“A labor psychologist cannot treat schizophrenic patients” – L’Express

Survey after survey, the results do not vary hardly: since the health crisis, the mental health needs of the population have increased, particularly among young people. The device “My psychic support“, Launched in 2022, made it possible to provide a first response to the French with moderate disorders, such as transitional anxiety or depressive symptoms. A device certainly perfectible, but which already allows the reimbursement of 15 sessions per year. The question of accompaniment of patients with psychiatric diseases remains whole, especially when they do not get a response to the hospital.

For these people with bipolar disorders, severe depression or psychotrauma, monitoring by a psychologist is not reimbursed in liberal. The ministerial delegate for mental health hopes to remedy this gap. He explains to L’Express the main lines of his project – which could deeply upset the conditions for the exercise of psychologists. Interview.

L’Express: The “My Psy Support” system was launched just three years ago. It remains very criticized by a large part of the representatives of psychologists. What assessment do you make of it?

Frank Bellivier: The starting point for our reflection, in 2019, was access to specialized psychotherapies for patients with psychiatric pathologies. These care is essential for these patients, but only a very small part of them can benefit from them outside the hospital and the medico-psychological centers, because in liberal, the sessions cost 50 to 80 euros, not reimbursed.

The health crisis arrived, and the degradation of the mental health indicators of the population. Multiple initiatives to promote access to front -line psychologists have then emerged, notably via complementary health, regional health agencies or the Ministry of Health (Psyenfantado) and that of higher education (Psyetudiant). This came to join our work and we obtained in 2022 the creation of “My Psy Support”. As of November 30, 2024, 478,972 patients used this device. A total of 2.5 million consultations were reimbursed, at a cost of 56.2 million euros. On the side of practitioners, we counted 5,406 psychologists approved on March 17, out of around 15,000 liberals fulfilling the training and experience criteria allowing them to apply. These data show that “my psychiatric support” meets expectations.

However, this device is intended for people with light to moderate psychological disorders, of the transient anxiety type, depressive symptoms or sleep problems. He is not intended to meet the needs of patients with psychiatric diseases. From this point of view, it is really a first brick, from the start of the story and not the end.

The representatives of psychologists contest these figures, indicating in particular that the convenient psychologists would actually be numerous to wish to leave the system, without achieving them. What do you answer them?

A psychologist who wishes to take a deconation must send a registered letter to his attachment CPAM. Damoning will be effective two months after the date of receipt of this letter. I was not aware of particular difficulties relating to this approach. A psychologist can also ask to appear in unavailability on the directory. In this case, its contact details are no longer visible. 193 Désonventation requests were brought to our attention. This figure may not be exhaustive, because I realized that not all the deconventions had been communicated to us by the CPAMs, but we must be close to reality.

What are the next steps?

Many specialized care techniques, such as cognitive remediation in schizophrenia, psychoeducation in bipolar disorders or in relapses in recurring depressive disorders, cognitive behavioral therapies in anxious disorders, or EMDR in psychotraumatism today benefit from probative data. This justifies making them more accessible to patients, by offering a refund.

We therefore want to launch a project that we could title: “For better integration of psychologists in care paths and support.” Our priority is to specify the skills that patients need and identify psychologists able to fill them, so that they can then register them in a device where consultations will be supported by the community. The profession claims a unique title of psychologist, but the reality is that the skills are very heterogeneous depending on the course. You cannot ask a work or education psychologist to lead psychotherapy for patients with schizophrenia.

For “my psychiatric support”, the practitioners submit an application on the platform. He is educated by health insurance, then by the experts of a selection committee. We want to do the same with this second device, but in addition with diploma requirements guaranteeing suitable training. At first, we will have to, in association with psychologists and neuropsychologists, describe the skills expected for the different pathologies. From there, the Ministry of Higher Education will establish a training repository, then the Faculties of Psychology, on the basis of volunteering, will organize the courses in line with the needs of patients in the health and medico-social sector. It is an important project that could require one to two years of work and which will also require reviewing the status of psychologists from the hospital public service.

What do you miss to get started?

A political order. This project has been validated by various health ministers, but it could not be started because in recent years, none having been enough for a long time to be able to really seize it. Ministers are seduced because psychologists bring significant added value to the care path of psychiatric patients. The Court of Auditors has shown that for 1 euro of engaged expenditure, their support generates 1.4 to 1.90 euros in savings in relapses and hospitalizations.

In previous governments, there was an alignment of the Ministries of Health and Research on this approach. Political leaders must now remain long enough to carry this project. Likewise, consultation with representatives of psychologists will be decisive. It is necessary to clarify the existing differences, both in the analysis of the situation and in the orientations to be taken, and to explain it. So, no doubt, a force of conviction of what should be taken care of of mental disorders and psychic sufferings will manage to emerge and lead to the crystallization of an essential collective will.

To say that psychologists are not united behind this project is an understatement: many are fighting it, like “my psychiatrist” moreover …

Some see it as a questioning of the single title, as well as the objective of “configuring” the profession, that is to say to place the psychologist under the tutelage of the doctor, a bit like with nurses for example. This is an old debate on relations between doctors and psychologists. I remind you that in many European countries, psychologists who intervene in the care of patients are considered as health professionals, and that their access is regulated by the prescription of doctors.

But in reality, it is not our subject: what we want is to succeed in better specifying the skills of psychologists who actually intervene in the field of health. As part of this approach, we also plan to extend the training of clinical psychologists by one year, so that they can offer them long internships in the hospital. Today, the psychology course ends with a five hundred hours internship, but it is not very supervised. Students have to fend for themselves to find a place of reception, sometimes with great difficulties. The internship supervisors are not approved, everything is done in a somewhat informal way, without specific educational objectives. These periods of professional practice can even take place in structures unrelated to the management of patients with mental health disorders, for example in surgery. Our objective: that it is no longer possible to validate training as a clinical psychologist without having passed through a psychiatric service.

The reform you describe concerns psychologists in training. What do you plan for professionals already in practice?

We would go through campaigns to validate the experience of experience for practitioners who would like to register in this system and be agreed by health insurance. We do not want to oblige anyone: what I want is to engage an approach which makes it possible to better codify the interventions of psychologists in the care path, and to give patients who need access to very precious resources for them, with recognized and validated expertise.

Should not also go to the creation of an order, a bit as for doctors and other health professions, so that patients have an appeal when they consider that their management was not suitable for their pathology?

From my point of view, an order is neither necessary nor sufficient to respond to the issues we are talking about here. Patients can already verify that practitioners are well registered with the RPPS, the shared directory of health professionals (ex-director ADELI), under the aegis of regional health agencies. This does not offer guarantees on the expertise of registered people, but it at least makes sure that they are well holding a diploma in psychology, unlike pseudo-therapists who abuse “psychiatrist” denomination. These psychocoachs, psycho-chaims and other psychogenealogists benefit from the fact that only the terms “psychologist” and “psychotherapist” are today protected. The first reflex to acquire for the population is to turn to qualified practitioners.

Then, “my psychic support” must allow patients to contact psychologists with validated skills, and it will go the same with the new device that we call for our wishes. Of course, there may be failures. An approved psychologist who proposed to his patients to enter into communication with “higher entities”, for example, was removed from the device after complaints from patients. But it is to my knowledge of an isolated case.