Despite France's pride in its national health-care system, awareness of the need for suicide prevention came late.
Dr Bernard Kouchner, who has just returned to the French ministry of health after serving as the UN's administrator in Kosovo, made it one of his top priorities as health minister in 1998. This was in part due to feedback from regional health conferences that asked Paris to do more about the problem.
French officials have been reluctant to keep a registry of attempted suicides, probably because lists of mentally ill and handicapped people had to be destroyed by doctors during the Second World War to prevent them being deported by the Nazis. This has made it difficult to organise prevention and follow-up, and the ANAES, the agency that evaluates and licenses health establishments, decided last October to carry out nationwide studies on the treatment of patients who have attempted suicide.
Preliminary findings indicate that the health ministry's recommendations are not always carried out. Anyone who attempts suicide in France is supposed to be kept in hospital for at least 48 hours. "In cases where a stomach is pumped or a cut vein is mended, patients are often dealt with too quickly by emergency services," said Francoise Casadebaig, a researcher at the French national science institute INSERM, and the president of the Suicide Prevention Study Group.
Another rule - that every suicidal patient who is discharged should have a fixed appointment with the same treating physician before leaving hospital - is observed in only one-third of cases, Ms Casadebaig said.
The French health ministry's budget allots £240,096 for suicide prevention each year. This includes better training for "frontline" medical personnel like GPs and school nurses, who have complained that they are ill-equipped to help suicide patients.
On a more practical level, French public transport, railway and local authorities constantly increase the number of barriers and nets intended to prevent people jumping from bridges or railway platforms. Recent legislation on firearms requires that weapons be stored unloaded and in inaccessible places.
Attention has focused recently on suicide among teenagers. To mark the fifth annual suicide prevention day on February 5th, French media gave extensive coverage to the Abadie centre at Bordeaux University Hospital, founded by the psychiatrist Xavier Pommereau in 1992. The centre is considered a model for the treatment of suicidal adolescents. Survivors between the ages of 14 and 25 are sent there from all over France.
