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

Background: This paper presents and epidemiological survey of 300 adults ra ndomly sampled among the Parisian population and 207 randomly sampled recip ients 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. Method's: The sub jects were evaluated by trained interviewers using collateral information p rovided by an informant, together with CIDIS, a simplified version of the C IDI, covering: somatisation, panic attack, phobias, generalised anxiety, ma jor depression and alcohol and illegal drug abuse (DSM-III-R and ICD-IO cla ssifications). Results: The response rate was 79% for the Parisian sample a nd 75% for the RMI recipients. As expected, the sociodemographic compositio n of the two groups adjusted for age differed considerably: RMI recipients were likely to be unemployed and single or divorced. The collateral informa tion showed that psychoses of all types were more frequent among RMI recipi ents (4.2% vs 1.2%, P < 0.02). There were large differences in rates for su bstance abuse and dependence, antisocial personality and lifetime depressiv e disorders, but no difference for mental deficiency. This corresponded par tly with the direct CIDIS measure: male RMI recipients suffered significant ly 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 d isorders. 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, e specially 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 th eir clients with (particularly) primary care services.