Written by Armance Robineau, Lucile Connil et Marine Kerviche (M2 PPCECC)
Journalist : Hi everybody, welcome to your new podcast about society interest. The 28th of September 2021, the French president Emmanuel Macron announced the reimbursement of the psychologists sessions for all the population of 3 years old and more. This new law will begin in January 2022, and it created a lot of debate and protest in the mental health community. In order to better understand this debate we welcome two psychology specialists: Doctor James, psychiatrist at Nantes Hospital, and Mrs Parker, liberal psychologist.
Hello to both of you, can you introduce yourselves to our listeners ?
Doctor James : Good morning, my name is Bond James, I’ve been a psychiatrist for 20 years in the adult psychiatric unit in Nantes Hospital. I had the opportunity to participate to the national day of mental health where we discussed the new law for the psychologist reimbursement.
Mrs Parker : Hi, my name is Jessica Parker, it’s a pleasure to be here ! I’ve been a liberal psychologist for 4 years now, and before that I also worked in Nantes Hospital for 10 years.
Journalist : Oh okay, It’s crazy, have you already worked together ?
Mrs Parker : Yes, indeed. The collaboration between different professionals from a same service is very important. But I still have to point out something, even if we are often working together, it’s still two different jobs. So, the fact that only psychiatrists were invited to discuss this new law, that affects psychologists, questions us.
Journalist : In fact, this law created many disagreements amongst psychiatrists and psychologists. I would like to hear your point of view. First, can you explain what are the modalities of the new law.
Doctor James : Yes ! With my psychiatrists colleagues we wanted to offer the possibility to have access to free mental care for the majority of people who need it. Of course, this right is subordinated to medical prescription.
Mrs Parker : I’d like to intervene to precise that as you say it, it sounds like everyone will have access to this new modality, but in fact, only patients with little to moderate forms of depression and anxiety are included in the program.
Doctor James : Well yes, but it already concerns a lot of patients…
Mrs Parker : Well, I have numbers with me showing that with the 50 millions euros budget that is estimated, it will only allow 0.5 percent of the French population to access the measure. And while I’m talking money, it has to be said that the amount of 30€ that is reimbursed is not enough to pay our taxes, our equipment, and just simply live from our work ! Not to mention that the process includes tons of new paperwork, and payment can be delayed with the “caisse primaire d’assurance maladie”. And you can’t have any fee overrun. The cost suggested by the government is half the average actual price of a psychologist session. We would only work for free, or even be losing money while working ! Of course I didn’t choose this job for money, but it doesn’t mean I don’t want to be sustained by my work, after a 5 years degree.
Journalist : Actually, you didn’t explain yet to our listeners how the process concretely works. Dr James, could you maybe tell us more ?
Dr James : Yes, that’s what I wanted to do. So, you first have to go to your doctor, who will give you a prescription for 8 sessions with the psychologist of your choice. These eight sessions are renewable. You get access to a first session which costs 40€, and the following cost 30€, all reimbursed.
Journalist : All right, so from what I’ve heard and understood, this need for medical prescription is something that bothers the psychologists community ?
Mrs Parker : Yes indeed. This measure is contrary to the code of ethics of psychologists because it breaks a major value of our job which is confidentiality. In fact, the patient will have to talk about their difficulties to their doctor, who can be their general practitioner so not particularly a mental health expert. Then the doctor will ask some questions to the patient in order to verify if they can be eligible for reimbursement, and send this prescription to the national health insurance fund. So in this system, a lot of different people intervene when it normally includes just two people : the patient and the psychologist. More than that, after receiving the patient, the psychologist will have to do a report to the patient’s doctor so they can prescribe the number of sessions and impose their rhythm.
I would also add that as psychologists, it is important for us to receive a person who wants to come and who has a personal demand. This is part of the fundamentals of our work. Welcoming someone who has been sent by their doctor, without a personal wish to start a therapy, won’t be pleasant nor efficient neither for the patient nor for us.
Journalist : Oh I see… And what about the modalities of the sessions, what do you think of their limited duration?
Mrs Parker : Well, at this price, psychologists have already warned that the sessions will only last thirty minutes. But eight sessions of thirty minutes are not enough for everybody ! Depending on each individual, the therapy can need to last longer. And we don’t usually work with thirty minutes sessions, it’s not enough for quality work.
Dr James : I feel like nowadays we need to learn how to work more efficiently, more quickly even in mental health ! Therapies lasting months and years don’t help with the overburdened hospital demands ! We need to have quick results of improvement…
Mrs Parker : Even if we agree with this point of view, instead of counting on liberal psychologists to change the overburdenment, we should invest more money into the public health system… Moreover, it won’t change much according to the small number of patients this system can support, and the limited three thousands liberal psychologists who can be included in the program. Plus, we also lack general practitioners. There will be a long waiting list to enter the program.
Journalist : We’re reaching the end of this episode. If you had to quickly express the general feeling of your community towards this new system, what would you say Mrs Parker ?
Mrs Parker : In the actual state of things, many psychologists refused to enter the program. We agree on reimbursement, but not at any cost, not anyhow. Psychiatrists and politicians taking decisions about our own profession of psychologists, without inviting us to the discussion and with their approximate understanding of our work, is very problematic. What we demand is access to reimbursement for every kind of mental health disease, in respectable conditions so we can pursue quality work.
Journalist : Dr James, some last words you would like to share as well ?
Dr James : We… me, the National Day of Mental Health team and many psychiatrists colleagues, feel like this is at least the first step in a good direction, and we sometimes have to try to know if something is good or not…
Journalist : Thank you to both of you for this enlightenment of the current situation. I hope our two guests and the rest of their professional communities will find some common ground to work on, and in the meantime, dear listeners, take care of yourselves and of each other ! Good bye.
Words we have learned :
- Overburdened : surchargé (dans notre contexte, “qui croule sous les demandes”).
- General practitioner : médecin généraliste
- Enlightenment : éclaircissement
- To bother : ennuyer, embêter
- Fee overruns : dépassements d’honoraires
