study was performed using reimbursement data from the French Insurance Healthcare system over the period 2006-2013 in a community-based sample of persons aged 16 years and over. An ecological design was used to assess whether lithium and clozapine prescribing rates were associated with socioeconomic and health resource characteristics of the zone of residence (n = 95 French administrative subdivisions).Results: Large geographical disparities were observed in dispensing rates: lithium dispensing rates by zone of residence ranged from 0 to 6.6 per 1000 (mean 2.4 per 1000) and clozapine dispensing rates ranged from 0 to 4.9 per 1000 (mean 0.8 per 1000). Higher density of GPs and regular communication between mental health services and primary care were independently associated with higher rates of lithium and clozapine dispensing and with a higher proportion of lithium users among mood-stabilizer users.Conclusion: A sufficient density of GPs and an effective communication and collaboration between mental healthcare services and primary care seems to favor greater access to psychotropic drugs with demonstrated efficacy but often viewed as 'risky' to prescribe.

Major parameters of French healthcare management and planning have been considerably modified with the policy reform entitled Hospital 2007. Special emphasis has been place on the role of space. «Health territory» has become the relevant area for management of care aiming to propose a more global approach of the health system and of the assessment of care needs. All the 22 French regions have been invited to redraw the boundaries of health areas on the principles of accessibility, proximity and continuity of care. More flexibility is allowed to manage these new health territories with the possibility of creating territories according to the level of care. This paper aims to analyze how regions picked up this new tool, which concepts, methods and level of care they used to divide regional spaces, Les paramètres majeurs de l'organisation et de la planification de l'offre de soins ont été considérablement modifiés dans le cadre de la réforme Hôpital 2007. Les schémas régionaux d'organisation sanitaire (SROS) de troisième génération couvrant la période 2006-2011 ont pour leur part été profondément rénovés. Ils sont dorénavant l'unique outil de planification, la carte sanitaire est supprimée et le territoire de santé devient le territoire pertinent de l'organisation des soins. De simple contenant, le territoire devient un élément structurant de l'offre. Ce changement sémantique correspond à une évolution importante de la place et de la conception de l'espace dans la planification sanitaire. Les régions disposent désormais de plus de flexibilité pour gérer ces nouveaux territoires avec la possibilité de créer des territoires gradués par niveau de prise en charge ou en dessinant des territoires selon les activités de soins. Nous montrons l'hétérogénéité des approches régionales à la fois en termes de méthodologie de construction des territoires et dans le degré de graduation des soins retenu., Coldefy Magali, Lucas-Gabrielli Véronique. Territoires de santé : comment les régions ont-elles organisé ce nouvel espace ?. In: Villes en parallèle, n°44, décembre 2010. Les territoires de la santé. pp. 130-147.

Cinquante ans apres la circulaire de 1960, force est de constater que si le secteur psychiatrique constitue un cadre organisationnel ou fonctionnel commun, la realite des pratiques organisationnelles, la disparite de l’engagement vers une psychiatrie communautaire comme des moyens humains, materiels et financiers mis a disposition des secteurs, font que ces derniers se caracterisent par une importante disparite.Cette etude vise a rendre compte de ces disparites entre secteurs de psychiatrie adulte et d’en analyser l’impact sur le recours aux soins des assures aupres des generalistes et des psychiatres liberaux.Nous avons realise une typologie des secteurs de psychiatrie adulte, s’appuyant sur les donnees des rapports d’activite des secteurs, mais aussi sur des donnees environnementales sur l’offre sanitaire et sociale et la population couverte, qui permet de classer les secteurs selon leur dotation et leur plus ou moins grand engagement dans les objectifs de la sectorisation.Nous avons ensuite analyse les liens entre ces disparites et l’intensite du recours aux soins aupres de psychiatres liberaux et des medecins generalistes sur une base experimentale en region Ile-de-France. Nous mettons en evidence un phenomene de substitution, dans les secteurs de psychiatrie qui peuvent etre consideres comme sous ou moins bien dotes que la mediane, entre la psychiatrie publique et la prise en charge par des medecins generalistes. Nous avons egalement mis en evidence que cette substitution s’accompagnait d’un recours plus frequent aux antipsychotiques, ce qui peut marquer la prise en charge de pathologies lourdes habituellement suivies dans les secteurs. Prat Organ Soins 2009;40(3):197-206

