Compensation for psychological counseling is far from unanimous

Mental health – it is now possible to see a city psychologist and get compensation from Social Security. Le dispositif “Mon psy”, lancé par le gouvernement ce mardi 5 avril, permet à tout patient de plus de 3 ans, souffrant de difficultés psychologiques “légères à modérées”, de se faire rembourser jusqu’à huit séances par an par l’ health insurance.

A promise made by Emmanuel Macron last September, at the end of psychiatry and mental health sessions, in order to meet the growing needs of the French population, exacerbated by the Covid crisis, and more recently by the context of the war in Ukraine.

The device has been trialled in four departments since 2015, and has already made it possible to treat 35,000 patients. So this experiment spread to the entire territory.

This is not a prescription.

Concretely, the patient must first consult a GP who can then send an “address letter” to one of the psychologists registered on the platform, depending on their geographic location. It is not a prescription, the Ministry of Health specifies. Rather, it is a means of endorsing a pattern of collaboration between the GP and the contraction.”

This first point poses a problem to a certain number of professionals. Myriam Goffard, general secretary of the National Federation of Psychotherapists and Psychoanalytic Practitioners (SNPPsy), stresses that “a clinician is not trained in mental illness and its clinical signs.” The fear is that doctors will miss out on some psychological distress.

“There are a number of situations in which a family doctor will not be the right person, admits Benoit Schneider, honorary president of the French Federation of Psychologists and Psychologists (FFPP), who participated in the negotiations. But nothing prevents a patient from going to another doctor.”

Insufficient salaries

The patient will have to pay €40 for the first evaluation session, after which he will be able to take advantage of seven sessions throughout the year at €30. The costs will then be reimbursed over the eight sessions by 60% with health insurance and 40% with mutual or supplementary health insurance – if the patient has a session.

The patient will have to pay the price of the consultation, as the liberal devices are not administratively equipped to allow remote transmission with Social Security. The Paper Care Sheet will allow for payment.

The issue of remuneration is a consensus among professionals who in these cases will not be able to resort to overpaying. For Miriam Govard (SNPPsy), this is a “complete devaluation of the practitioner’s act”. “We don’t fully understand that some psychologists accept this,” she adds.

“We could have had more flexibility and this is very unfortunate, believes Benoit Schneider (FFPP). This is an indisputable obstacle for a certain number of psychologists.” According to the ministry, these rates were set “in line with the health professionals’ compensation levels with equivalent training levels approved by the health insurance.”

During the trials, the fee charged was €30 for the evaluation session and €22 for the next seven. “This is only part of their activity, we justify it. Psychologists are volunteers and find their accounts in it.”

They are not carpet dealers.

Also, the limited number of sessions is a hindrance for some. “We are not rug dealers. Ultimately, this device as it is designed can force therapists to turn toward shortcut methods and treatments, sees Miriam Gouffard (SNPPsy). However, we know that a lot of suffering gets away with these methods.”

On the part of the ministry, on the contrary, the freedom that is left to the practitioner is emphasized. “The duration of the sessions is free, as is the type of practice, we justify it. If we notice the need to continue care, the relay will be taken over by traditional care counters, in consultation with the GP.”

“It is a downside, even if, moreover, real work can be done on the basis of these sessions, as Benoit Schneider (FFPP) puts into perspective. I have already gone in the door to go further during the oversight committees. There will be a need Thereafter to resume discussions with the government on the most serious problems.”

For him, it could also encourage patients who can afford it to take care of their mental health. “Some will take advantage of those eight sessions and then keep paying,” he defends.

Training of psychologists

Psychologists are registered on the platform on a voluntary basis. Since applications opened four weeks ago, just over 600 psychologists who met the selection criteria have applied, “in all departments,” according to the ministry. 50 new applications will be checked daily since then.

Psychologists must have 3 years of experience in psychological care and either a diploma or additional training in clinical psychology and psychopathology. “These are very normative standards, criticizes Myriam Goffard (SNPPsy). There is no standard for the quality of a professional.”

On the FFP’s side, we are dealing with: “There will be no people coming from college, without experience, assures Benoit Schneider. Among the candidates involved in the experimentation, we did not notice an influx of young practitioners.

‘Resignation from public service’

The protest of a number of psychologists against this device is also related to the conflict between public service and liberal practice.

“This device is an advertising effect to mask the misery of the mental health field, Miriam Govard (SNPPsy) thinks. Why not strengthen the public service system for this? It is as if we are privatized and resigned from public service.”

The government’s stated goal is “prevention, not just treatment.” “We want to facilitate the conduct of these sessions in the city and remove the stigma of difficulties that a part of the population may face,” we justify. The estimated cost of the device is 50 million euros for 2022 and will be 100 million euros for next year.

See also on HuffPost: The war in Ukraine and its dire consequences for children’s health

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