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The COVID-19 pandemic led to a rapid transformation of the health care system to cope with the risk of contamination and of developing a severe form of the infection. Although it is an international crisis, strategies have been decided nationally. In France, priority was given to hospital reorganization, especially intensive care units. Reorganization of primary health and mental health services took place with late and inadequate national guidelines or coordination. For mental health services, lack of visibility on the crisis impact on mental health, and difficulties in defining their place in the overall health strategy appeared as the main challenges to overcome. These rapid transformations impacted the whole organization of community mental health care. Any strategies developed must ensure that every person enjoys the highest attainable standard of physical and mental health. Using a systemic approach, it has been necessary to identify both status and risk factors of communities, and to implement appropriate and efficient health promotion and crisis resolution actions. These theoretical issues and their practical impact are discussed using the field strategy developed during the first 28 days of confinement by the 59G21 service in Lille, France.

Objective: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not).Method: Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data.Results: Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment.Conclusions: Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

La 11e version de la Classification internationale des maladies de l'OMS (CIM-10) est en cours d'élaboration au niveau international et la conclusion des travaux est prévue pour 2012. Très directement liée au chapitre V de cette classification traitant des troubles mentaux et du comportement, elle donne lieu à de nombreux débats car les entités décrites par la classification sont utilisées internationalement pour la définition des troubles psychiques, les comparaisons internationales et les remboursements des assurances maladies. Ce numéro spécial est consacré aux débats des experts.

It is proposed as a conclusion to briefly outline the ideas and interpretations presented in this report, adopting the plan recommended by the coordinators for summarising national case studies. To begin lets noticed that in France there are : - very few publication on « mental health », no scientific journal called « Mental Health ... », no or very few academic -university training degree in Mental Health and very few continuous professional training in mental health. - very few State, national, regional or local agency, office, bureau, organisation for « mental health » and in practice a still strong institutional psychiatric system with some Community Based local initiatives. - The First « Mental Health » National plan was published in 2005. - The first National promotion / information campaign on mental health (depression) supported by the government was launched in 2005 - They are no or very few explicit allusions at WHO national reports, laws, academic or professional training, university publications.