Mental health, an essential component of health

Mental health is an essential component of health and represents much more than the absence of mental disorders or disabilities. According to the WHO, mental health is a “state of well-being that enables everyone to realize their potential, cope with the normal challenges of life, work successfully and productively, and be able to contribute to the community.”

At the first WHO European Ministerial Conference on Mental Health (Helsinki, January 2005), the ministers of the Member States of the WHO European Region recognized that mental health promotion, prevention, treatment, care for mental disorders, and rehabilitation were a priority for the WHO and its Member States.

The Three Dimensions of Mental Health

• Positive mental health, which encompasses well-being, personal fulfillment, psychological resources, and an individual’s ability to function effectively in their social roles.

• Reactive psychological distress (triggered by challenging situations and existential difficulties—such as grief, relationship breakdowns, or academic failure—which does not necessarily indicate a mental disorder. Symptoms, which are relatively common and most often involve anxiety or depression, generally appear in the context of life’s setbacks or stressful events and may be temporary. In most cases, people experiencing psychological distress do not require specialized care. However, if poorly identified or inadequately supported, psychological distress can push a person into illness or exacerbate social difficulties. When it is temporary and follows a stressful event, it is considered a normal adaptive reaction. On the other hand, when it becomes intense and persistent, it may indicate a mental disorder.

• Psychiatric disorders of varying duration, ranging in severity and/or disability, which are classified according to diagnostic criteria and targeted therapeutic interventions, and which require medical management. The consequences of psychiatric conditions can be significant:

  • disabilities,

  • premature death,

  • discrimination and exclusion.

Mental Disorders: A High Prevalence

Mental disorders span a very broad spectrum, ranging from mild, occasional episodes to severe, chronic, and disabling conditions. Mental disorders represent one of the main burdens in terms of years of healthy life lost. In France, “psychiatric illnesses” associated with all “chronic psychotropic treatments” (including anxiolytics and hypnotics) account for 14% of total expenditures and are the leading expense for the National Health Insurance system. They are the leading cause of years lived with disability. They account for 35 to 45% of absenteeism from work.

Mental Health: A Top Priority

Mental health is a major public health issue and a priority for the agency. Our mental health program is cross-cutting and forms part of our broader mission: from knowledge to action. Its goal is to improve the well-being of the population and reduce morbidity and mortality associated with mental disorders. This program prioritizes the surveillance and prevention of the most common disorders in the general population—namely, anxiety and depressive disorders—as well as suicidal behavior.

Mental Health Surveillance

Mental health surveillance concerns both the general population and specific groups such as workers, adolescents, children and youth, and individuals in the criminal justice system.

It is based on:

• Healthcare utilization data: including emergency department visits for psychiatric reasons (via Sursaud®) and data from the National Health Data System (SNDS).

• Dedicated epidemiological surveys that can be repeated over time, enabling a more comprehensive monitoring of mental health (ranging from positive mental health to the most common psychiatric disorders, including various degrees of distress) as well as its determinants, including the issue of social inequalities in health. For example, the General Population Health Barometer, the EnCLASS study in schools (in partnership with the OFDT, EHESP, Inserm, and the French Ministry of Education), or cohort follow-up for work-related epidemiological surveillance (Coset cohorts).

• Specific, one-off studies focused on a given population (for example, among prisoners or among people exposed to the November 13, 2015, attacks, such as the ESPA study).

This surveillance enables the regular production of indicators in the general population or in specific settings, including the workplace. These indicators cover anxiety and depressive disorders and other mental health conditions (well-being and psychological distress, etc.), as well as suicidal acts and behaviors in the general population and in specific settings or populations such as the workplace, prisons, or among adolescents.

More recently, indicators of the prevalence of less common disorders have been developed: psychotic disorders, mood disorders, and autism spectrum disorders.

Prevention efforts led by Santé publique France

In the field of prevention and health promotion, three strategic priorities can be identified that require the development of interventions targeting individuals and their environments:

• promoting well-being and preventing health issues;

• identifying and referring individuals early to prevent health issues from taking hold, worsening, and becoming chronic;

• improving the quality of life for people with health issues.

The Mental Health Promotion and Prevention Program prioritizes three areas of focus:

1. Strengthening protective factors and promoting positive mental health through the development of psychosocial skills in children and youth. To this end, the Agency identifies, evaluates, and implements evidence-based interventions. Santé publique France leads the evaluation and monitoring of the implementation of several school-based programs such as Unplugged, an addiction prevention program focused on developing psychosocial skills, and GBG (Good Behavior Game), a program to prevent disruptive behavior in the classroom, as well as the family and parenting support program at the municipal level. In addition, a framework on the development of psychosocial skills, aimed in particular at equipping institutional partners, is currently being developed.

2. Suicide prevention through the evaluation of the Vigilans system, which involves monitoring and following up on suicidal patients (to prevent recurrence), as well as support for health hotline operators, including the national suicide prevention hotline project led by the Lille University Hospital.

3. Information and communication aimed at the general public to increase the population’s capacity to take action and combat the stigmatization of people with mental health disorders (social marketing initiatives; a partnership agreement with the Psycom website to provide validated, high-quality information on mental health, and with Premiers Secours en Santé Mentale France to roll out the mental health first aid training program).

A National Reference Website

Santémentale-info-service.fr is the new national reference website on mental health, designed for the general adult public. Its goal is to provide information on the various aspects of mental health and to position it as an essential component of overall health. The site offers reliable information, practical advice, and concrete tools to help people understand mental health, take care of it, recognize signs of psychological distress, support a loved one, and access appropriate help. To ensure accessibility for as many people as possible, including those with low digital and health literacy, Santémentale-info-service.fr offers information presented in plain language, educational and engaging resources, and intuitive navigation.

Remote Assistance

To meet the public’s need for information and support, several remote support services (hotlines, online assistance) are available. Santé publique France supports several nonprofit remote support initiatives working in the field of mental health through a targeted grant program.

• Volunteer helplines working in the field of suicide prevention and mental distress: SOS Amitiés, SOS Suicide Phénix, Suicide Ecoute, and Phare enfants-parents.

• More specialized services such as the Ligne Azur, run by the SIS Association, designed for calls from LGBT+ individuals in distress, or Fil Santé Jeunes, a general-purpose service for those under 25 run by the Île-de-France School for Parents and Educators.

To support these services in a process of continuous quality improvement and better meet public expectations regarding the quality of responses in the health sector, Santé publique France has established the “Aide en santé” label. This label must be renewed and enhanced through best-practice guidelines, particularly in the field of suicide prevention via remote assistance, which will be developed as part of the coordination efforts to be established with the national suicide prevention hotline.