French attitude to mental disorders

(david watson) #1

We have lived off and on for 5 years in France and have used the health service quite extensively for physical disorders such as heart problems hip replacements etc and have found the service excellent and very efficient and not unduly expensive. My wife (not the only one) suffers from depression and she has seen her GP here in France who has helped her enormously over the years, even helping her to pioneer new and effective drug therapies. Everything has been fine but at the end of this week she went down, down, down and became suicidal. Over the weekend how do you find help in such a situation? She had spent a short time in a local specialist hospital to good effect. I contacted them to see if they could help her over the weekend and they said I had to go urgences first who would get a medecin to refer immediately to their hospital. I confidently took her today sunday to our brand new state of the art hospital which had impressed us so much in the past. I explained the situation in my not too good French ( my wife is fluent) and they admitted her but because they had "beaucoup demand" she was wheeled into a waiting area and told she would be seen sometime in the next 4 hours! The nature of her illness means she gets very agitated so being a fiery Welsh woman who is articulate especially in French, demanded attention immediately . They told her she would have to wait as there were more urgent life and death patients . So she said fine I am leaving to which the nurse said she could not and must return to the hospital. My wife complied but still agitated demanded to see the medecin and threatened to leave. The response was unbelieveable. I was waiting just outside and heared her screaming for me to come to her, when I arrived the nurses had strapped and locked her torso and both arms to the bed to stop her getting out. I said that was unacceptable and to release her immediately but they refused and said it was only the medecin who could undo the straps and she was busy with more urgent cases!!

We had gone to the hospital voluntarily following French protocol to ask for help for a serious and potentially life threatening condition to find my wifes right of freedom removed because she emphatically voiced her dissatisfaction with the treatment she was receiving. The hospital was obviously overstretched and was not coping so incarceration was their way of coping with a mental illness. She could have been left like that for hours awaiting the medecin! I managed to get them to "release" her saying I would take responsibility for her but we still could not leave before the medecin had seen and discharged her. I waited until the nurses where occupied and then we both sneaked out like escaping prisoners.

My wife is traumatised and I am horrified by her treatment and just wonder who approach in order to make a complaint or do I have to accept that this is an acceptable procedure in a supposedly civilised democracy!

(John Scully) #2

David, On one occasion in a Dublin A&E during one of my wife's episodes the psychiatrist happened to be English. She put me under a lot of pressure to sign my wife into care and mentioned that while she had no power to compel me to do so under Irish legislation in the UK she could have "sectioned' her. I truly wish you all the best in managing this horrible illness. Despite having done everything I possibly could I will never forgive myself for not having fixed it for her.

(david watson) #3

I have followed the discussion re my original posting and the comments made have given me a great deal of support and I express my gratitude to the forum for that. Your comments have enabled me to put our experience into context and helps develop further our understanding of living in a foreign country and its ways. I realise now from the comments that we made the wrong decision to go to urgence we did not follow the traid procedure which could potentially have avoided the situation we experienced and I appreciate now the medics did what they could to deal with the situation so we are in no position to make a complaint as they did follow their procedures. But herein lies the problem that we have experienced in the UK as well that understanding of mental illness is given very low priority. I have for many years dealt with this situation singlehandedly as there is very little help available. I am used to this but every so often a crisis arises and you need to seek help. What I found so distressing was that my request for help was met with in my view, knowing the patient who is in my care, such inappropriate and primitive treatment. We have been in similar situations in the UK but have never been met with forced incarceration.

(John Scully) #4

You are correct Doreen. The issue with mental illness, as we all know, is that sufferers seem OK. A physical ailment has outward symptoms but the pain that mental illnesses cause is often invisible. With the benefit of 20/20 hindsight I should have taken my wife's episodes much more seriously and worked harder to get her help. The problem was that when she was well she was very well and we just put the episode behind us until one day the episode was just too much for her. I wouldn't want David to fall in to the same trap.

(John Scully) #5

My wife committed suicide at 53 years of age due to depression eighteen months ago. You should thank the hospital for their care not criticise them. You can sneak out of the hospital but not out of the illness. I suggest you face up to the fact that your wife is very, very ill.

(Marie-Claire Gauthier) #6

Unfortunately if someone is described as suicidal, on call doctors will probably just call "les pompiers" who will then bring the person to A&E where, depending on who's on duty and how full the place is, treatment may be pretty primitive.

(Peter Bird) #7

Well said Dori. The waiting list in my local hospital is very short, usually someone will be seen within half an hour.

(Brian Milne) #8


(Véronique Langlands) #9

Fulbourn? In my 1st year 10% of my college's undergraduates had spent a bit of time there... (not me).

I was delighted to see in the Cambridge Evening News though that in an inter-institution competition, the chef at Fulbourn won first prize in the baking class, for a decorated fruitcake.

(Dori Schwartz) #10

If your wife was truly suicidal, then untying her and taking her out of the hospital put her life at risk. So if you make a complaint I think the response you're going to get is that either you put your wife's life in danger, or you all were just wasting their time to begin with. When people become a danger to themselves, they can be held against their will for a reason, to keep them alive!

Emergency rooms typically have a 5 hour wait for non life threatening emergencies. I don't know where you're from, but if you're in Lyon I could tell you where to go to have a shorter wait, or what psych hospital to go to. We have two psych hospitals here, and they both have emergency departments. They wouldn't let her go either, but probably wouldn't tie her down. It sounds like it would be helpful for her to have a psychiatrist who can have her admitted to any number of private clinics that can help her. They are a nice alternative for people who don't want to be in a hospital with "crazy" people. Also it's more like a hotel than a hospital, which makes it easier for some people who are resistant to regular hospitalization to get the help they need. Your general practitioner could probably have her admitted as well, but for the future she should probably be seeing a psychiatrist.

