Myths of Mental Health: Revelations from the French System for the United States

Abstract

Drawing on an analysis of the French mental health system, this essay examines four presumptions about mental health care dominant in the United States: (1) the required abolition of the hospital for psychiatric deinstitutionalization;(2) the substitutability of public and private financing; (3) the importance of a "dangerousness" criterion for involuntary commitment procedures; and (4) the need for an ever-expanding scope of care. These claims hold little weight when subjected to comparative scrutiny, and the essay closes by discussing the implications of these revelations for US mental health care policy and ethics.M ental health systems face competing imperatives to respect patient autonomy, ensure access to long-term comprehensive treatment, and also control costs. In the United States, the system has tilted towards incentivizing private health care providers to deliver voluntary, community-based care. Although some analysts have criticized aspects of this approach, US-based policymakers, researchers, and practitioners tend to view deviations from established policy pat-