Proposition 54K1848

Projet de loi modifiant la loi du 4 avril 2014 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 et modifiant la loi relative à l'exercice des professions des soins de santé, coordonnée le 10 mai 2015.

General information ¶

Submitted by

MR Swedish coalition

Submission date

May 23, 2016

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

health care profession doctor recognition of diplomas mental health paramedical profession psychology access to a profession

Voting ¶

Voted to adopt

CD&V ∉ Open Vld N-VA LDD MR

Voted to reject

Vooruit PS | SP DéFI PVDA | PTB

Abstained from voting

Groen Ecolo LE PP VB

Party dissidents ¶

• Kristof Calvo (Groen) voted to reject.
• Muriel Gerkens (Ecolo) voted to reject.

Contact form ¶

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Discussion ¶

June 29, 2016 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, colleagues, the Public Health Committee discussed the bill in first reading at its meetings on 24 and 31 May. On 14 June, the draft was discussed in second reading. The Government has also called for the urgency of this draft.

The discussion of the draft began with Mr. Onkelinx’s request to organise an hearing. She pointed out a delicate dossier, on which a broad consensus should preferably exist. Mrs Van Camp, observing chairman, recalled Article 28 of the Rules of Procedure, which provides that in the absence of unanimity a majority vote must exclude the organization of a hearing. Colleague Thiéry asked the Minister whether the draft had had a prior consultation with the sector. Mrs. Muylle also pointed out the history of creation. In 2012-2014 there were roundtable talks with the sector and then there was no consensus possible. Then and now, the Minister has decided to make progress and submit a draft. It is important that the design can enter in September 2016. Subsequently, the Minister handed over the list of persons he heard during the preparation of his draft. The committee rejected Ms. Onkelinx’s proposal to organise hearings with 11 votes against 3.

Subsequently the introduction was given by the Minister and the general discussion was opened. Collega Hufkens recalled the long trajectory of this dossier. Qualitative progress is being made in healthcare. On behalf of her group, it is obvious that psychotherapy should be evidence-based. It was also asked whether the minister also considers regulating the profession of clinical sexologists. The colleague also stressed the importance of the law entering into force in September 2016, as stipulated in the government agreement. The colleague also calls for an immediate repayment, also within the framework of the future budget.

Collega Onkelinx recalled that when she dealt with the dossier in her capacity as Minister of Public Health, she made every effort to take into account everyone’s opinion. Eventually, a compromise for a minimum training, supplemented by a theoretical and practical internship, was approved. The present draft does not follow this. Ms. Onkelinx also overlooked the concerns formulated by the State Council and came to the final conclusion that the draft is simply unacceptable. His vision is purely corporatist. The draft comes back to an agreement, a compromise, obtained after years of discussion and months of work between majority and opposition, between Dutch-speaking and French-speaking, between the actors on the ground. According to her, the text testifies to an unimaginable lack of coherence, it does not take into account the reality in the field and it will in no case provide the opportunity to protect the patient in an effective way, as was possible in the law of 2014.

Ms. Muylle recalled the creation of the law of 2014. The committee then decided to proceed in a phased manner and approved the compromise text. The committee considered it important to create a legal framework for the reimbursement of mental health care. The design implements the principle that psychotherapy can only be performed by a doctor, clinical psychologist or clinical orthopedist. Nevertheless, many bachelors today deliver brilliant work in mental health care. Mrs Muylle also pointed out the importance of very broad transitional measures and of the perspective offered to the bachelors, including the perspective of a cooperation between private institutions, colleges and universities.

Ms. Somers said that she also considers it important that the law effectively enter into force in September 2016. According to her, the twist point in the debate is the positioning of psychotherapy. In the present draft, psychotherapy is not recognised as a separate profession, but rather as a form of treatment that can be applied by persons who have already completed a certain prior training, acquired a professional title and also have a recognition and a visa. The integration of psychotherapy in the law of 10 May 2015 provides, according to Ms. Somers, the necessary guarantees in terms of quality. The transitional measures are also very broad.

Colleague Jiroflée pointed out that the 2014 law was intended to respond to an influx of psychotherapists, but that aspect is completely eliminated. The transitional measures planned by the Minister do not change that. She also says that her group is concerned about the quality of care that the patient is entitled to. This quality of care was guaranteed in the law of 2014. By limiting access to the profession of psychotherapist, it not only reduces the diversity of therapeutic approaches, but also threatens to cut the supply of care. Collega Jiroflée also stated, among other things, that the proposed bill appears to have been written tailor-made for certain occupational groups in order to ensure that certain persons are no longer allowed to practice psychotherapy in the future.

Ms. Dedry pointed out four different points of the design and also formulated four concerns. She pointed out the importance of the legal basis for psychotherapists, with the prospect of reimbursement. Furthermore, she was also positive about the broad transitional measures and about the minimum skills imposed by the bill to separate the cattle from the wheat. The bill also provides a place for psychotherapy in healthcare.

However, Ms. Dedry had doubts as to the seriousness of the pre-established minimum standards for access to the profession. She also supported Mrs. Muylle’s observation that bachelors who had previous medical education should be able to benefit from transitional measures.

Collega Caprasse wondered why the minister abolished the profession of psychotherapist and reduced psychotherapy to treatment. She found it incomprehensible that some members opposed the law in 2014 and now support the present bill. She also carried out training. According to the design, it is enough to have a master’s degree in clinical psychology or to be a doctor. She also wondered what the place of the sexologists is in the design.