(Brian Milne) #11

Others have said it, but there is little difference one country to another. In fact I think there is the 'nice' face of psychiatric medicine presented publicly and the one that is hidden that is certainly not what many people would consider nice. Restraint is far more common that you might think.

In the late 1960s four of us used a substance that went wrong. We all found ourselves in a local institution, Véronique knows the place albeit not from inside I believe. All four of us were restrained. I was there for three days until my tutor 'rescued' me, two others the next day when their tutors had been coaxed to collect them by mine. The other bloke? Nobody knew, he certainly never appeared back in college. A long time ago of course, so things might have changed. Or so one imagines. In time I became a student supervisor and did some years as a replacement tutor for colleagues who were not available for some time. That was up to about 10 years ago. One in a dozen students has some kind of mental health problem. Either that comes with them or the stress of study and exams does to them. No doubt alcohol and illegal substances still contribute too. Of the dozen, perhaps one has serious problems and may well need to be restrained. So, on the back of my own couple of days I made a point of being a rescue squad. Every now and again they were strapped to beds or wheeled stretchers. They seemed completely OK to me, but then I was told that once the benzodiazepine or diazepam wears off...

I was told it went to the degree of restraining somebody who would try to leave the hospital who if left in a closed, locked room may try self-harm. So, I basically gave up and only tried getting them out once the immediate treatment and restraint was over. It is also part of the equation that people who are contained that way still feel shame, so families are not always informed immediately, sometimes not at all. In my time I refused giving family details. However, when family see people bound that way they tend to question it or protest.

So, it appears the question is describing my short experience decades ago still happening now for the same reasons which comes as no surprise. Of course it is dehumanising but then the alternatives are probably no better. Benzodiazepines, other psychiatric and neurological drugs are far more damaging in the long term, so the choice is narrow. Even then, somebody who is really 'wound up' needs to be physically restrained until the drugs kick in. Instant reaction is the stuff of TV hospital dramas that saves showing the possible unpleasant bits.

France, in 99% likelihood, is like most other countries. It is very unpleasant but trying to get apologies, lengthy explanations or rationalisations is very unlikely. A complaint, sad as it is to say, will probably be dismissed.

(Peter Bird) #12

David did as you said and went straight to Urgences who didn't help much, the contrary it seems. Wouldn't it be quicker to call the local GP on call so he or she can see at first hand and explain better to the Urgences or send her straight to the specialist hospital ?

I'm just thinking aloud and I have no idea if i works like that.

(Bruce Brewer) #13

It's not just France though. Mental illness has always been the ugly sister in the British NHS too!

(Helen Laziou Roger) #14

feeling for you - I suffer from bipolar/anxiety/ptsd/severe depression and have been suicidal.

As a practical if she ever is this bad again straight to the hospital A & E - they will arrange for a french equivelent cpn to visit within 24 hours and if necessary admittance to a pyschiatric hospital (they are not that bad) Long term she may benefit from the services of the cmp (centre medico pyshiatrique) where you can get free consultantions with cpn s, pychatrists etc - they have been no end of help to me these last 10 years I've been battling

(Véronique Langlands) #15

It is worth ringing ahead for situations like this and making sure you have the name of the SMUR doctor & explain the situation, as the clinic had said you needed to go via urgences - this would normally mean you get referred on to the specialist clinic a lot faster because a bit of triage has been done over the telephone. Usually A&E is busy and simply doesn't have the time or the resources to deal as gently with patients as one might like, so patients who for whatever reason are agitated & demanding are dealt with fairly summarily - I saw a chap brought in by the gendarmes a while ago because he'd been throwing his furniture out of his window into the street a couple of floors below & threatening to follow it: anyway he was handcuffed for his own & everyone else's security.

(Marie-Claire Gauthier) #16

David, I'm very sorry this had to happen to you and your wife, I hope she is feeling better and that you will be able to see your GP tomorrow. You were absolutely right to leave, next time it might be better to sign a discharge to avoid getting caught without one though!

You could, of course, file a complaint about what happened at the hospital, but I very much doubt anything would come out of it. I have several friends and acquaintances who work in psychiatry and what they describe is sadly often more upsetting than what you have had to go through, my brother did his civil service in the psychiatric ward and tried to fight the inhumane treatment of patients, to no avail whatsoever.

Generally speaking, prescribing is our forte here and we haven't been able to develop any other care, or any other humane approach to mental health in hospitals. This said, I fear the situation isn't any better in other European countries, with the exception of Finland, perhaps.

The only thing I can advise you to do is to refer to your GP, and go to a specialist if needed, but avoid the hospital system completely, hoping of course you can. I wish you and your wife the best of luck

(Peter Bird) #17

Horrifying story David ? I feel for you both.

Isn't your GP allowed to transfer her to the clinic she spent time at ?

This is a 'civilised democracy' but some things are done badly.

(Véronique Langlands) #18

A suicidal person who becomes agitated and is violent (verbally or physically) is deemed a danger to him/herself and will be restrained in order to stop them doing something silly - in a hospital, doing anything else is regarded as non-assistance à personne en danger. Did a doctor see her or did you just sneak out without being seen? Unfortunately agitation in people suffering from mental illnesses is seen not as a 'normal' reaction to waiting etc but a further symptom of illness and will be dealt with accordingly which means restraints if the person is shrieking or flailing about or seeming irrational.

So grim & unpleasant but I don't think you'd get much of an apology.