Proposition 53K3243

Projet de loi réglementant les professions des soins de santé mentale et modifiant l'arrêté royal n° 78 du 10 novembre 1967 relatif à l'exercice des professions des soins de santé.

General information ¶

Authors

CD&V Nahima Lanjri, Nathalie Muylle
Ecolo Muriel Gerkens
Groen Wouter De Vriendt
LE Catherine Fonck
MR Valérie Warzée-Caverenne
Open Vld Ine Somers, Lieve Wierinck
PS | SP Marie-Claire Lambert
Vooruit Maya Detiège

Submission date

Dec. 12, 2013

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health care profession recognition of diplomas mental health organisation of health care psychology access to a profession

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP Open Vld MR

Abstained from voting

N-VA LDD VB

Party dissidents ¶

• Peter Luykx (CD&V) abstained from voting.

Contact form ¶

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Discussion ¶

Jan. 30, 2014 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker of the Speaker. The lead author, Ms. Muylle, first emphasized that this was the result of years of debate and that it pursued a triple objective: the recognition of clinical psychologists and clinical orthopedagogues within the framework of Decree 78, the framework for the exercise of psychotherapy and finally the creation of the Council of Mental Health. In the end, it is topical!

The Minister of Public Health believes that this proposal meets a real health need. He supported the committee’s work and I thank him for that.

While recalling the many hearings of field actors that had been conducted, ⁇ within this parliament, the minister was pleased to see that a compromise was finally found by operating the synthesis of different movements and sometimes even the synthesis of different currents within the same psychological or therapeutic movement.

All the speakers supported the bill in its objectives, acknowledging an overall rise in illness and mental health disorders in our society. Moreover, the majority wanted to reiterate the importance of training and the strict framework of requirements set out in the proposal.

Together with several colleagues, I myself emphasized the importance of creating the various councils, namely the Federal Council for Clinical Psychology and Clinical Orthopedagogy, the Federal Council for Psychotherapy as well as the Higher Council for Mental Health. Like Ms. Somers, I have pointed out that the issue of reimbursement for these consultations would likely need to be addressed in the future.

Mrs Gerkens and Mr. Bacquelaine, on the other hand, welcomed that the proposal guaranteed the autonomy of mental health professionals.

Regarding the issue of psychoanalysis, the Minister wanted to clarify that it does not fall within the scope of this law. De Bont expressed disapproval on this point and therefore introduced a series of amendments aimed at amending the text. All of them were rejected. However, Ms. Fonck, Gerkens and Somers stressed the need to continue the debate with psychoanalysts and their representative organizations.

by mr. Bacquelaine then estimated that the many enforcement orders to be taken under this future law should be deliberated in the Council of Ministers, various amendments in this sense have thus been filed by the MR, the Open Vld and the CDH. The minister objected, arguing that these should, in any case, be taken after consultation and the opinion of the Federal Council of Psychotherapy. These amendments were rejected by a majority of the members.

Ms. Detiège, on the other hand, drew attention to certain points that should be clarified in the preparation of these royal ordinances, namely, in particular, the question of clinical sexologists and that of the distribution of competences between the different professionals.

Regarding the various recognised currents in psychotherapy, Ms. Fonck and Mr. Bacquelaine insisted that it was appropriate to follow the developments in the matter and that they should not constitute a limiting list.

On the initiative of Mr. Bacquelaine, an amendment was submitted and adopted by the committee to change the composition of the Federal Council of Psychotherapy. Those who have effectively practised psychotherapy within the framework and have held academic positions for at least five years will be proposed by the universities, after consultation with the professional organisations and not directly by the professional organization, as originally envisaged. These are people who have an academic background, academic functions and who, of course, fall under universities.

Regarding the composition of the Mental Health Council, Ms Gerkens would have wished other professionals to be involved. The minister, though understanding this concern, found it initially illusory.

Various purely technical corrections were finally made to the text, which was adopted by 12 votes and 2 abstentions by our committee, which thus worked well in a day.

I will now speak on behalf of the Socialist Party. Twelve years ago, with my colleague Colette Burgeon, we had filed the first text regulating the professions of mental health. Then my colleague Marie-Claire Lambert took over the flame of this bill and co-signed the text that is now under consideration.

Patients should be protected by providing quality care. It was then already an obvious and more than an obvious, a need to oppose a current, a vision that seemed to prevail at that time, and which consisted of trying to manage mental disorders through a system exclusively based on medicinal consumption, the consumption of certain products.

The direction chosen is, in any case, another, which I look forward to. It consists of a much more holistic approach to health, integrating both physical and mental problems. It is necessary to consider the individual as a whole, in phase with the reality on the ground, as evidenced by the many auditions we have conducted.

The discussion led us to the compromise we voted for in the committee. As I said, the goal is and has always been to ensure the protection of patients who seek support, accompaniment, but who do not always know whom to turn to or who are afraid of falling on what is commonly called charlatans. Indeed, if many practitioners in the field of mental health perform their work correctly, the deviations exist, and they must be put to an end. This protection of patients could only be ensured by ensuring that the professionals to whom they turn have the adequate training and experience to help them.