Colleague Thiéry believed that everything should be done to protect the patient. This means that the healthcare provider has ⁇ a training that meets scientific requirements as well as the patient’s expectations. In 2014, the MR group already encouraged the approach to include psychotherapy as a type of treatment reserved for clinical psychologists, orthopedagogues and doctors. Mr Thiéry recalled that his group has always held the view that the training in psychotherapy is a specialized competence, with the most natural way of access either a master’s degree in psychology or a degree in medicine. Mr Thiéry was also pleased that the training will be given to universities and colleges.

Mr Senesael referred extensively to the opinion of the State Council of 29 March 2016.

Collega Gerkens regretted the process in which the actors involved were not heard and the debate was therefore extended. The draft law does not provide additional protection to the patient. Furthermore, colleague Gerkens stated that the training in psychotherapy as such does not exist and that the training as such is a sub-training. Educational institutions primarily train practitioners, such as doctors, clinical psychologists and clinical orthopedagogues. According to her, the basic training of a general doctor is not enough to start a training in psychotherapy. She also criticized the composition of the Federal Council for Mental Health Professions and shares the opinion of colleague Onkelinx after reading recent scientific literature.

Collega Janssens limited himself to two questions relating to the composition of the Federal Council.

After a long debate, the Minister responded to the various questions by once again clarifying the objectives of the draft, including that the draft law aims to maintain the diversity of treatments and that the freedom of therapy is liberated. Mental health care should be included in the Coordinated Act of 10 May 2015 on the exercise of the health care professions because the patient must be assured that his provider has received a quality training and that the quality of care will be monitored.

The Minister concludes his speech with a response to the comments made by the Council of State.

Mrs Gerkens begins the second round with the words that it is unacceptable for her that the university law should be amended because they refuse to organize the bridge program.

She also stressed that reimbursement for mental health care should be regulated. According to Ms. Gerkens, the draft leads to a drastic reduction in the number of healthcare providers from whom the interventions are reimbursed.

Colleagues, then follow the article-by-article discussion and the vote, without a final vote, which took place on 14 June 2016. The committee then held a second reading of the draft.

Mr Senesael then began to argue that the profession of psychotherapist is not recognised. He continues that the legislator ignores the wealth of well-trained professional practitioners.

He also considers that the Federal Council for Mental Health Professions is insufficiently representative.

Ms Fonck began her speech with the fact that she agreed to the objective of providing the patient with a value added in terms of quality.

Ms Fonck also considered it a good thing that attention is paid to the accessibility of health care. However, she has comments on the offer of care for the patient and on the transitional measures.

Finally, Ms. Fonck also stated that she is concerned about the impact of the design on the structures employed by psychotherapists, as those practitioners lose their autonomy.

Mr Frédéric discussed in his speech the rights acquired and the protection of the title of psychotherapist. He argues that, by not providing for an authorisation or recognition, the legislature does not provide sufficient protection to the patient.

Also Ms. Gerkens shows from the report of the first reading that a lot of questions remain unanswered, including questions about the concrete consequences of the position held by the minister on psychotherapy and in the exercise of the title of psychotherapist.

She also considers that the responses of the Minister regarding the specific description of the supervision are not sufficiently clear.

There were also insufficient answers to questions about the possibilities of repayment, the reference frameworks, the training centers and the composition of the Federal Council.

Minister De Block stressed that she continues to believe that psychotherapy is a form of treatment that is part of psychological treatment. Those who provide psychotherapy within the framework of the project will also be called a psychotherapist.

The patient should also be protected as much as possible and the accessibility of care should be sought. According to the minister, she wants the draft to connect the struggle against phosphorism and sectarian washing.

The Federal Council should be established as soon as possible, as it plays an important role in the drafting of implementing decisions. The minister concludes the debate with the fact that a pacification is indispensable. Hence the broad terms contained in the transitional measures.

The entire bill was adopted with 10 votes against 3 and 2 abstentions.

Mrs Muylle, I would like to thank you for the report and inform you that the general discussion has been opened.

In addition to the report, I would like to briefly communicate our views in this dossier. Let me be clear, I think today we are taking another important step, just like in 2014. It is an important step to create the necessary safe framework for the patient-client who is in an extremely vulnerable situation.

We know the context very well. There is an enormous increase in psychological care in our society. We prescribe too much medication, we treat too little, we have too long waiting lists and the financial thresholds are often too high. The repayment should come quickly, but this cannot be done without the recognition of healthcare providers and a strong organizational model of our mental health care.

This project is a first important step in this regard. It amends the 2014 law on some fundamental points that prevented the implementation of the 2014 law. In particular, it concerns the procedure before the Constitutional Court of Orthopedagogues, the inability to organize the bridge program and the complexity that has arisen in the issuance of authorizations for psychotherapists as a result of the sixth state reform.

Colleagues, the observations of the orthopedagogues are addressed in the draft by incorporating a minority counsel in the Federal Council and adding a diagnosis to the definition. These questions were also on the table in 2014, but due to the very different educational landscapes in both regions and the lack of a full-fledged master in French-speaking education, it was impossible to integrate this at the time. In the future, access to psychotherapy will only be made possible for the masters.

Of course, at the first reading, I was also upset, because in 2014 we made different choices. Through the bridge program, we saw the bachelors infiltrate in psychotherapy.

