Behind this figure lie very different costs, spread across France’s national health insurance, private supplementary plans, and employers.
Mental Health: What the Study Actually Quantifies
Mental health problems cost 24.7 billion euros per year in France. National health insurance shoulders 60%, employers 31%, and supplementary insurers 9%, estimates the firm Asterès in a new study. This distribution provides an initial indication of the scale of the phenomenon. It shows above all that the financial consequences of mental health disorders far exceed reimbursements for consultations and treatments.
To measure the cost of mental health, economists first defined the population under study. Their analysis covers people aged 20 to 64, regardless of whether they are employed or not. An essential clarification: the scope does not simply cover workers who are in active employment, nor does it encompass the entire French population.
In total, 3.4 million people were affected by the disorders or treatments studied in 2022. Of them, 1.48 million had a psychiatric illness identified within the framework of hospitalization or a long-term illness. The remaining 1.92 million had received psychotropic treatments without meeting this first category. This second category includes people on antidepressants, anxiolytics, hypnotics, or antipsychotics. It does not necessarily imply an absence of a psychiatric illness. Simply, no diagnosis meeting the hospitalization or long-term illness criteria used by the study was recorded for these patients.
Economically, Asterès distinguishes actual expenditures from production losses. The former include hospital care, consultations, medications, and benefits paid to insured individuals. The latter concern the consequences of absences and deaths on business activity.
On the other hand, certain effects escape calculation. Psychological distress, declines in quality of life, or personal consequences of mental health problems are not translated into euros. Household out-of-pocket expenses, notably some consultations outside standard care pathways, are not included either. Stress and burnout are also excluded when they do not meet the defined medical criteria.
In other words, the 24.7 billion euros do not constitute the exhaustive cost of poor mental health in France. They represent a bounded economic estimate, based on identifiable expenditures and modeled production losses.
Psychiatric Disorders: Hospitalization as the Primary Expense
It is national health insurance that absorbs the largest share of the bill. Its mental health expenditures for people aged 20–64 reach 14.8 billion euros per year. The firm estimates that this figure represents about 6% of all expenditures reimbursed by the agency.
Two categories stand out clearly. Patients with a psychiatric illness account for 11.5 billion euros, or 78% of the cost studied for the national health insurance. People receiving psychotropic medications without hospitalization or a long-term psychiatric illness account for the remaining 3.3 billion euros.
For psychiatric illnesses, hospitalization overwhelmingly dominates the expenses. It accounts for 7.5 billion euros, about 65% of the bill in this category. This line item covers hospital care associated with the studied pathologies. It alone weighs financially more than all production losses estimated for employers.
Outpatient care comes next, with 2.2 billion euros. These are the reimbursed medical expenses outside hospitalization, including consultations, medications, and other relevant care. Finally, cash benefits amount to 1.7 billion euros. They correspond to daily allowances and disability benefits within the scope of the calculations.
The ranking changes notably for patients receiving psychotropic medications without a psychiatric illness counted in the first category. Outpatient care constitutes their main item, at 1.6 billion euros, according to Asterès. Cash benefits reach 1.4 billion euros, while inpatient expenses are estimated at 222 million euros. In this population, sick leave and care provided outside of hospital play a proportionally much larger role.
Not all psychiatric illnesses weigh equally on public spending either. Substance use disorders come first, at 5.3 billion euros for the national health insurance. They are followed by neurotic and mood disorders at 3.6 billion euros, then psychotic disorders at 1.5 billion euros. Other categories account for a smaller share of the total.
This difference also emerges when viewed on an individual basis. The average annual cost to the national health insurance for a patient with a psychiatric illness is estimated at 7,800 euros, versus 1,700 euros for a patient in the psychotropic-treatment category outside the first group. For substance use disorders, the average expense per patient even exceeds 16,100 euros.
However, a high amount does not automatically indicate a more severe illness. It also depends on care pathways, hospitalizations, treatments, and benefits paid. It is precisely this combination that explains the gaps between the different categories.
Mental Health: The Study Reveals the Bill from Supplemental Insurers
Mutuals and other supplemental organizations occupy a smaller share of the total cost, but their contribution remains substantial. They account for 2.3 billion euros per year. Unlike the national health insurance, their expenditures are mainly associated with people on psychotropic medications outside hospitalization or long-term psychiatric illness. These patients account for about 1.5 billion euros for supplements, versus 793 million euros for those with a psychiatric illness counted in the first category. This distribution is notably explained by reimbursement rules and the long-term illness framework.
When a pathology carries a recognized long-term illness status with an exemption from co-pays, the corresponding care expenses can be covered by the national health insurance at the reimbursement rate. The financial exposure of supplementary insurers is thus reduced. Conversely, patients not covered by this scheme are more likely to involve their supplementary coverage.
For psychiatric illnesses, the supplementary expenses focus mainly on outpatient care. These represent 702 million euros, versus around 91 million euros in inpatient care, according to Asterès. Outpatient care thus plays a particularly important role in their reimbursements.
The phenomenon is even more pronounced among patients on psychotropic medications outside the criteria of the first category. Outpatient care reaches about 1.1 billion euros, while hospitalizations account for 402 million euros. Antidepressants and anxiolytics account for the bulk of these costs, ahead of hypnotics and antipsychotics.
On a per-patient basis, supplementaries bear an average expense of 500 euros for a psychiatric illness and 800 euros for a psychotropic treatment outside the first category. This difference mainly reflects the balance of care between mandatory insurance and supplementary coverage.
Mental Disorders: Employers Face the Cost of Absences
The third major category sits on the employers’ side. According to Asterès’s calculations, work-age people’s mental health problems lead to 7.6 billion euros in production losses per year. This amount does not correspond to a direct outlay by companies but to an estimate of the wealth they cannot produce in certain situations. Two mechanisms are taken into account. The first concerns sick leave, which temporarily reduces productive capacity. The second concerns deaths, which can lead to long-term losses until positions are filled and successive replacements have allowed the organization to regain stability.
In this estimate, psychiatric diseases account for 3.4 billion euros in losses for employers, versus 4.2 billion euros for patients receiving psychotropic medications outside the first category. Companies thus bear more costs associated with the latter group, even though it weighs less heavily for the national health insurance.
Neurotic and mood disorders are the leading line item among psychiatric illnesses, with 1.9 billion euros in production losses. They are followed by substance use disorders, estimated at 696 million euros, then psychotic disorders, responsible for 454 million euros. Other pathologies account for a smaller share of the balance sheet.
For patients on psychotropic medications, anxiolytics account for about 2 billion euros in losses for employers, ahead of antidepressants and mood regulators, at 1.7 billion euros. Hypnotics are associated with 347 million euros, while antipsychotics account for 109 million euros.
Prevention represents another economic angle explored by the researchers. The firm estimates that halving high-stress work situations could, under certain assumptions, avert nearly 50,000 cases of antidepressant use and generate around 200 million euros in savings per year. Almost half of this potential savings would benefit employers.
Survey: Are you a victim of work-related stress?
