L’implémentation des soins psychologiques de première ligne en Belgique : profil et satisfaction des psychologues et orthopédagogues de première ligne

Abstract

Primary psychological care was implemented in Belgium between January and April 2019 as part of the “psy 107” mental health reform. This is part of a wider trend of strengthening primary care at the international level. Belgium, like the Netherlands (Derksen, 2009), Ireland (Corcoran et Byrne, 2017), Australia (37), England (Clark, 2018) and the United States (McDaniel, DeGruy, 2014; McGough et al., 2016), has moved towards a public health model based on a community approach to improve access to psychological care. However, the implementation of psychological treatment in primary care is still relatively recent and has been promoted by the work of clinical researchers who have reported the need to integrate mental health care into their practice (Kaitz et al., 2020). From this perspective, integration can take different forms; in fact, there is no standard model for integrated care but rather several models (Runyan, 2011; Seaton et al., 2021). In line with the “psy107” mental health reform, the federal authorities have implemented first-line psychological care in Belgium for patients aged 18 to 64 with reimbursement from the National Institute for Health and Disability Insurance (RIZIV). For the first time in history, 4 and up to 8 primary psychological sessions per year are reimbursed for mild to moderate symptoms of anxiety, depression or dependence on alcohol or sleeping pills. The implementation of these agreements resulted in the setting up of 20 adult mental health networks delimited on a territorial basis and later the creation of 11 networks dedicated to children and adolescents. In the context of the COVID-19 health crisis, this measure was extended on 2 April 2020 to include patients under 18 years of age and over 64 years of age, as well as the reimbursement of video-consultations. Each session costs the patient 4 or 11.20 euros, depending on whether or not they have an enhanced intervention.

Objectives

The research for this study was commissioned through a public procurement tender and led to the research project “Evaluation of Primary Care Psychology” (EPCAP) conducted by researchers from two universities. The research, which started in February 2020, has four components, focusing respectively on the epidemiological profile of the patients, the place of primary care psychologists and orthopedagogists (PPLs) in the health care network, the economic analysis of this measure, and the development of recommendations for the sustainability of this project. The purpose of this article is to present the profile of psychologists and orthopedagogists, their personal satisfaction, and the implementation of collaborative practices with general practitioners.

Methods

An online survey was distributed via network coordinators to all primary care psychologists and orthopedagogists who are engaged to provide this care in at least one adult network between September 2020 and January 2021. A census of the total population was carried out in September 2020 on the basis of FPS Health files. The final sample consists of 310 psychologists and orthopedagogists, out of 641 practitioners registered for first line psychological care in September 2020, of which the vast majority (74.5 %) is female and with 25.5 % male.

Results

The 310 professionals, most of whom are experienced clinicians, also used different epistemological approaches. The results underline a commitment on the part of these professionals to the democratization of mental health care and their desire to adopt a community-based approach by promoting the accessibility of psychological cares to all patients. The majority of PPL were satisfied with this activity and the collaboration with general practitioners. More specifically, the results highlight the fact that the implementation of collaborative practices is a contributing factor in professional fulfilment. However, certain points are a subject of expressed dissatisfaction such as disparities in remuneration and contact with colleagues and collaborators.

Conclusion

The implementation of these new systems in Belgium and internationally is a major step forward in preventive and early mental health care. Taking these results into account, a new agreement was adopted on 2 November 2021 as part of the psy107 reform and was accelerated in the context of the health crisis. This new agreement is currently being implemented in the various networks with significant changes. The withdrawal of the medical prescription is an important change, while at the same time raising the question of how collaboration between GPs, PPLs and, more broadly, the care network will be organized.