I have also experienced how one has silenced in the last year to be able to realize this bridge program. If this does not succeed, then I think that choices must be made. I also see the benefits of the encapsulation of psychotherapy in KB no. 78, which was not possible in 2014 because the minister then only once decided to open the KB, only for psychologists and orthopedagogues, and we then rightly sought a solution outside the KB.

Thro ⁇ the debate, I have always asked for three points of attention.

The first point of attention is the appreciation for those who are doing great work in the field today. The skills acquired must be honored, they must be validated.

The extensive transitional measures proposed today give that guarantee, whatever it may be said.

The additional requirement for non-health professions to cooperate with other health professions is also strong. This is not a negative discussion about autonomy. It is for me a positive discussion about cooperation, networking and multidisciplinarity of our care, which must work reinforcing for all healthcare providers and which is the only right path for the future.

My second concern is to also give a future to the many bachelors who see their future in mental health care and cannot or want to take the first step to a master’s level.

With the supporting GGZ profession, we give them a very nice perspective there and we also fill a need on the ground, which is in high demand. I therefore ask the Minister to work swiftly, together with the Communities, on the supporting mental health care profession.

Thirdly, I would also advocate not to interpret the access of the masters too narrowly and also to quickly expand the list. I think, among other things, of the masters of psychiatric nursing and the sexologists, which is also made possible by the design.

The further involvement in practical sessions, both for graduate psychologists and in the therapy training, is also positive, as is the inclusion from 2017 of the therapy training within the educational field, by allowing them to collaborate with colleges and universities.

Colleagues, training courses for recognized health professions or acts should therefore be encapsulated in the field of education.

Is this design ideal? and no. Does it deserve our support? and yes. It will also be important that the many royal decrees are done quickly and substantially well, Mrs. Minister.

Will there be any more euphemisms on our way? Certainly, because for that, the working field is complex and the file is also complex, but let’s solve it together.

I would therefore like to thank everyone, both ministers, their employees, colleagues of the majority and the opposition, for the long journey taken in the dossier.

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, Mr. Speaker, Mr. Speaker, Mr. Speaker. She has morality in Berne, I obviously do not teach you anything.

The latest check-up of the Belgian health system, conducted by the KCE, INAMI and the Scientific Institute of Public Health, shows that the number of suicides is high, the consumption of antidepressants is constantly increasing and the support in psychiatric institutions are constantly increasing.

We know that there is a very large variety of mental suffering: depression, burn-out, ill-health are becoming more and more common. And if the feelings of anxiety, impotence, loss of landmarks, self-confidence that arise from them must be taken care of, they must obviously not be done only by the consumption of medications.

Of course, drugs are effective in treating certain mental pathologies and certain disorders, but they are not in all cases, on the contrary. Taking care of certain mental sufferings through speech, dialogue, communication is in fact essential, beneficial for the patient. This is the very essence of what is called psychotherapy.

To name just one example, I will talk about depression management. According to a KCE report published in 2014, psychotherapy combined with antidepressants should be the preferred option in this context. And if the patient with major depression does not want combined treatment, it is psychotherapy that should always be offered as the first choice, because it is at least as effective in the short term as drugs and it is more effective in the long term.

A psychotherapy conducted by a quality practitioner therefore offers chances of healing and well-being. And when reading scientific literature, what characterizes a good psychotherapist is his ability to adapt, flexibility. It is in fact this reactivity by which the psychotherapist adapts his intervention to the patient and to his particular situation in one goal: to create a relationship of collaboration, help, trust in order to maximize the effectiveness of his intervention.

I would like to welcome the work of these many professionals who, today, provide effective and indispensable assistance to those and those who feel the need. In this matter, it is necessary to be able to remove the eyelids, to get rid of prejudices, to open up, to listen, to look, to become fully interested in this area so specific as psychotherapy, at the intersection of medicine, psychology and social sciences. Psychotherapy is complex and should not be considered as a simple medical act.

To make my point clear, I would like to give a precise example, which is that of Siegi Hirsch, awarded the "Mensch" prize of the year 2002. It is recognized in many countries as one of the forerunners of family therapies in Europe. Jew of German origin, it was in a concentration camp that he forged his idea of the individual, of his ability to change and of the importance of the imaginary as a refuge against barbarism. He was first educator in children's homes, but only much later will he study as a social worker. To help the teenager in difficulty build an identity, he preferred an approach related to how his family works. In France, Siegi Hirsch passed on his experience of therapeutic work in an institution. He has trained educators, psychologists, judges for children. Without knowing it, he also passed his approach to hundreds of family, couple, and institutional psychotherapists in Belgium. He has trained trainers of trainers. He has trained an impressive number of psychiatrists. One of the psychiatrists also said of him that "when he takes care of families of deported, Siegi encourages them to remember positive anecdotes that go in the direction of life rather than work through reemergence of trauma. It was through his thinking, his work as a pedagogue and psychotherapist that he contributed to the work of memory."

This is a reference that should lead us to reflect. This example allows us to observe that from a lifetime experience and serious practical training, this man has been recognized worldwide as a reference in psychotherapy.

Today, with the bill that many are about to vote, Siegi Hirsch could not be recognized as a psychotherapist. Let us not cover our faces. Alongside experiments like this and high-quality psychotherapists, there are also charlatans. Derivatives exist, as do harmful interventions and abuses.

