“Psychology in the News” by BERNARD-DE AMBROGGI Marine ; COYAN Emma ; MOISDON Clémence. M2 PPCECC
MonPsy scheme, what is it ?
MonPsy scheme was implemented in early april (2022) by the government. In general terms, this involves going to see your doctor so that he prescribes 8 sessions at the psychologist that will be reimbursed by the health insurance.
Good news, you say ?
While the principle of reimbursement for psychologist sessions is something that has been long awaited, students and professionals are concerned about how to proceed. Indeed, one of the points is that you have to consult your doctor before going to the psychologist in order to be reimbursed. Psychologists are not currently paramedical professionals, they do not work under the direction of a doctor and therefore do not need medical prescriptions to practice. This measure may therefore seem to be the beginning of a challenge to the status of psychologists, which would lead to a loss of autonomy. In addition, the patient should be free to consult a psychologist without being referred to a “partner” psychologist, without really choosing his or her psychologist, and without being obliged to tell their doctor. There are difficult subjects that we don’t necessarily want to discuss with many professionals, not necessarily trained in psychotherapy.
Going to see a mental health professional is not always obvious, it is a personal step that requires taking a first step to try to get better, this scheme could then discourage patients. Moreover, confidentiality is undermined because the psychologist must report to the doctor on his intervention.
A danger for the patients ?
Another problem is how these sessions are set up. In fact, the patient is only entitled to 8 sessions, which may be renewed by a doctor, who is not a specialist in psychotherapy. This is questionable because the doctor may refuse to extend the care, yet the patient is beginning therapeutic work and may feel the need to continue. The patient may feel that he is not normal because he could not solve his problems in a few sessions, thinking that 8 sessions was what he needed and experience this as a failure. This is tantamount to making patients believe that, according to psychotherapy, healing occurs as if by magic, in only 8 sessions, their problems will be solved.
Moreover, this can even be dangerous for the patient. Indeed, the patient comes with a complaint, which he can partially resolve, then, over the sessions, he discovers his real need, after several meetings. At the end of the 8 sessions, the initial problem may be resolved but other problems may be discovered. It would then be dangerous to let the patient go back with suffering. However, the doctor may refuse to extend the care because the problem for which the patient was initially seen has been resolved.
In addition, this system is only intended for patients with mild to moderate disorders, so it excludes from the protocol a large category of people who would also need to be taken care of. Indeed, patients with severe forms of anxiety or depressive disorders are not included in this scheme, as well as eating disorders, neurodevelopmental disorders and substance dependence. As a result, the system excludes a portion of the population. Why ? According to the guide to the system, people with non-inclusive disorders must report to specialized institutions. However, these institutions are overcrowded, so it is difficult to get appointments and therefore to be taken care of quickly.
The government has decided to implement measures based on psychologists in private practice, why only in private practice ? The means could be put in place in the already existing public services, where waiting times are very high for people in great suffering.
And what about the burden on liberal psychologists?
The health insurance only reimburses 30€ per consultation, with no possibility of exceeding the fees. Nowadays, the majority of consultations in France cost almost twice as much. The amount reimbursed is problematic because it does not correspond to the reality of the profession. The MonPsy scheme could lead professionals to reduce their consultation time, if they are paid 30 € per consultation with each patient, in order to be able to live off their work.As a reminder, the 30€ do not include the numerous charges that the psychologist must face as a liberal professional.
Unfortunately, it seems difficult to adequately address very difficult topics in a short period of time. With shortened time frames, patients may leave their sessions in a vulnerable state, without having been properly accompanied. The risk is that professionals receive many patients in a row, to the detriment of their own patients, with a lower quality of work. Liberal psychologists are then caught between the need to accompany their patients with a quality follow-up (and thus to do long sessions), and the need to earn their living.
Liberal psychologists are then targeted by citizens, accusing them of not wanting to help those in need when they refuse to register in this scheme, despite their well-founded intentions.
And for the next step ?
These new measures frightened students and professionals, worried about the future of the profession. While it was thought that COVID-19 and the resulting psychological disorders could have raised the profile of mental health in our society, the feeling that the profession of psychologist is being devalued and that the government is undervaluing the skills of professionals is present. We hope that mental health and the autonomous status of psychologists will be recognized. This will allow access to care for all, with psychological consultations reimbursed by social security without any limit on the number of sessions (as when you go to a physiotherapist, for example), with a rate that respects the knowledge and training of psychologists.
words I/we have learned/learnt
- challenge : remise en cause
- obvious : évident
- scheme : dispositif
- report to : rendre des comptes
- be entitled to : avoir droit à
- tantamount : équivaut à
- fee : honoraires
- frighten : effrayer