MENTAL HEALTH – The current health crisis highlights the importance of mental health, and the major role of psychologists.

The Court of Auditors recommends the generalization of a reimbursement experiment carried out in 4 departments since 2018. The objective: to relieve congestion in public consultation centers, and to save the cost of treatment.

If psychologists can only be associated with a reimbursement process and rejoice in it, the form announced is very far from reality and will lead to an abusive, incoherent, even repulsive course for the patient. Psychologists are rising up today to denounce these conditions and prevent them from spreading. Their goal: to facilitate access to mental health care.

While the notion of reimbursement is widely disseminated in the media, the words of the main stakeholders are not relayed, and the real consequences of such measures remain unknown to the general public. Concerned about access to their expertise, psychologists have come forward to denounce what will prove to be a real obstacle course for patients, when the needs have never been greater.

Under the conditions announced, this means 5 steps before benefiting from any psychotherapy session

  1. The general practitioner, already overwhelmed, and often without specific knowledge in psychopathology, assesses your request. Only certain patients, corresponding to precise criteria, can benefit from it, effectively excluding all the others;
  2. The patient chooses a psychologist from a list who must also carry out an assessment and report to the doctor;
  3. The general practitioner decides whether the prescription is relevant;
  4. If this is the case, the doctor prescribes up to 10 “support” sessions (no psychotherapy) of 30 minutes, reimbursed 22 euros, with no possible excess fees;
  5. The patient returns to see his attending physician, always overwhelmed, who sends him to meet a psychiatrist, even more overwhelmed, who does not know him and who assesses his needs;
  6. If the psychiatrist and the general practitioner deem the need relevant, then finally, the patient will be able to benefit from up to 10 sessions (not one more!) Of “psychotherapy” of 45 minutes, reimbursed 32 euros, always without exceeding the fees.

Consequences for users

Where it is sometimes difficult to quickly get an appointment with a general practitioner, adding these steps makes the process even heavier for patients, who will have to “justify” their need throughout their support, emotionally bare in different places, in defiance of the relationship of trust necessary for such a sharing.

The communication is centered on the reimbursement of the sessions with the psychologist. But the reality is that people in need will have to meet various very excluding criteria to benefit from it: to be between 18 and 60 years old, not to be under treatment linked to mental suffering, to present, according to standardized scales, to “mild anxiety or depression. to moderate ”. If these conditions are not met, no access to reimbursement.

The patient will have to go through a long process, and meet three professionals, before being able to claim psychotherapy, where he can freely access it today.

The confidentiality of meetings with the psychologist is also tainted since the latter will have to report to the doctor on the patient’s progress.

Calling on a psychic care professional is not an easy process, the task should be made as easy as possible for those who need to consult a psychologist in private practice.

Psychotherapy represents a unique time and rhythm, built between patient and psychotherapist. It cannot be formal, and even less standardized, it would be a misunderstanding of the necessary singularity of the meeting between the patient and his therapist. Some psychotherapies require 1.5 hour consultations!

It cannot, moreover, be limited in time. Because what happens after having “exhausted” the reimbursed consultations? How will people who do not have the means to pursue psychotherapy in their own right be supported, when they will have linked a privileged and unique bond with their psychotherapist?

For patients with the lowest incomes, liberal psychologists have always adapted, by offering adjusted rates. Otherwise, they can claim public support, paid by the taxpayer. But…

The goal?

The objective is not to support these institutions, to treat one of the major causes of the problem: the saturation of consultation centers, their lack of human and financial resources. It aims to unclog them, by “filtering” patients and shifting the problem to liberal psychologists who do not benefit from a structure on which to rely. Liberal and public activities cannot substitute for one another. These practices are different and complementary. The psychologists have neither the same missions nor the same functioning. Psychiatry and public institutions are left in their distress and today, the state asks the private sector to come and fill their shortcomings.

Facilitating access to the liberal under unacceptable conditions for quality work without at the same time supporting the public sector financially and humanly is nonsense and a danger for access to psychological care. It is a question of disempowering the State with regard to the good care of its public sector.

For these ethical, economic and social reasons, a large part of liberal psychologists refuse to participate in these devices if they were to become generalized.

They ask to be heard in order to build a coherent reimbursement project adapted to their specificity, allowing patients to access quality psychological care.

A refund, yes, but not just any old fashioned way.

See also on The HuffPost: “After 3 sessions, what happens?” The student psychiatric check, a fragile measure