For several years, some, in particular parliamentarians, have considered it necessary to frame the practice of psychotherapy with one and only goal: that of protecting patients. And in the matter finally, two trends were very quickly distinguished: on the one hand, those who believe that the diploma must prevail and, on the other, those who believe that it is the training that is essential. Is it really necessary to see things in such a dichotomical way in this so complex area?

While I was Minister of Health, it is without preconceived opinion that in close collaboration with the parliamentarians of the commission, majority as opposition, we had decided to take this problem hand in hand. A complex but fruitful work that had resulted in an important consensus between these trends I have just mentioned, between majority and opposition, a consensus responding to the different sensitivities between the North and South of the country, between the actors in the field and between the different currents. The aim of this law was to protect the patient by guaranteeing trained and experienced professionals to help him.

It was also an important advance for practitioners themselves, clinical psychologists, clinical orthopedagogues and psychotherapists who were thus recognized and protected through a professionalization of their practices. This text was ⁇ not perfect, like many. It ⁇ deserved some adjustments and clarifications: a law-program and implementation resolutions would have resolved it without difficulty.

Instead, Mrs. Minister, you are completely questioning the compromise achieved and, it is true, you have been supported by parliamentarians who have completely turned their jackets. I have in mind what Mrs. Muylle, who left in the meantime, who had been an ardent defender of this conception of this law and who, today, claims exactly the opposite.

Mr. Speaker, I would like to point out that I will let Ms. Onkelinx go further in her approach and in her speech. But in my speech, I will answer a number of accusations that are raised by Ms. Onkelinx and with which we obviously disagree.

To say that he will intervene, it is interesting!

You are harming the very essence of psychotherapy which, in your opinion, must also be based on evidence. To submit this practice to the only logic of evidence-based medicine is to ignore the importance of subjective elements, life elements, and above all, the scope that words can have in the relationship between the patient and the psychotherapist.

There has been a lot of discussion about what psychotherapy is compared to medicine. Why should psychotherapy be able to deviate from the logic of evidence? Medicine seeks an adequate response to remove a symptom, a treatment that removes a cause. Psychotherapy mobilizes the resources of the person, the family, their network to increase their freedom of choice. There is no single good solution. The causes of unhappiness are either exogenous, then we seek what power we can have over these causes, or endogenous, then we will seek to restructure the way proper to the person to think, feel, act. The work is done in a relationship process and in a specific epistemological framework.

This definition helps to understand why, in the matter, it is questionable to want to work as if it was a medical act like another on the basis of all this reflection on the evidence. Increasing the objectivation of care will inevitably lead us to the objectivation of mental illnesses. I am already afraid that if a refund of these care should be considered in the future, it would then be linked to what is traditionally called a care journey: “Madame, you have an anxiety disorder. You are entitled to four sessions of psychotherapy. After that, it will have to get better. And if this is not the case, much worse!"The psychotherapist will simply become an intermediary who can no longer freely judge the follow-up to the treatment. The patient, he, will no longer be able to benefit from care adapted to his situation, which can be moving, as is known.

I said it; you reduce psychotherapy to a mere medical act and seem to make a corporatist choice by restricting its practice to only clinical psychologists and clinical orthopedists. You prioritize a trend by prioritizing the diploma over the experience. You clearly give the impression that a community orientation has been chosen.

For you, people who currently train psychiatrists could not welcome patients as psychotherapists because they do not have the degree planned, because they are not in the three professional categories you have held.

And then there is what I call “the consolation lot”, the “consolation lot” for those who already practice psychotherapy, since everyone will be able to continue doing it. It was felt there that there was a negotiation, that a part of the majority was not quite agreeing to return his jacket completely and, therefore, negotiated something for the transition period. All psychotherapists, good and bad, will be able to continue exercising for a very long transitional period.

Currently, students in training will also be part of the transition period. You can imagine the deadline. The negotiation between the two trends of the majority, we see what it has brought.

During this transitional period, the madness is that the safety of patients is absolutely not guaranteed. There is no distinction between a psychotherapist who subscribes to extremely strict training requirements and others. In the Public Health Committee, Mr. Frédéric, who has long presided over the Sects Committee in Parliament, explained to you the sectarian deviations that continue to increase in medical matters. This is all the more true because you no longer even recognize the four currents specified in the 2014 Act. This would enable patients to provide suitable, diverse, clearly defined care, while excluding certain harmful or questionable practices. Today, you merely tell us that these currents are outdated without being able to specify in what field psychotherapy should be practiced in the future. Pluralism, yes, let go of it, no! We are far from the rigour you claim to defend.

Finally, your way of working is dividing, it is contemptuous and that deeply disturbs me. This bill, whatever you may say, was drafted without much consultation with the entire sector. Just recently, at the invitation of a large part of the industry, we attended a press conference where more than sixty representatives of associations not only criticized the project but said: “Stop lies!” When you say that we negotiated this project, that we listened to the whole profession, that is not true!

Your project is constantly being denounced. There are petitions. Opposition letters are increasing. They come not only from psychotherapists, but also from leaders of institutions, directors of training institutes, teachers, academics, student representatives. There is therefore a major problem with the future application of this law, because it is absolutely not carried by the majority of those who practice psychotherapy on a daily basis.

