Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 29, Issue 1, 2026. Pages: 15-22
Published Online: 1 March 2026

PERSPECTIVE: Community Health Centers: The Missed Opportunity to Widely Integrate Mental and Primary Health Care in France

Matthias Brunn,^1* Wladimir Hindryckx,²Elodie Malvezin²

¹MD, PhD, Psychiatrist, Belleville Health Center & Sciences Po – LIEPP, Paris, France.

²MSc, Psychologist, Belleville Health Center, Paris, France.

³MD, General Practitioner, Belleville Health Center,Paris, France

*Correspondence to: Matthias Brunn, MD, PhD, Centre de santé de Belleville (GOSB), 27 rue Levert

75020 Paris, France

Tel. +33-1-4033 8040

E-mail : m.brunn@gosb.eu or matthias.brunn@sciencespo.fr

Source of Funding: None declared.

Abstract

This perspective examines the role of French community health centers (centres de santé, CDS) in integrating mental health and primary care. Using national policy documents and a case study of the Centre de Santé de Belleville in Paris, it shows that CDS can provide accessible, team-based care for socially vulnerable populations through salaried multidisciplinary practice. The Belleville case illustrates both the potential of CDS to improve coordination between general practitioners, psychologists, and psychiatrists, and the limits of the model. These limits include structural financial fragility, dependence on temporary public funding, weak political representation, and the continuing dominance of self-employed ambulatory medicine in France. For mental health policy, the French case highlights how institutional history and professional power shape the diffusion of integrated care models.

Background: Access to mental health care and its integration with primary care remain critical challenges worldwide. In France, these problems are compounded by fragmented provision, poor coordination, and limited reimbursement for psychotherapy, despite the country’s high levels of health expenditure.

Aims: This perspective examines how community health centers (centres de santé) can contribute to integrated care, understood as the systematic coordination of physical and mental health services across providers. We analyze the case of the Centre de Santé de Belleville in Paris as an illustration of how CDS can host significant mental health capacity for vulnerable populations, and explore why the model remains marginal in the French health system.

Methods: We combine analysis of national policy reports, academic literature, and internal audit data from the Belleville center to situate CDS within French health system dynamics. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) grid is used to summarize the model.

Results and Discussion: The Belleville case illustrates that CDS can deliver integrated mental and primary care, with salaried teams of general practitioners, psychologists, and a psychiatrist serving a disproportionately vulnerable population. However, structural weaknesses - financial fragility, fragmented representation, reputational risks, and the enduring dominance of the self-employed, independent physician (“liberal medicine”) - limit their wider diffusion. Policy windows linked to financing reform, workforce shortages, and broader frames such as sustainability occasionally elevate CDS on the agenda, but institutional path dependency keeps them peripheral.

Implications: Community health centers in France illustrate how institutional legacies and professional power can constrain the adoption of organizational models aligned with policy goals. For international readers, the case underlines the importance of political economy and system values - in this case, liberal universalism - in shaping the possibilities for integrating mental and primary health care.

Received 22 September 2025; accepted 11 December 2025