Mental health and use of care in people receiving a French social benefit.

Background: This paper presents and epidemiological survey of 300 adults randomly sampled among the Parisian population and 207 randomly sampled recipients of a social benefit. The RMI (Revenu Minimal d'Insertion) provides a regular minimal income to any person with resources below a certain level. It is not targeted at people with mental health problems.

Methods: The subjects were evaluated by trained interviewers using collateral information provided by an informant, together with CIDIS, a simplified version of the CIDI, covering: somatisation, panic attack, phobias, generalised anxiety, major depression and alcohol and illegal drug abuse (DSM-III-R and ICD-10 classifications).

Results: The response rate was 79% for the Parisian sample and 75% for the RMI recipients. As expected, the sociodemographic composition of the two groups adjusted for age differed considerably: RMI recipients were likely to be unemployed and single or divorced. The collateral information showed that psychoses of all types were more frequent among RMI recipients (4.2% vs 1.2%, P < 0.02). There were large differences in rates for substance abuse and dependence, antisocial personality and lifetime depressive disorders, but no difference for mental deficiency. This corresponded partly with the direct CIDIS measure: male RMI recipients suffered significantly more from severe depression than male Parisian controls: 16.7% compared to 3.4% (P < 0.01 lifetime) and from drug and alcohol abuse or dependency disorders. Depressed RMI recipients made less use of available medical care for their depression than Parisians controls, mainly because RMI recipients did not consult psychiatrists, whereas controls did (21%, P < 0.0001). On average, the duration of depressive episodes is longer in RMI recipients, especially in women.

Conclusion: The high rate of psychiatric disorders and poor access to resources in RMI recipients have implications for the health system. Care would be improved if social workers administering the benefit were better trained to recognise psychiatric problems, and able to link their clients with (particularly) primary care services.