But beyond our fundamentally divergent visions, your bill is filled with shortcomings, inaccuracies, ambiguities and contradictions. This is also stated by the State Council. All this, of course, can only be harmful, both for patients and practitioners. The state council was strict with your project. Without a doubt, if this bill is voted as it is, its journey will not stop with the vote in parliament.

So I said: flaws, inaccuracies, ambiguities, and contradictions. As for the practice of psychotherapy, first of all, it is a radical change of direction: in the future, only physicians, clinical psychologists and clinical orthopedists who have undergone a specific training will be able to practice psychotherapy. You say you are based on the opinion of the Higher Hygiene Council of 2005. But we have to be accountable. Either you have not read it in its entirety, or you have selected only the parts that agree with you. You want someone who defends a supposedly rigorous principle view, you will allow me to be skeptical.

Recently, one of the professionals who participated in the drafting of the opinion of the Higher Hygiene Council ⁇ strangled following the remarks you made regarding the interpretation of this opinion. The Council says that health professionals candidates for a specific training in psychotherapy will have followed with fruit the teachings of master level, but it also says that this may not be the case and that training supplements are therefore necessary.

This is a party taken by you. I regret, of course, that this opinion has not been followed on this point as on many others.

Beyond this aspect, by restricting the practice of psychotherapy to these three categories of professionals, you clearly reduce the supply – and I speak, of course, of the quality supply – at a time when mental health problems within the population are clearly on the rise. I have already said it; Ms. Muylle, in her speech, also recalled it. So, we are witnessing a growing need for psychotherapy and a decrease in the quality offer. It is enough, by the way, to see the waiting times to get an appointment in a mental health center or with a health care professional.

More seriously, as you place the supervision of the practice of psychotherapy in the hands of doctors in particular, the risk of greater medication of disorders is not to be neglected. I remind you that they are also prescribers, that medication only works in a small number of patients and that we have been struggling for years to reduce the consumption of antidepressants in our country.

Finally, and this is one of the biggest contradictions of this project, you are integrating psychotherapy into the law of 10 May 2015 on the exercise of health care professions "so that quality guarantees and protective measures are applied". You will apologize to me, but it makes absolutely no sense to include it in this law, since you no longer consider psychotherapy as a profession. In addition, you do so without subordinating the exercise of it to any authorization, as is the case for other health care professions. No requirement in terms of continuing training or practical hours is mentioned. Therefore, I do not think that you will protect the patient with this new legislation.

In terms of transitional measures, there too, the patient is in danger. You are opening extremely broad transitional arrangements “for,” you say, “to respond to what is currently happening on the ground and allow for calm.”

Therefore, you clearly acknowledge that you have not taken into account the specifics of the field. You do nothing to protect patients. Patients who may find themselves facing incompetent practitioners, or even charlatans, who have undergone fantasy training or who do not have the necessary psycho-medical-social skills. At the same time, practitioners with decades of experience will need to be supervised by healthcare professionals who will come to complete their training in psychotherapy but who, for their part, will be able to exercise independently, while they will have no experience. The primacy of the medical degree over training and experience, again at the expense of patients and practitioners, one begins to get used to it! The way you are considering treating osteopaths is ultimately not very different.

In terms of training, there are also inconsistencies, ambiguities. You plan on a specific training of at least 70 credits provided by universities and colleges, as well as a professional internship corresponding to two years of practice. I still cannot understand. Either the planned training will be extremely demanding – so it will be difficult to put it into practice for practitioners and future practitioners – or it is not at all and it is no longer a training that will actually protect the patient.

But the most dramatic thing in this context is to ignore the richness and diversity of approaches of training institutes, which sometimes have been organizing specific long-term training for years, and which otherwise already collaborate with universities. These are the indispensable pillars of the profession to which you turn your back. I remind you that institutions, in anticipation of a political compromise that has been expected for years, have continued to form appropriately for most. Today, if this project continues, they should put the key under the straw.

A few words more about the Federal Council of Mental Health Care Professions and the exercise of clinical psychology and clinical orthopedagogy.

I would still like to say a few words to highlight the little consideration you have, Mrs. Minister, for these professionals and their specific experience. In fact, you believe that doctors can practice clinical psychology and clinical orthopedagogy because "current medical training pays more and more attention to the psychosocial aspect". Reducing the support of mental health care in our society with such an argument can make us doubt your real willingness to protect the patient.

Finally, I come to the single Council that you have decided to set up. You have simplified. I do not see any disadvantage in this simplification. This may even be a good thing. But it is this Council that will ⁇ have to decide on the future of the practice of psychotherapy, he who could potentially not have any practitioner of psychotherapy within him. It is simply notorious. I stop here because the shortcomings and ambiguities of this project are obviously much more.

Humans are complex, so are mental health problems. Ensuring quality mental health care and patient safety was our goal in 2014, which is clearly not your case today, Mrs. Minister.

In an open letter that was addressed to us, someone said that “the air of time increasingly treats individuals as things and the sick as diseases.” This is a narrow vision of health care. And, unfortunately, this is the vision you are defending for mental health care. Let me tell you that you are terribly disappointed!

Mr. Speaker, I will be brief, because the advance of this bill has taken a lot of time and the design has had a lot of feet in the ground.

The discussion has been ongoing for more than twenty years, and today, after many extensive discussions in the committee, a breakthrough has finally been achieved. It can be said that the bill starts from the law on psychotherapy of April 4, 2014, which is a merit of the colleagues from the previous legislature. They have thus paved the way for this text.

