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HEALTH

How France plans to overhaul its much-criticized approach to autism

France will spend €344 million on a new plan to help autistic children and adults after the country's approach to autism was once blasted as "a violation of citizens' rights" by the UN. Here's what you need to know.

How France plans to overhaul its much-criticized approach to autism
French President Emmanuel Macron on a visit to Rouen hospital. Photo: AFP
France's new strategy for autism, which the government has said aims to give autistic children and adults a life “as normal as possible”, is set to be officially unveiled by French Prime Minister Edouard Philippe on Friday. 
 
It is hoped that this new plan will make up for the outdated treatment of children and adults with autism in France that has been denounced by the United Nations as a “widespread violation” of citizens’ rights.
 
During his election campaign Macron said that he wanted everyone “to be included in school and everyday life”.
 
Autism is a developmental disorder that affects communication and behavior and affects “about 1 percent of the population”, which translates to about 700,000 people in France, including 600,000 adults, according to the French authorities.
 
The budget for the autism plan, which is the country's fourth, is €344 million which will be spent over five years, from 2018 to 2022 and aims to improve research, testing and management of autism. 
 
Here's what you need to know. 
 
French President Emmanuel Macron speaks to hospital workers during his visit to the Rouen hospital. Photo: AFP
 
Earlier diagnosis
 
From January 1st 2019, when the plan is set to be launched, around €106 million will be dedicated to an “early intervention package”. 
 
That means that during mandatory medical examinations that take place when an infant is nine months and 24 months-old, doctors will have to do a basic check and warn the parents if it seems like their child is showing signs of autism.
 
At the moment, the process of diagnosing autism at an early age can take several months or more and 45 percent of children are diagnosed between 6 and 16, which the government says is “too late”. 
 
Their argument is that if the disorder early and followed up quickly with intense medical support that in some cases developmental gaps could be made up and the extent of the disorder could be limited. 
 
Professionals such as psychomotor specialists, who provide mind-body therapy, and occupational therapists are currently not supported by the French social security system.  
 
But once the new plan comes into effect, by 2022 families will be supported with a fund of €90 million per year and will be able to access this kind of specialist care even before an official diagnosis. 
 
Photo: AFP
 
School enrollment 
 
With its new strategy the government aims to make sure that every child born with autism from 2018 is enrolled in France's pre-school Ecoles Maternelles by the time they turn three. 
 
At the moment, just 30 percent of the 8,000 children born with autism every year goes to an Ecole Maternelle. 
 
The plan has earmarked around €103 million euros for the extra school places and the government plans to “triple” the number of places in EMU teaching units in kindergartens, which are small classes for children in need of enhanced support.
 
On top of that, approximately 100 autism extra teaching positions will be created to  provide support to teachers who have autistic students in their classrooms.
 
Primary school and high school enrollment will also be reinforced through local school authorities.
 
No long-term hospitalisation
 
It is believed that some 600,000 French adults, or one in 100 adults, are autistic but only 75,000 are diagnosed.  
 
As a result, far too many people with autism are put in long-term mental hospitals because the disorder has gone unrecognised and untreated. 
 
“The goal is to no longer have long-term hospitalization for autistic people by the end of the strategy” in 2022, according to the government.
 
In order to bring this ambitious plan to fruition, a strategy for diagnosing adults in health and medico-social institutions will be launched.
 
And staff training will be increased because “all professionals are not yet at the level of best practice”, the French government has said.
 
€115 million has been earmarked for this part of the strategy. 
 
Family support and research
 
The government will also devote €6 million to creating a “rest system” for each department in France.
 
This will provide temporary carers, for a few hours or days, for children or adults with autism, so that their families can rest or go on holiday. 
 
On top of that €14 million will dedicated to autism research. 

For members

HEALTH

When can doctors in Denmark refuse to continue treating patients?

General Practitioners in Denmark have the right to break off a patient-doctor relationship in specific circumstances.

When can doctors in Denmark refuse to continue treating patients?

Although doctors in Denmark have the right to decide not to continue treating a patient – requiring them to find a new GP – the circumstances in which this can happen are limited, and must be approved by health authorities.

The frequency in which the circumstances arise is also low. A doctor decided to no longer receive a patient on 375 occasions in 2016, according to the medical professionals’ journal Ugeskrift for Læger. The following year, newspaper Jyllands-Posten reported the figure at 458.

There are two main categories of circumstances in which a doctor can choose to take this step. The first is in instances of violent or threatening behaviour from the patient towards the doctor. 

The second (and most common) is when the doctor considers the relationship to have deteriorated to the extent that confidence has broken down, according to Ugeskrift for Læger.

It should be noted that patients are not bound by any restrictions in this regard, and can decide to change their GP without having to give any justification.

A patient also has the right to appeal against a doctor’s decision to ask them to find a new GP. This is done by appealing to the local health authority, called a Region in the Danish health system.

In such cases, a board at the regional health authority will assess the claim and if it finds in favour of the patient may order the doctor to attempt to repair the relationship.

Doctors cannot end a relationship with a patient purely because a patient has made a complaint about them to health authorities. This is because patients should have the option of making complaints without fear of consequences for their future treatment. 

However, if this is accompanied by the conclusion on the doctor’s part that there is no longer confidence in them on the part of the patient, they can remove the patient from their list.

The right to no longer see patients in the circumstances detailed above is provided by doctors’ collective bargaining agreements, the working conditions agreed on between trade unions and employer confederations under the Danish labour market system.

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