Through this proposal of law, there will no longer be proclaimed psychotherapist who will. To bear this title and those of clinical psychologist or clinical orthopedist, it will be necessary to meet the strict requirements that the law lists and which appear in our report.

This is a fundamental step forward for both patients and practitioners who are thus recognized and protected through a professionalization of their practice, but also through their own accountability. I think of the obligation to constitute a “patient” file, to redirect the patient to other competent care providers, or the obligation to respect the freedom of the patient.

Finally, while the plurality of basic training and the diversity of approaches are currently guaranteed by this text, the establishment of the various councils seems to us essential. It will create real future opportunities by opening doors to different guidelines and practices. This is also important in a sector that is and must remain in constant evolution.

Today we are setting fundamental milestones in taking care of the mental health of our population. My group welcomes the quality of the work carried out by all members of our committee and will vote enthusiastically on the proposed text.

The proposal presented today will improve the quality of psychotherapeutic, psychological and mental health care: patients will be able to use service providers with established recognition on the basis of knowledge and quality criteria.

This is a strong step forward, which I emphasize, which makes it possible to close a debate that has begun many years ago. The proposals submitted have been multiple and we have now achieved a good balance that now allows us to ⁇ the two objectives set.

These two objectives are, on the one hand, the need to secure the exercise of the profession and to ensure that everyone can resort to these care providers with the certainty of trusting themselves with quality persons; on the other hand, the valuation of the titles themselves and the possibility for clinical psychologists, in particular, to clearly register in the Royal Decree No. 78.

This phase was long anticipated by clinical psychologists and we are now reaching it with – this is important – a guarantee of autonomy for psychologists: indeed, it was appropriate to stay attentive to this principle that some previous bills questioned. This autonomy of psychologists has become possible thanks to the requirement of quality training required to carry the title in question.

Autonomy and quality of training go hand in hand: the higher the quality of training, the more autonomy can be ensured for psychologists and psychotherapists. This autonomy represents a freedom and, like all freedom, it must be accompanied by responsibility. This responsibility is dedicated to Article 5 of the project.

It was necessary to pay attention to the need for a relationship between the psychologist and the physician treating the patient when certain pathologies are concerned and certain forms of therapy result from them. However, the freedom of the patient must also remain guaranteed. The relationship between the psychologist and the doctor can therefore only be established with the consent of the patient and can in no way constitute a barrier to the recourse to the psychologist. It was important to find this balance.

The proposal meets these requirements, and we welcome it.

With regard to the regulation of psychotherapy, exercise has turned out to be a bit more complicated. At some point else, I wondered how many thousands of psychotherapists our country counted, so much we were asked and bombarded with emails every hour of day and night. Those of us who had not yet resorted to a psychotherapist even asked themselves questions.

The experience was interesting. We all had the opportunity to meet a number of psychiatrists. I confess to you that I have taken the measure of the seriousness of those people who advocated above all the qualitative aspect of the organization of the profession.

A training and certification system had to be agreed upon. Unfortunately, there are still charlatans in this area. One of the objectives of the proposal is to eliminate them. We probably will never ⁇ this ideal, but I think we are making a big step forward towards eradicating it.

As I said in a committee, I used to quote Nobel Prize winner Albert Claude as saying, “If you want to prevent a project from succeeding, demand it to be perfect.”

The recognition of psychotherapy will therefore protect the patient, who will have the guarantee that the holder of the title will have benefited from a valid training and that the care provided will be of high quality. The psychotherapist is protected because he is no longer exposed to the competition of people who have not received valid training or even no training at all. Let us not deceive ourselves, those who do not meet the criteria of this law will probably continue to practice with various qualifications. Psychotherapy in Belgium may not have ended with charlatanism, but I think we are progressing.

Psychotherapy interests a multitude of professionals and it currently admits multiple levels of prior training, academic or non-academic. There are many schools and paradigms. We asked ourselves the question in commission, rightly, of a necessarily reducing definition of the number of categories. This definition cannot be fixed in time; it will probably evolve as discoveries occur. The evolution of the neuroscience sector is today such that we probably still do not suspect the new directions that may occur in a more or less near future. The heterogeneity of schools leads to very different, sometimes even opposed interests, and we must wish that evolution remains possible in the sector.

Training in psychotherapy is for us a specialized competence whose most natural access is that of a master's degree in psychology or a psychiatric specialist doctor's training. We accept and recognize that an openness should be considered to allow people who have followed a different path to access psychotherapy training. We insist that persons holding a bachelor’s degree, for example, actually have the opportunity to undertake a university-type complementary training program – the law now provides for it – prior to the specific training in psychotherapy. This is the whole question of the prerequisite that is indispensable to guarantee the safety of patients. It is not conceivable for us to accept a leveling from the bottom but to pull everyone upwards.