Honesty commands us at the same time to say that that law is not aligned with the professional and academic reality and contains a number of shortcomings, making its implementation impossible. This is being corrected today.

In addition, the bill, contrary to what a previous speaker claims, is indeed tested by the sector. The Minister consulted, among other things, 23 interest groups, the opinion obtained from the High Health Council and was based on 23 different country studies. In other words, the draft law does indeed contain a support.

I said it in the beginning of my speech, we achieved a breakthrough with the bill. Today, unfortunately, we must note that mental health problems only continue to increase. Data from Tele-Onthaal showed today that more and more people complain about mental health problems. There is also an increasing number of failures in the workplace.

For these reasons, it is of great importance that patients with mental health problems receive appropriate, safe and quality care. Due to an enormously fragmented landscape, in which almost everyone can call themselves psychotherapists, patients unfortunately become a playball between different therapists before they receive appropriate help. In times when suicides are increasing, this is nefarious!

Despite differences on both sides of the language boundary, the bill no longer allows anyone to simply call themselves psychotherapists. Through a clear definition of psychotherapy as a form of treatment and by the clinical psychologist and orthopedic in the Royal Decree no. In addition, charlatans will no longer be able to simply hang a sign of “psychotherapist” at their door. Some call that medicalization, but I am convinced that the bill is the only way to finally provide the patient with the necessary protection against those who think mental health problems are very easy to remedy by, for example, tantra or meditation.

As always with major breakthroughs, this bill has also raised questions in the sector. There was fear of a deterioration of the mental health landscape. This is a legitimate concern and the sector today deserves additional support, but it is being addressed. There was a lot of concern among the experienced bachelors of Psychotherapy who feared that they would no longer be able to carry out their job independently and among new students of Psychotherapy, who have an unclear vision of their future. Therefore, in the first exchange of thoughts on the bill in December last year, our group asked to provide for very clear transitional measures for persons who, for example, have only ⁇ that bachelor’s degree or who are still starting the course Psychotherapy today.

Our group is therefore very pleased, Mrs. Minister, that you have provided very broad transitional measures for those who will not practice a medical profession but can start working as supporters in a mental health care profession. In addition, the supply will not be reduced. The bill still enables the opening of the profession to other disciplines, such as clinical sexologists. In short, for us, the bill creates the necessary clarity and opens the perspective for individuals who have gained years of experience in the field and for newcomers who want to step into psychotherapy.

Furthermore – this is also a great merit – the bill bridges for the first time between the different disciplines. It connects the entire workplace. In addition, the Minister has assured that additional measures will be followed which will only improve the obligation of referral and interdisciplinarity. We congratulate that.

I am going around, colleagues. The design on the table is not perfect, but it is a beautiful design that removes the ineffectiveness of the previous text, takes into account the sensitivities on the ground, both on the Flemish side and on the French-speaking side, and – most importantly – prioritizes quality and safety.

Our group therefore absolutely supports the draft and considers it extremely important that it can come into force on 1 September 2016, as also stipulated in the government agreement, even if it was only because the draft law does not mean the end. The bill and the clear definitions of who can practice psychotherapy will allow to investigate the reimbursement of psychotherapeutic consultations. We really need to start that discussion, especially as mental health care is becoming increasingly important in our society.

Mr. Speaker, Mrs. Minister, dear colleagues, I think that too frequently at this tribune, even if it is the democratic principle that supposes it, we tend to rearrange the debates that have already taken place in committees.

I listened carefully to Ms. Onkelinx. If there are a certain number of points on which we can find ourselves, there are others on which, as it had also been meant on both sides in the committee, we did not agree. We have a very different view of the matter.

By reviewing the report of the committee’s work and ⁇ the first reading, I found that Minister De Block had already answered most of the arguments and objections that you still raised today, Mrs. Onkelinx. I am therefore a little surprised, because if, ultimately, one may not agree with the position of the minister, the answers to the questions, there have been.

I would like to return to a rather fundamental point. You said in your speech “The State Council is extremely strict with your project.” "You have taken into account a number of elements, but not all, and so in the long run it is likely to pose a problem." I would simply say that, to my knowledge, in the previous draft, the State Council had not had the opportunity to give its opinion.

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I simply say that here we have made a specific request to the State Council which has given a number of remarks which have been taken into account in part. In the previous project, however, this was not the case.

I would like to return to that because, if I have a good memory - I refer, of course, to the document that was handed over to me, so the first reading report - it is stated: "The minister believes that the April 4th law was undoubtedly a giant step in mental health care but some gaps threatened the applicability of this law and therefore required adjustments, for example, in the composition of the Federal Council of Clinical Psychology and Clinical Orthopedics".

In the same order of ideas, if I refer to an opinion given by the Belgian Federation of Psychologists, it was necessary to wait 2014 before the profession of clinical psychologist was recognized as a healthcare-related profession. Unfortunately, legal problems appeared in the first bill and, more specifically, in the section dedicated to the regulation and practice of psychotherapy. These legal problems were such as the enforcement of the law – one of the keys to the Michel government’s health care policy – was put in jeopardy.

It is of course logical to have a different vision or approach that will allow, in the long run, the applicability of this law. This was not the case before.

This bill is important, very important. I will come back to this when I take the word. It is ⁇ mesquin to compare bills drawn up by all parliamentarians on the basis of several bills submitted by different parliamentarians from different political groups and which have been confronted with field actors and a reflection.