International audience; This chapter provides an overview of the practice variations in care delivery for mental health and addictive disorders and some of the system-level funding and structural factors that contribute to such variation. Practice variations are described for five populations, along with their expected clinical picture and service needs:Children and adolescentsThe elderlySevere mental illnessMild/moderate illnessSubstance use disordersThese variations occur in a system-level climate which has been transformed over the past decades because of a fundamental change in how appropriate care is defined. Specifically, Western countries have been shifting from institutional to more community-based care – a process labeled “deinstitutionalization.” National differences in how services are funded and organized in light of deinstitutionalization are described. Pending gold-standard outcome indicators such descriptions allow more in-depth examination of what the potential drivers for system change are and how different funding and structure configurations might be compared and evaluated.

INTRODUCTION: The objective of this study, carried out in France, was to analyse important psychiatric sector disparities in the rate of compulsory hospitalizations as a function of the severity of disorders among the people hospitalized, and of certain variables linked to the territorial landscape (socio-demographic context, and primary and psychiatric care offer).METHODS: The 125 sectors that took part in this study were divided into three groups on the basis of their compulsory hospitalization rates.RESULTS: The results did not reveal any link between compulsory hospitalization rate and severity of disorders.The hospitalization rate was correlated with variables specific to urban areas: it was higher in more densely populated areas with a larger proportion of people living alone and a greater number of shelters and social rehabilitation centres. It was also higher in the sectors with larger hospitalization capacity, with longer mean hospitalization durations, but with a lower rate of resort to psychiatry and larger human resources.CONCLUSIONS: The frequency of resort to involuntary hospitalization in France does not seem to be linked to the severity of patients’ disorders, but it is higher in sectors with a profile specific to urban areas, larger hospitalization capacities and human resources.

Les soins de premiers recours jouent un rôle essentiel sur la santé de la population. En France, bien que la densité médicale soit l’une des plus élevées d’Europe, l’accessibilité aux soins est aujourd’hui un enjeu majeur des politiques de santé, du fait du rôle important accordé au médecin généraliste, de l’existence de disparités spatiales de l’offre de soins et des tendances démographiques à la baisse du nombre de médecins sur le court terme ainsi que des fortes attentes d’une population vieillissante aux besoins de soins élevés et à la mobilité réduite. Dans cette recherche, nous nous intéressons à la mesure de l’accessibilité spatiale au médecin généraliste. Profitant des récents développements en géographie de la santé sur les soins de premiers recours, nous proposons de construire un indicateur permettant de considérer simultanément l’offre, la demande de soins et l’accès aux soins, en nous appuyant sur la méthode du Two-step floating catchment area développée dans quelques pays anglophones. Nous l’adaptons ici au contexte des soins français et proposons quelques pistes d’amélioration dans trois dimensions principales : i) la définition et la quantification de l’offre de soins, ii) l’intégration du besoin de soins du côté de la demande, iii) une définition plus précise de l’interaction entre l’offre et la demande. Au final, l’indicateur d’Accessibilité potentielle localisée (APL) propose une approche renouvelée et améliorée de l’accès aux médecins généralistes libéraux, prenant en compte l’offre et la demande de soins à l’échelle de la commune. L’APL répond ainsi aux principales critiques faites aux indicateurs usuels d’accessibilité aux soins tout en restant relativement aisée à calculer dans la mesure où elle mobilise des données facilement disponibles. L’APL s’interprète comme une densité et constitue ainsi un outil complémentaire utile à l’observation et au pilotage de l’organisation des soins à un niveau local.