We therefore want to protect patients through legislative guarantees of rigorous, transparent and controllable training.

This prerequisite must therefore allow to give bachelor students basic notions concerning psychology, psychopathology and psychiatry; the objective being obviously that the service provider thus trained can judge, if necessary, if, for example, he is not facing a somatic problem, and that he can thus refer the patient with full knowledge of the cause to a service provider otherwise qualified to treat the patient.

Let me stop for a moment on the legal technique used. Considering that this law is in fact a framework law, a kind of authorization law, I wish in committee that the execution decrees can be taken deliberately in the Council of Ministers. I have not been followed; this will obviously not prevent me from voting on the draft. You cannot always be right on your own.

On the other hand, as regards the composition of the Federal Council of Psychotherapy, I thank the members of the committee for accepting the amendment I have proposed, which provides that academics are appointed on the basis of their knowledge of psychotherapy, and after consultation with associations of psychotherapists, but by universities. It seems to me that this will prevent potential conflicts of interest and that the quality of the training decisions taken in the context of the necessary scientific bases will be further enhanced.

I am very pleased with this amendment and this law in general. Before I conclude, let me just make two incisions. One concerns psychiatrists. As we have repeated well in the committee, psychiatrists are already authorized to practice therapy using INAMI nomenclature codes specific to psychotherapy. We therefore reminded that this law will not deprive psychiatrists and the services they run of these nomenclature codes.

Second, we take note and support the distinction established in psychoanalysis. This may not be obvious to the patient. There is still a slightly vague range in this area; we will have to be quite precise in the guidelines to be given in this regard. Psychoanalysis, when it expresses a personal history of the patient, therefore, will not be concerned by this project. This opinion resulted in a large majority.

In conclusion, Mr. President, Mrs. Minister, Dear colleagues, my group will support this bill, being convinced that it constitutes a major advance for clinical psychologists, for psychotherapists, that it values and secures their profession, that it improves the safety of patients.

The draft text thus lacks the foundations for the exercise of high-quality psychotherapy, which will need to be properly framed in the future.

Ladies and gentlemen, I will shorten my speech, for your understanding.

This proposal was extensively discussed in the committee. As already stated, this discussion began twelve years ago following a proposal from Mr. Mayeur, which was later taken over by a number of colleagues. The final result is this bill, which is supported by most parties.

This proposal comes with reason. The rise of psychological problems is not only ⁇ by Belgium but also by the WHO. Unfortunately, in 2020, depression will be the second leading cause of disability. So that is a significant figure that everyone should shake up.

Good regulation is therefore essential. Our country must offer good psychological and psychotherapeutic guidance to the Belgians who need it.

The sp.a supports this initiative, which, as already said, has been preceded by many years of discussion because we recognize the importance of finally having a viable arrangement.

The process took a long time because it was difficult to find a consensus with the players on the ground. Each of us has heard of psychiatrists, general practitioners, psychologists, clinical psychologists, psychotherapists, representatives of universities and colleges, clinical sexologists, orthopedagogues and others. What I noticed during those conversations is that they all share the same ambition to optimize the care of those who suffer mentally. Therefore, it is important to take into account the critical comments they have made.

We want to ensure that the essence of the new law effectively consists in making a new contribution to better mental health care. The enforcement of the law is, ⁇ in terms of psychotherapy, dependent on a significant number of enforcement decisions and on the input that the Federal Council for Psychotherapy will give.

For this reason, the implementation of the law was justifiably postponed until 2016.

As part of an open debate, I will cite a number of examples of elements, as I did in the committee, which must ⁇ be submitted for evaluation. Everyone knows that clinical psychologists have been rightly asking for recognition for years. Nevertheless, there are other professions that make a valuable contribution to mental health care such as psychotherapists, clinical orthopedagogues and clinical sexologists. However, this latter group was not included in the bill.

We believe that at the time the law enters into force, all relevant groups should be recognized according to their contribution to mental health care. For clinical psychologists, clinical orthopedagogues and psychotherapists, the powers are defined in the bill. In order to avoid unnecessary conflicts of competence, the assessment of the concrete consequences of the allocation of competence remains a focus.

The training requirements and the pre-training requirements for psychotherapists were established on the basis of the information available today. It is therefore ⁇ not excluded that those insights on the subject will be refined in the preparation of the implementing decisions. We also received comments from various schools and training centers that all interpreted the scope of certain sentences differently, and these will need to be clarified in the near future.

The proposal that is being voted today, as in the past was the case with the notorious Cola Act of 1999, is extremely important, but it remains a framework law. This means that we will support the proposal in so far as it is the first step towards creating an effective functioning scheme.

For sp.a, the debate is ⁇ not over after today’s vote. We will ensure that the framework law will be effective in the future.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. After years of discussion, here is finally the legal framework for the recognition of psychologists, psychotherapists and clinical orthopedagogues. My colleague Lieve Wierick and I are especially pleased as Open Vld Chamber members. This is only due to the good cooperation between the many parties involved.

