Why is France refunding pills but not counselling?

Sessions with a psychologue in France are the usual equivalent of seeing a counsellor or psychotherapist in the UK and, as you say, they are largely not reimbursed by the French social security system, whereas antidepressant medicines are.

This is partly because a psychologue is not a medical doctor – although they will have a psychology degree – whereas antidepressants can be prescribed only by doctors, including GPs and psychiatrists.

Sessions of “talking therapy” can be reimbursed by social security only in limited cases, such as:

• Where the sessions are with a psychiatrist – this is not the norm for long-term counselling or psychotherapy. Sessions with a psychiatrist are reimbursed at 70% of the fixed state tariff (€46.70).

As with other specialisms, some doctors levy a higher rate than the fixed state tariff, though in this case rates are supposed to be set “with tact and moderation”. A few are outside the reimbursement system and can charge what they like.

Reimbursement is lower if you do not go via your own GP for referral, apart from in the case of 16-25-year-olds.

• Where the psychologist practises in a state hospital or a centre medico-psychologique (CMP), which mostly exist only in larger towns and cities. You need to be referred by your GP and there may be long waiting lists. Sessions at a CMP are free.
• Some mutuelle top-up policies offer some reimbursement, sometimes up to an annual set amount for a fixed number of sessions. However, there is a growing awareness of the usefulness of sessions with a psychologue, including in possibly reducing use of antidepressants.

Four departments are undertaking trials of reimbursed sessions with approved private practice psychologues: Haute-Garonne, Morbihan, Bouches-du-Rhône et Landes.

In these areas you need a prescription from your GP for an evaluation session with a practitioner on an approved list.

If the psychologue then thinks that it might benefit you, you can ask for a prescription for 10 half-hour sessions, and finally another 10 45-minute sessions if necessary.

This will be rolled out to other departments in future years after evaluation.

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