Expanding the offer and assuring the quality of training in psychotherapy: a clear necessity
Press Release of the French National Academy of Medicine[1]
April 19, 2021
The Covid-19 pandemic has led to an impressive rise in mental suffering among the population. This cannot remain unaddressed for long. Anxiety or depressive disorders and addictive behaviors will not disappear without leaving traces if they are not rapidly handled.
The difficulties observed in this respect highlight the inadequacies of our healthcare offer, including, first of all, the difficulty of getting an appointment with a doctor qualified in psychotherapy. This recurring observation has led the National Health Insurance Fund (CNAM) to experiment, since 2018, in four departments, the reimbursement of psychotherapy procedures carried out by non-physicians on prescription of the general practitioner. This experiment shows that general practitioners are prescribing psychotherapy sessions, that psychotherapists who are not doctors, mostly clinical psychologists, adhere to the principle and the amount of reimbursement set up by CNAM, and that patients use this offer.
Several French institutions, such as the Court of auditors (“Cours des comptes”) and the Economic, Social and Environmental Council (“Conseil Economique Social et Environnemental”), have recently come out in favor of expanding the access to psychotherapy and in the reimbursement by the Health Insurance of acts performed by psychologists. Supplementary health insurance companies have announced on their side that they will immediately reimburse four consultations with psychologists after medical referral, in view of the Covid-19 impact on the mental health of their insured members.
Beyond the current emergency period, this desire to provide a broader response to a real need of the population will require that the supply of psychotherapy be, on a permanent basis, subject to precise rules and shared by the various health care actors for an adapted and rapid treatment of people with mental suffering.
The French National Academy of Medicine recalls that there are several types of psychotherapies based on distinct theories of psychic functioning, whose efficacy differs according to the patient: faced with a given symptomatology, the psychotherapy implemented must respond to the patient’s wishes and even more to the scientific data justifying the choice of one type of psychotherapy rather than another. It also points out that the skills of psychotherapists are heterogeneous, as was emphasized by the French General Inspectorate of Social Affairs in October 2019, and that psychotherapy training is much lower in France, in terms of requirements and duration, than what it is particularly in Belgium, Switzerland and Germany, or in the Netherlands and Canada.
The National Academy of Medicine recommends to:
1) Plan the evaluation of the efficacy and health efficiency of expanding the access to psychotherapy. Indicators such as the reduction in psychotropic drug consumption rates and morbidity, and the inclusion of patients in a coordinated care pathway will help to have the practice evolving;
2) Encourage the continuing professional development actions, able to provide prescribing physicians with updated information on psychotherapies and evaluations of their efficacy;
3) Engage actively in reflections and work to strengthen the conditions of access to competence in psychotherapy by establishing a model of initial theoretical and practical training for doctors, nurses and clinical psychologists who wish to have this competence recognized.
[1] Press release of the Academy’s Rapid Communication Platform validated by the members of the Board of Directors on April 19, 2021.