Today anyone can call themselves a clinical psychologist or psychotherapist. Therefore, there is a possibility that a patient will end up with a coconut ointment. The recognition of the professions was therefore urgent, ⁇ due to the increasing social demand for psychological assistance. I also referred to this in my question at the plenary session last week, when we discussed the figures surrounding suicide. It also showed that the Belgian is not easy to go to the psychologist and that it is difficult to talk about it. I think what is put to the vote here today can contribute to an improvement.

The bill makes clinical psychologist a medical profession, but the therapist must link back to the general physician and the treating psychiatrist may not prescribe medicines. This is a necessary revolution in the industry. Nevertheless, we must continue to ensure that, in the long run, this reform does not excessively pressure the social security cost bill. This remains a priority for Open Vld.

Additionally, as has already been said by other colleagues, it is important that the bill only creates a framework that will be developed in various implementing decisions that will ensure the concrete development and are therefore essential.

It is important to note that this legal framework must be constantly reviewed to the social reality and the situation on the ground. I give a few examples.

We talked in the committee about the difficult boundary between the psychotherapists who practice psychoanalysis and are subject to this law, and the psychoanalysts who are not subject to this law given their specificity. This needs to be closely followed in practice. The developments in the sector need to be followed up and it is necessary to consider whether additional legislative work is not needed in the long run.

As for clinical orthopedagogues, it is also appropriate to monitor the practice permanently. There is no mention of diagnosis in the definition. They can, on the one hand, detect and, on the other hand, treat. It is therefore clear to our group that this automatically also involves diagnosing. However, this must be continuously monitored in practice. It is also a pity for them that emotional problems were not included in their field of work because the behavioral problems they deal with are often a result of them.

These are some examples that show that it is very important to continue to test this in practice and adjust it where necessary.

Mr. President, I have been a grandmother of a little Louise for an hour, and that makes me upset. This is a great moment! And since my well-being is total today, I will be able to approach in a ⁇ positive way this bill which eventually became a collective bill proposal from different bill proposals filed.

As others have ⁇ , Ecolo-Groen has also been working on this case for more than a decade, not only to protect people who consult psychologists or psychotherapists but also because the health approach must be a global approach. It is true that the affective, relationshipal, psychological dimension is part of everyone’s health. Therefore, a whole pan was left on the side and it was important to take this into account.

Initially, the adopted text will not allow the interventions of clinical psychologists and psychotherapists to be integrated into the field of INAMI reimbursement beyond what is currently planned. This will be considered in a secondary way, once the entire arrangement of this law for recognition and clarification of requirements concerning these mental health professionals has been realised. We know that a deadline will be needed.

Among the elements that we wanted to remember more specifically in this work, it was important for ecologists that there is recognition of the autonomous exercise of clinical psychology and that it is recognised in Royal Decree 78 of health professionals. With regard to psychotherapists, we accepted the compromise aimed at first recognizing these people through access to the profession by setting quality, training and guidance conditions, so that we can eventually integrate them into the health professionals in a second time if the process goes well. At least this is how we see it.

When it comes to the requirements for psychotherapists, we are ⁇ strict. Of course, we have relaxed the rules of admission. Thus, the university deans ⁇ desired, at first, a master’s degree in psychology as the gateway to being a psychotherapist. Now, we know today that psychotherapy training exists, that they are serious. Some people do charlatanism. We want to avoid them. That is why we have drawn up this law.

These are specific, rigorous and demanding training for those who enroll. Among these requirements, there are, in addition to training, basic knowledge and skills, also requirements for development, transpersonal analysis work to finally be able to start this specific training.

Among these people, many are those who are not academics or psychologists in advance, who have studied as educator, as a social worker and then a series of complementary training. Having this requirement of bac in the psychosocial educational orientations, having also the intention to define achievements and skills to be able to start the specific training, it will be necessary that this training is organized and I do not see who other than the universities could implement it. We really tagged that not only basic training and then specific training in psychotherapy is high quality.

It was also important in our eyes that this specific training in psychotherapy was applicable to everyone. It is not because one is a psychiatrist or psychologist that one can consider and operate or work as a psychotherapist. This is another dimension. In relation to all these demands and aspirations, the proposal we co-signed and which was adopted truly meets our goals and concerns.

Among the important elements, note that the device set up will allow for evolution over time. It will be necessary that the Council of Mental Health and Psychotherapies sets up both the requirements, begins to approve training centers, approves future psychotherapists and necessarily, elements will appear as definitions to refine, to complete. Maybe new directions in psychotherapy will be recognized because there is evolution of practices, sciences and knowledge. That a law allows this dynamic evolution is an interesting element, especially in the approach to mental health.

I would like to clarify here that psychoanalysis is not concerned by this bill. I would like to pause a little on this issue. As it was said in the committee, if we succeeded in drafting this bill, it is because the different political parties worked together, that the minister agreed to participate in this collective work by involving all the parliamentarians who had worked on the subject, but also because psychotherapists and psychologists gathered around platforms and decided that they should agree to approach the political world and finally reach a text.

