French psychiatry is currently facing a period of profound change, as many of what were considered its most specific characteristics and traditions have been called into question. It is therefore difficult to draw a profile of French psychiatry, because it has to take into account a radical splitting between, on the one hand, what is still the common profile of most French psychiatrists and, on the other, the new model imposed by stakeholders and policy makers who want French psychiatry to take on a more Anglo-Saxon profile, with evidence-based practice coming to the fore, for instance.

Staffing

In this context workforce issues are becoming a major concern for French psychiatrists. Until very recently France was ranked second in the world in terms of the per capita provision of psychiatrists (nearly four times higher than that in the UK, for example), with, at its peak, about 13 500 psychiatrists for a general population of some 60 million. Nevertheless, around 20% of public hospital positions remain vacant, which reflects a growing preference for private practice. There is also a marked geographical disparity: the population density of psychiatrists is 10 times higher in Paris than in the north-east of the country.

Most stakeholders wish to correct the French figure for psychiatrist density. There is a trend to reduce the number of all types of doctor to the European average, but psychiatry is particularly affected in this regard, and since 1990 the number of psychiatry students has dropped by 37%. Accordingly, the number of psychiatrists will be 40% lower in 2020. If there is no significant increase in the number of psychiatric students, or if psychiatrists’ freedom to choose their type of practice is maintained, the present disparity in the provision of psychiatric resources will be exacerbated, and a large part of the French population will have very limited access to psychiatric services.

The same disparity also exists for allied professions: France has 58 000 nurses working in psychiatry. Their number is set to decrease with the recent termination of a specific psychiatric nursing diploma. There are also 35 000 psychologists and psychoanalysts, but for historical reasons they are still not officially considered health professionals (the idea was opposed by both medical and psychological organisations for ideological or economic reasons).