In this case, we are facing a text from a minister; it is a bill submitted to the State Council’s opinion. So don’t get involved in trying to compare two processes! The content of the State Council opinion on the bill criticizes poor characteristics of definitions between different service providers. These criticisms have not been met and are still there.

As for the legal elements relating to the 2014 Act between orthopedists and clinicians, these are questions of definitions that we can support in repair, improvement and correction. But you know well that the foundation of criticism of this bill and its scope does not consist of easily adjustable elements.

I will not repeat what Ms. Gerkens said very well. In fact, we are facing two very different approaches. The first is a consensus approach. Everyone, majority and opposition, except the Vlaams Belang and the N-VA, agreed with the professionals I had gathered, an countless number of times, French and Dutch-speaking. Together, we all agreed and we wanted to move forward. For years and years, this has been dealt with in parliament. The second approach remains, which is a dividing approach, where we choose and decide at the expense of a whole range of practitioners and patient protection, without worrying about the past consensus established.

You argue by saying that the law was not perfect, but I said it myself. It was sufficient to take a law containing various provisions, at the beginning of the legislature, concerning the advice for the component of clinical orthopedagogy, clinical psychology, a small amendment, and on the other hand, to work immediately, from the beginning, in the framework, in the follow-up, in the aftermath of the law 2014, on the decrees of application. If we had worked like this, this law, now, would have been applied. The choice was entirely different: we corrected what was supposed to be, and then we threw those years of work, that consensus into the garbage. And we choose a divided path.

Mr. Thiéry, you who had accepted, in the beginning, this consensus, you followed the way of the minister and you actually completely turn your jacket since these two options are totally different on psychotherapy. You cannot compare them. You made a choice A during the previous legislature, then you make a choice B later. Don’t tell me that it’s because you need to fix a law! It has nothing to do with this: we have changed philosophy.

Mr Gerkens, as regards the basis of the project and the consensus, I will come back a little further in my speech. However, there is a certain consensus, whether we want to hear it or not.

Mrs. Onkelinx, you say “it was enough.” If I have a good memory, in the law of 2014, it was also said, in conclusion, that in the end, this law was a first advance, that at least a number of things were highlighted but that this law would also be brought to be improved. What are we doing now? We took the opportunity to improve it. I understand your frustration. You say “to detricot” but it is a complementary approach that is stricter, more orderly and more controlled. I understand that this annoys some. Here, the intention was to set up a system that is now extremely clear and that dislikes some. What I no longer want to hear is when we are told – and this is a message that regularly passes on social networks or even by email – “with the law that is put in place now, you will lose the employment of 3,000 or 4,000 psychotherapists or practitioners.” This is absolutely not true! This is disinformation. This is not the first time we hear of disinformation in this Parliament!

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Madame Onkelinx, this is not against you. I didn’t say it was you. I just said that’s what I see, that’s what I read on social networks and these are messages that are relayed by several representatives as well. But I didn’t say it was you in particular.

There may be a complementary element. Without wanting to repeat the entire debate that has already been held in the committee, I would still like to point out that you say that the 2014 draft was unanimous. I simply see. I referred to this white paper of 6 January 2014 published in a well-known newspaper on the French-speaking side and which had been written by twelve French-speaking university professors. So, back to the community issue. I was told, “First of all, it is a community issue because the problem is not the same in the North as in the South of the country.”

Obviously, this is not the case because, when we read the white card of the academic specialists on the French-speaking side, they already warned the political authority of the divergences that could exist between the project set up and the objectives pursued. I have given them in the committee, I will not recall them here. Everyone will be able to find them in the first reading.

Mr. Speaker, I do not question this white card that was written and that we actually received at the time. What did the signatories of this white card want and what did they get? Training is provided only through universities. They are the same ones who refused to set up gateways to allow people who had a bac but who did not have the pre-requisite skills required in the 2014 law to acquire them before starting their training in psychotherapy. Through this bill, you have thus not only chosen to change the direction of the 2014 law but also to hear them, only them and not all the actors, including psychotherapy trainers. Some of these university professors have been trained outside the university but want to keep the monopoly of these formations. This is what you are relaying!

This is true because we have always defended the position that training, as such, should resort to a master, or even a doctorate. As is indicated in this white card, in several countries, some require that the training has the degree of the doctorate and not the master.

Thus, through this project, psychotherapy is conceived as a form of treatment practiced by a doctor, a clinical psychologist, like the opinion no. 7855 of the Supreme Council of Health.

This opinion states that psychotherapy is a specialization of a number of health care professions and that the importance of scientific foundations and the complexity of the evaluation of psychotherapeutic practice requires that the basic training be at least the level of the master. It is true that I went to review, on the occasion of the debates of 2014, what was our position, then defended by Mr. Bacquelaine. That was that position.

You cite Mr. Bacquelaine, at the time a member of Parliament, who was the home of negotiators. He has always demanded a substantial and serious training. Initially, he wanted a complete university cycle. We had a long and serious training on the table. If you were not a bachelor in a particular orientation, you would have to have at least acquired in a whole series of branches, plus 500 hours of theoretical training and four years of practical training. It was on the basis of what we had proposed in terms of extremely serious training that Mr. Bacquelaine found that it was a good project.