Along with the mobilization of psychotherapists and psychologists, psychoanalysts mobilized themselves. The latter were eager to defend secular psychoanalysis in its "none development" dimension while starting from the principle that this "personal development" can have a therapeutic effect in some people. That said, this practice is not psychotherapy as such.

The compromise is to say that in view of this dimension, psychoanalysis is not concerned by the law. In doing so, the psychoanalyst who wishes to exercise as a psychotherapist must, like the psychiatrist and psychologist, comply with the requirements. Nothing prevents you from being a psychoanalyst and psychotherapist or psychotherapist with psychoanalytic orientation from the moment you meet the requirements provided in the text of the law.

We can therefore only support the draft law that we have drafted together and hope that the various actors continue to mobilize so that it can be realised before September 2016. This would be good news and a great step forward in a comprehensive approach to health.

Mr. Speaker, Mrs. Minister, dear colleagues, I would like to thank first and above all the Minister and the colleagues of the Comoros Parties and congratulate with the bill for the regulation of the mental health care professions, after years of – has already been mentioned – disagreement between, among others, the Flemish and French-speaking politicians on that matter, which was once called the BHV of health care.

There is at least one legislative proposal. I know that it was not an easy exercise to reach an agreement. The ministers and the proposers of this bill may put that plum on their hat, because no one can deny that the regulation and recognition of the mental health care professions is of the utmost necessity, given the dramatic state of our mental health and the prospects that mental problems will become the disorders of the future, or surely and firmly underlie more than half of the disorders of the future.

Our mental health care needs to be organized more efficiently and, above all, made accessible to all and in time, which I mean preventive. Of course, mental health care alone cannot solve all mental problems, but this bill is a step in the right direction. Unfortunately, this is a very small step. Better a small step than nothing, Ms. Onkelinx said. That is so.

I ⁇ welcome the first part of the bill, which deals with clinical psychology and clinical orthopedagogy. In the committee and in the previous discussions there was not much discussion about this, but I cannot find myself in the second part, chapter three, which deals with psychotherapy. I could still agree to the compromise on the necessary training conditions if separate training conditions were set for psychoanalysis and the bill would at least also provide a clear legal framework for that discipline. We have discussed this in the committee extensively. I do not want to repeat that discussion here, but it is still unclear to me whether or not this bill applies to psychoanalysts.

This is mentioned in the report and the explanatory note expressly states no.

The lay psychoanalysts and the lacanian psychoanalysts who are active mainly in French-speaking Belgium, including through intense lobbying, are very happy about this. They do not want legal recognition because otherwise they would lose some of their autonomy, including in the field of their education.

On the other hand, one has the representatives of a different tradition, who are mainly affiliated to the oldest and largest association, the Belgian Association for Psychoanalysis. It is the only Belgian organization for psychoanalytic training recognized by the international psychoanalytic association, with the majority of psychiatrists and psychologists specializing in psychoanalysis operating in Flanders affiliated. They do not want to be excluded from this regulation. In direct contacts and in discussions in the committee, they are then shown that a arrangement has been made for them, but then under the name of psychoanalytic psychotherapists, and that nothing changes for psychoanalysis itself. That is a dubious. There are still colleagues who do not find this so clear.

I find this extremely unfortunate because one does not recognize psychoanalysis as such and does not mention it anywhere in the law, and therefore one does not provide sound training and experience conditions for the practice of psychoanalysis, which does not protect the citizen from malicious practices that at any cost want to stay outside the medical framework, but want to assume their clients that they can fix something to their mental health.

Especially now that a legal framework for psychotherapists has been created, there is a danger that those who are not eligible to bear the protected title of psychotherapist will offer themselves as psychoanalysts, while a sound psychoanalysis requires even more thorough preparation than the preparation for a psychotherapist.

After all, a psychoanalyst should be able to determine which therapy is most appropriate. It is much more than an accompaniment.

I had planned not to intervene, but you continue to hammer on it. You would not repeat the debate, but you do.

When I hear your presentation, I notice that you say all sorts of things that really do not conform to reality. It is true that today there are two major trends within psychoanalysis. The first is the school of Lacan, which exists mainly in the French-speaking part of the country and which does not want to be included in the bill. The majority of psychoanalysts belong to the Belgian School and the Belgian Association for Psychoanalysis.

You say that there are currently insufficient conditions to ensure that the training provides the required quality. Today, this training already exists at the Kuleuven. It is a postgraduate degree of four years. We are going to legally anchor what exists today in the field, a four-year postgraduate degree at the KULeuven. We will recognize them within the psychotherapeutic reference framework of psychoanalysis. In addition, we will be legally anchoring the conditions for the already existing training, colleague De Bont.

To say that there are no guarantees for training and that all this remains so is not true. For the majority of psychoanalysts, there is already a four-year training – bachelor, intermediate training and an additional training – at the Flemish universities. These quality standards simply remain.

