A comparison of French and British mental health legislation

A comparison of French and British mental health legislation 1 French psychiatry is known to be using quite different operational definitions of psychiatric syndromes (Kellam, 1989) from those used by English speaking doctors.Another way in which French psychiatry differs greatly in everyday practice is in its legal framework.In contrast with the intense activity in mental health legislation since World War II in Great Britain, the French psychiatrists continued to use the 1838 Statute until June 1990 when it was revised.At the time of its creation the 1838 Statute represented great progress allowing mentally ill patients to gain access to treatment for their disorders in specific and appropriate institutions (Quetel, 1988).Indeed, the first article of the 1838 Statute compelled each geographical de'partement of France to have a psychiatric in-patient institution.These institutions were thought to be essential by Pinel in the promotion of his ' traitement moraV (Pinel, 1806).His disciple Esquirol played an important role in the elaboration of the 1838 Statute.The two orders of the 1838 Statute, the placement doffice and the placement volontaire, reflected the theoretical ambiguity with which 'insanity' was considered in those times.On the one hand, mentally ill patients were considered to be dangerous individuals who needed detention in order to protect society.On the other hand, following Pinel's treatise they had also come to be considered as ill people whose illness was treatable and who deserved medical attention.It was some indication of progress that lunatics were no longer regarded in the same light as delinquents.Although they would be detained this would not be in the company of criminals.It is remarkable that the 1838 Statute remained in force until 1990.In this article we will first define some legal terms necessary for the understanding of what will follow.We will then present a summary of the 1838 Statute of psychiatric legislation in France since it forms the basis of the 1990 Statute and this will be followed by a review of the 1990 Statute.We then comment on differences between the Mental Health Act (1983) of England and Wales (Bluglass, 1983) and the 1838 Statute.This is then followed by a discussion of the practical implications of the 1990 Statute for the patient, for his family and for the psychiatrist. I. DEFINITION OF SOME RELEVANT ADMINISTRATIVE LEGAL TERMSCommissaire de police This is the person in immediate charge of the police in any town of 10000 or more (Thody & Evans, 1985). Commissaire de la Re'publiqueIt has recently been proposed that this term should replace the designation 'pre'fet'.However the word 'pre'fet' is still the expression used in the 1990 Statute (see below). Conseil generalThe assembly of conseillers ge'ne'raux (county councillors) elected by direct local elections in each de'partement.Le president du conseil general is elected by the conseillers ge'ne'raux and has executive powers in the departement, which until 1982 were entrusted to the pre'fet.