Studying the application of the 1838 law which until 1990 governed the distribution of psychiatric hospitals in France, the author shows that far from obeying objective geographic centrality or demographic distribution criteria, the siting is in two respects a fact of representation of the disease : through its location, for many years preferring rural or peripheral spaces, and through the actual design of the architectural forms chosen., Étudiant l'application de la loi de 1838 qui régit jusqu'à 1990 la répartition en France des hôpitaux psychiatriques, l'auteur montre que loin d'obéir à des critères objectifs de centralité géographique ou de distribution démographique, l'implantation est doublement un fait de représentation de la maladie : dans sa localisation, qui fait longtemps préférer des espaces ruraux ou périphériques, dans la conception même des formes architecturales choisies., Coldefy Magali. La géographie asilaire française : éléments d'analyse spatio-temporelle. In: Villes en parallèle, n°44, décembre 2010. Les territoires de la santé. pp. 20-47.

As in other European countries, specialised psychiatric hospitals were established throughout France during the 19th Century. The construction of these hospitals can be considered as the concrete expression of a therapeutic innovation which recognized insanity as an illness that could be treated in such specialised institutions. The spatial diffusion of these innovative institutions through 19th and 20th century France is analysed and we explore how far this can be understood through theories of diffusion of innovations including geographical models of hierarchical and expansion diffusion (or whether other conceptual models are more appropriate). The research reported here particularly focuses on the period 1800–1961. It involved the construction of an original historical database of both psychiatric hospitals and information on the cities where these institutions were located. This was used to examine and interpret the different phases of development of psychiatric institutions and the parts of the country and types of geographical setting where they were concentrated. A multiple correspondence analysis was then performed to examine the connections between different aspects of the diffusion process. The study shows the limitations of classical models of spatial diffusion, which are found to be consistent with some, but not all aspects of the development of psychiatric institutions in France. An alternative political ecology approach seems more appropriate to conceptualise the various processes involved; national policies, social representations, medicalisation of care of mental illness, and urban and economic growth all seem to be associated with the emergence of a variable and complex pattern. This paper also opens a large field of research. Compared with other western countries, the geography of French psychiatric care is relatively under-researched, although there has been a strong spatial dimension to mental health policy in the country. This analysis provides a context for studies of more contemporary processes of French deinstitutionalisation, which is strongly structured by the past heritage of these large asylum facilities., Research highlights ► This is the first detailed analysis of the development of the geographical distribution of psychiatric asylum institutions in France during the period from 1800-2000. ► The study makes innovative use of a range of historical and contemporary datasets. ► The processes relating to development in France of specialised institutional care for people with mental illness are discussed and compared with those in other countries. ► We critically discuss the relevance for this research of 'classic' theories of spatial diffusion of innovations and argue that the complex processes of diffusion illustrated here may be better understood through theories such as political ecology.

Les paramètres majeurs de l'organisation et de la planification de l'offre de soins ont été considérablement modifiés dans le cadre de la réforme Hôpital 2007. Les schémas régionaux d'organisation sanitaire (SROS) de troisième génération couvrant la période 2006-2011 ont pour leur part été profondément rénovés. Ils sont dorénavant l'unique outil de planification, la carte sanitaire est supprimée et le territoire de santé devient le territoire pertinent de l'organisation des soins. De simple contenant il devient un élément structurant de l'offre. Ce changement sémantique correspond à une évolution importante de la place et la conception de l'espace dans la planification sanitaire. Nous montrons que la définition de ce nouvel instrument a été traitée de manière assez différenciée selon les régions. Un tiers des régions ont préféré stabiliser le découpage du SROS2 en maintenant le découpage précédent, en regroupant des secteurs ou encore en les modifiant à la marge mais la grande majorité a cherché à inventer les territoires de santé en développant une nouvelle méthodologie. Le résultat final aboutit à une légère augmentation du nombre de secteurs, avec sept territoires supplémentaires, et notamment des petits territoires de moins de 200 000 habitants. À la lecture des différents SROS, nous constatons que les régions se sont relativement bien emparées de certains concepts de ces nouveaux schémas tels que la flexibilité permise pour ces nouveaux territoires entre niveaux de soins, l'utilisation sans réserve des différentes natures de territoire (organisation, projet et concertation). Par contre, certaines activités comme la psychiatrie, le secteur médico-social ou la médecine de ville sont encore insuffisamment intégrés dans la réflexion territoriale globale.