The participants are very satisfied because if they meet the conditions of the proposal they will also be recognized within the psychotherapy. I think you should talk well with those involved.

Mrs. Muylle, I also have contact with those people and I know that training exists. That training is followed by a part of those who call themselves psychoanalysts. This is what my speech is about. The title of psychoanalyst is not protected by this law. You say that this may still be realized in the future, but the big problem is that some people will continue to call themselves psychoanalysts while not having the necessary training. They will still be allowed to carry the title because the title of psychoanalytic is not protected. This does not provide legal certainty, neither for patients nor for health care professions.

This is the point I want to do, Mrs. Muylle. There are indeed training programs arranged for what you call pychoanalytic psychotherapists. But you don’t want to talk about psychoanalysts, because some individuals want to continue working as psychoanalysts and don’t want to attend the training courses. This creates a legal vacuum for those who carry the title, and uncertainty for the patient, who does not know which psychoanalyst he goes to.

In addition, a difference is created between all who offer psychoanalysis. The psychiatric psychotherapists and the psychiatric psychoanalysts can continue to work and they can provide their patients with a certificate of the partial refund by the RIZIV. This was previously guaranteed and can still be done now. However, the costs for a psychotherapy session with those psychiatrists are usually higher, because they and higher personal share charge for their treatment. In addition, for the same treatment, there are the psychologists who offer psychotherapy and psychoanalysis. They can not provide a certificate so far, but they are exempt from VAT. A third group of individuals can offer the same treatment: the non-psychologists who offer psychotherapy and psychoanalysis. They are obliged to charge 21 % VAT to those who consult them.

That is the current situation. The present text does not amend it. It may be the intention to point the potential patients the right path, but it is not understood. The bill does not increase the access to sound psychological counseling, which could prevent a thorough medicalization of mental health care. Therefore, I regret that psychoanalysis is not regulated in the legislation.

In short, we think there are still many shortcomings in the bill. I think that could have been avoided with five minutes of political courage and with the proper use of the resources. Vlaams Belang has submitted a number of amendments in the committee, but as already mentioned in the discussion, that was in vain.

The minister does not deny that something in the future will need to be updated and supplemented, but considered this legislature no longer feasible. We regret that. We consider this a missed opportunity and we hope that no decades or periods of office will have to pass before that aspect can be settled. After all, the plum on the hat is only half a damaged plum.

The Flemish Interest Group cannot support the bill as it is presented. We will remember.

I hope not all of you are asleep. But ⁇ the various interventions have made you the effect of a psychotherapy.

Mental health is nothing but an anecdotic, it must be acknowledged. According to the World Health Organization, the disease is becoming the most common in the 21st century.

It is also known the evolution of the consumption of neuroleptics and other drugs. As colleagues have pointed out, there are also risks of charlatanism in these professions.

Neither psychology nor psychotherapy are gadgets. These approaches have their place in health care and their benefits for patients no longer need to be demonstrated as psychology or psychotherapy treatment is more effective than drug therapy alone.

The advances of this text are as follows. The patient will be better protected. This is of course the priority. Professionals will be credited. We will make the difference between the pros and the others. This text will also help to better inform and guide the patient on the indications and specifics of each treatment. It is true that it is sometimes nebulous and the patient does not always know whom to address. Furthermore, this text will maximize the benefit of this type of approach for patients.

We have pursued a quality goal, whether in terms of training requirement or strict ethical rules.

I have insisted, in our various discussions, on the importance of not carrying out this type of treatment in closed vase but rather in connection with other health professionals. This element is primary for the patient, for the quality of care, follow-up, diagnosis and treatment.

In terms of clinical psychology, writing the text and discussions were relatively easy. For psychotherapy, the opinions were, at first, more than divergent.

Once the text has been voted, it will remain to be debated to clarify nuances regarding the initial training, to prevent psychotherapy from fitting into the four current currents and to detail how to apply the law, that is, the implementation decisions.

Amendments were submitted, some of which were accepted and others did not. Per ⁇ , later on, this law will have to undergo remodeling; the future will teach us that.

So, my colleagues, is everything done? No to No! At least two points will remain to be resolved. First, the reimbursement of benefits in clinical psychology: clinical psychologists have been active for a long time and it would be time, beyond the title, for their benefits to be recognized. Second, the attribution of a framework to psychoanalysis: it will have to be taken into account in all its specificities. Furthermore, for the credibility of these professionals, I think it is important that they benefit from a legal framework.

Mr. Speaker, Mrs. Minister, colleagues, it is undisputed that this bill is a serious step forward for the recognition and further expansion of mental health care professions.

First of all, I would like to thank the Minister and the tractors in this dossier, namely Mrs Maya Detiège and Mrs Nathalie Muylle, for the openness they have shown to involve the opposition, in any case to involve one of the opposition parties, undoubtedly the most constructive.

Colleagues, I have a few comments, merely to complement what Ms. Muriel Gerkens said in her excellent presentation.

We had to do this reform in the interest of the patient, in the interest of protecting the patient from wildlife in the field. We have had a good and long debate on training conditions, on quality control, on quality care and have come to a good and balanced proposal. Of course, we and cours de route were confronted with differences across language boundaries, differences in training offerings and in culture. We have been able to overcome that and have been able to come to a balanced and good proposal.

There will also be established bodies that monitor the further development and expansion of what is stipulated in this bill. It is a federal council for clinical psychologists and orthopedagogues, focusing, among other things, on the training conditions and the training offer. For individual cases of recognition there is also a recognition committee.

It is obvious that the implementing decisions will be very important, but Ms. Gerkens has already talked about this.

It is also about the recognition and protection of the title of psychotherapist, just to counter that wild growth for a bit and to make clear to the patient who bears which title and with what right and for what reason, and also to make clear what training that person has ⁇ .

We have come to a good, two-part structure with a basic degree in health care professions, pedagogical sciences and social sciences, which can be completed quite widely. That is important. This can be achieved not only at universities, but also at colleges. Furthermore, there is the specific training in psychotherapy for several years. Here too, a federal council for psychotherapy is needed in relation to the training offer, to further monitor and refine it. Important for those who are already engaged in psychoanalysis and especially psychotherapy, is that a transition period is provided.

I will conclude with an essential point that has emerged several times in the discussions. The referral remains the responsibility of each practitioner of a healthcare profession. If a practitioner of a health care profession is faced with a medical diagnosis, then a psychotherapist who is not a doctor has the responsibility and duty to refer through.

The Conclusion . We have developed a good and balanced proposal. Of course it is a compromise, but even a compromise proposal can be a whole step forward and remove a whole lot of uncertainty in the sector. I think we did this effectively.

In the last decade, we have seen an exponential increase in mental health problems. This mental suffering is the result of various biological, psychological and social factors. The increasing complexity and pressure of today’s society requires people to have an ever-increasing capacity. People are looking for a quick solution. RIZIV figures show that in 2012 almost 283 million euros were spent in our country on antidepressants. Many agencies agree with us that too many medicines are prescribed too quickly and that too little is treated.

Often there is also hesitation to knock at mental health practitioners out of fear of falling into the hands of a fox salve.

We have spoken extensively about the great danger of charlatanism, especially in mental health care where patients are just very vulnerable and influenced. With this proposal, we have put an end to this. Since the law of 8 November 1993, the title of psychologist is protected. To date, there was no specific regulation for clinical psychologists, but from now on they are included in Royal Decree 78 of 10 November 1967, which creates a legal framework for all health professions, i.e. for doctors, dentists, kinesiologists, nurses, healthcare professionals and so on. They no longer work in the illegality, and that is important to us.

Also clinical orthopedagogues are included in the Royal Decree 78. For the first time now there is also a regulation for the exercise of the profession of psychotherapist. No one can simply own the title.

The establishment of the High Council for Mental Health also ensures that the three professional groups must work together on a number of issues on the problem of mental health care and can assist and advise the ministers in this country in the field of mental health care.

Colleagues, given the complexity of the problem and the diversity of the field of work of mental health, this proposal has had many feet in the earth. After more than ten years, we have finally been able to reach a compromise; several colleagues have referred to it. The patient, and that is for CD&V the most important thing, gets a quality guarantee and the healthcare practitioners are protected. That was the starting point and the main concern of everyone who worked on this.

This is a first important step. In this respect, we can speak of a framework law. Widespread powers shall be conferred on the King, who shall, on the basis of the advice of the federal councils established by law, have to draw up additional rules. These include, for example, the granting and withdrawal of accreditations of practitioners, the adjustment of the list of psychotherapeutic reference frameworks, the fields of expertise, the internships that psychotherapy training should provide and the conditions for continuing education.

The next few months are crucial. The sector must organize itself, together with the various professional organisations, and develop these technical aspects together with the members of the federal councils, so that the implementing decisions can be taken in a timely manner. By 2016, everything in the field must be operational.

Now that these professions are recognized, it is up to the next government to take a step further and make decisions, including regarding the reimbursement of psychological, orthopedic or psychotherapeutic treatments.

Mr Fonck also mentioned this. For CD&V, it is important to investigate that refund, especially in the light of certain care paths and care paths for chronically ill people. After all, our health care has evolved so that in many cases the entire trajectory from the diagnosis to the treatment to the aftercare, by the various healthcare providers, already takes place in a multidisciplinary context.

Finally, Mrs. Minister, I would like to thank you for the cooperation and for the support I would ⁇ receive in the first part of the proposal from your cabinet, also on the technical level. I would like to thank my colleagues for the constructive cooperation in this dossier and not least the trade unions and the representatives of colleges and faculties.

Colleagues, I know, it is a framework law and a first step, but o such an important step.

We have been discussing the recognition of psychotherapy in Belgium and within this parliament for fifteen years.

During all these years, it is true that an extraordinary work of hearings has been carried out by the committee and sub-committees. But after all these years, we had to find that we were in a bag of nodes: difficulty in reconciling the views between professionals and between parliamentarians.

And then, about two years ago, a barometer was published following a study conducted by a mutuality. This showed that there was not only a huge expectation in mental health care, but that the situation of our fellow citizens was challenging.

The suicide rate in Belgium, for example, is much higher than the European average. Among young people, suicide attempts reach 16 percent between the ages of 16 and 25. A constant call for help is received by general practitioners, who also call for help to be supported in the framework of mental health care.

And then there are these unheard numbers: every year, 1.1 million people consume antidepressants in our country. The number of medicines consumed in 2012 exceeded - keep it tight - 230 million!

And yes, it was time to intervene. I wanted to take, with my team and administration, my part in this struggle, in this work. I saw a lot of professionals; and I saw all the parliamentarians who had invested in the debate. It was obviously not for me to confiscate this debate in parliament – it would have been totally stupid – but rather to try to find the path to consensus.

It was not easy. There was a fundamental debate about whether all psychotherapists should be considered as health care professionals recognized as such in this famous decree No. 78. There were profound differences in views on this subject.

Another question arose. Should, yes or no, the initial training of psychotherapist candidates be taken into consideration, or should their individual path, diversity, plurality of practice and professional training be taken into consideration? Gradually, we found consensus that I consider interesting, intelligent about subjects some of which are recognised in the decree – I think here of orthopedagogues and clinical psychologists – as well as a framework of qualification to bear the title of psychotherapist.

This was achieved after 15 years of work. This is a very good news. This does not mean that from day to day everything will be arranged. First, people without training will continue to use appealing titles for vulnerable people. The French and Dutch dictionaries are important enough to “offer” consciousness managers, coaches of this or that. Not everything can be framed. But, in any case, the population will know that if they consult a psychotherapist or a psychotherapist, the latter or the latter will be a man or a woman who has undergone a serious initial training, a serious professional and continuous training.

In addition, some time will be needed. We have two years to carry out all the execution orders. In this regard, let me emphasize that in the first rulings, we will finally constitute a Council of Mental Health and a Council of Psychotherapy. This is the evidence that an increasingly important place will be given to mental health in our country.

And then, but this will be the subject of another debate, under another government, with another parliament, we will have to decide on the question of whether, yes or not, reimbursement of psychotherapy sessions. This is a difficult question.

You know, I think it will be necessary to open the door, probably within a limited framework, at first, in care journeys including a network of general physicians, psychotherapists, social aid in particular, around a suffering person. But for now, too many women and men who are suffering do not have the psychotherapeutic support they or they should benefit from, for budgetary reasons.

I would like to thank you very much for the very high quality work that has been done. Together with you, I would also like to thank all the professionals who not only invested but who, too, found the path to consensus.

March 27, 2014 | Plenary session (Chamber of representatives)

Full source

I am referring to the written report.

Mr. Speaker, thanks to the Senate, we have been able/must have this important bill discussed for a second time in the committee. During the first discussion, I had already made it clear on behalf of my group that, as far as we are concerned, there is a lot wrong with this draft. The recognition of clinical psychology and clinical orthopedagogy is okay for us, but with the recognition of psychotherapy we had some problems. However, our concerns were wiped out of the table without any discussion. It is wrong, it turns out.

In preparation for the discussion in the Senate, the Wetsevaluation service reviewed the text once again and found that there were many legal uncertainties.

For example, it is very questionable whether the federal legislator has any authority to determine the content or modalities of the training of a psychotherapist. Current jurisdiction says no. The Minister also acknowledged in the committee that some consultation with the Communities is needed on this.

The crucial question remains: what will happen if the Communities do not want to recognize training? Can psychotherapists be recognized?

The Wetsevaluatie service also has questions about the disciplinary sanctions, more specifically regarding the constitutionality of Article 46. If the sanctions imposed by the King contain a temporary or definitive ban, this must be regulated by law and not by a royal decree. Therefore, it seems to us essential that the discussions continue until there is clarity about the recognition of psychotherapy. We proposed to ask for an opinion from the Council of State, but that was also deleted.

There was another uncertainty. According to the Department of Medical Law of the KU Leuven, the definition of “clinical psychology” as it is now available would have the unexpected effect that psychiatrists are also criminalized when they treat their patients. This could never have been the intent of the authors of the bill.

Our group is still convinced that this bill is not mature, not finished. We will therefore abstain.

I would like to point out the importance of the amendment. A few weeks ago, we voted after a long time of consideration.

The proposed amendment completely eliminates the discrimination concerning social promotion institutions providing higher education, in the context of access to psychotherapist training; these institutions are subject to the same quality assessments, thus qualifying in the same way.

The fact of ⁇ ining in the text the phrase "full-time teaching" was discriminatory compared to the social promotion that very correctly qualifies psychotherapists.

I welcome this amendment.