It is exact. I could even recall what Mr. Bacquelaine said in this particular place in 2014: “Psychotherapy training is for us a specialized competence whose most natural access is that of a master’s degree in psychology or a specialist doctor’s training in psychiatry. 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 rather to pull everyone up.” I think this cannot be clearer. That said, this is not entirely contrary to what you say.

The essential being, and it is also an element that was defended by Mr. Bacquelaine, that the provider can diagnose that he is not facing a somatic problem and that, otherwise, he can send the patient with full knowledge of the cause to a provider otherwise qualified to treat it.

I would like to reiterate that the project was concerted. I heard in the committee that there was no sufficiently open consultation. Ms. Hufkens reminded us of the number of people, the number of associations that were concerted. But who says concertation does not specially say that we will find a global consensus that puts everyone in agreement. The most important thing, in this consultation, is at least to hear and listen to the opinion of each, and to dictate a line of conduct on this basis, which of course does not always correspond to the ideas of one and the other.

Some reproaches relate to the removal of different currents. We talked a little about it recently. This obviously does not mean that a cognitive-behavioral oriented psychotherapist, for example, will no longer be able to practice. It is false. What I would like to say is that when you send the serious message that 3,000 to 5,000 people will lose their jobs and find themselves on the streets because they will no longer be able to practice, it is totally false.

Some, of course, will have to practice differently. These are those who do not currently have the required degree as stipulated in the law. But they will continue to practice with some sort of supervision. The big advantage is that supervision will not only protect the patient, but it will simply protect the profession of psychotherapist, because there will be control over how people work.

You recently cited an exceptional example of psychotherapists who profess impeccably based on their personal experience. But of course, and I think we can all agree with this approach. The interest is that these people will be able to continue working and, if they are more performing than some others, this task will be multidisciplinary and will allow everyone to find themselves there.

But to say that there will be between 3,000 and 5,000 people who will lose their jobs is a lie!

Mr. Thiery’s speech is quite surprising, since it responds to a criticism that I have not really heard. It is quite strange! I have never spoken or heard this argument in parliamentary work.

You are talking about performance. I prefer to talk about quality professionals. It is not about performance. What matters is to have a diversity of approaches by quality professionals.

of course . Yes Yes Yes.

This is very important, because it is the philosophy itself.

I agree with you.

The Minister or the majority must answer.

When you talk about control, what is it about? Can you show me the articles of the law that explain this notion? What are the modalities? Who is charged? This is the first time I hear this argument.

The principle of supervision was repeated in our discussions in the committee. I do not know if you have had the opportunity to read the document completely because I know that, unfortunately, for other reasons, you could not attend the entire debate. Meanwhile, the Minister had developed several arguments in this direction and explained the system. I think she will talk about it soon.

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Okay, we understand each other.

Mr. Speaker, colleagues, I did not intend to intervene, because this debate has been held in the committee for days, but now that the discussion is about the cooperation of health and non-health professions, about interviews and supervision, I must intervene.

Just then I said in my presentation that it is not intended to conduct a negative discussion about autonomy and control, because that is not stated in the text and that is not the spirit of the text. The spirit of the text is, as our colleague said, multidisciplinarity.

I have not been involved in petitions and the like in the last few weeks. I did not get it from the Flemish side. I have only received many questions from psychotherapists who have visited me to explain their concrete situation and their path. They ask themselves what they are waiting for and how they can move forward. Over the past two weeks I have seen more than thirty psychotherapists, or heard by phone, or read via email. Well, almost everyone is affiliated with a psychiatrist or a psychologist and thus already works in a collaborative association. That means that with this law nothing changes for them. Everything remains as it is. They are already exchanging documents with each other, they are already talking to each other. It is precisely through the cross-pollution of the various professions and of the different inputs that they are now much stronger in their profession than if they were to perform the solo, autonomous.

Very little will change. They talk about dismissals and the loss of autonomy. I know that the opposition likes to feed those things, but that is totally unfair, and unfair to the people on the ground.

Madame Muylle, who, in the opposition, feeds these rumors of job losses? Who is ? I do not understand your word.

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I don’t know, but please answer my question. Mr. Thiery is not in the opposition. I do not understand your word.

I would be surprised, given the activity, at the moment, of all political parties on social networks that no one is aware of, especially at the level of the members of your group.

I absolutely do not know what you are talking about!

I will send you the various emails that are circulating. I also invite you to visit Facebook to get acquainted with the different information that is currently circulating there.

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Mrs. Onkelinx, I don’t understand why you feel targeted. I just said that there was disinformation and that, as by chance, this is not the first time that this happens. Let me just ask you the question.

I have not heard of the loss of 3,000 jobs due to the project. On the other hand, I have heard of concerns from some who are currently working with a certain status, a certain training and who fear the vote on this bill.If we had taken the time to properly consult a number of practitioners, they would ⁇ have expressed their concerns before and during the committee work.

That said, there is Facebook. A lot of people are mobilizing. There are petitions. Many messages are sent. You have to assume! You have decided to adopt a bill that contains a whole host of unforesees, which raises concern and contains elements that we criticize, as do field practitioners. Do not be surprised by such reactions. You should not turn against the opposition. Instead, you have to turn against yourself. This is the result of the choices you have made.

Mr. Thiéry, I insist that you respond to the arguments we have put forward in committee rather than referring to statements that may have been held on social networks. I think in particular of the eventually programmed disappearance of the training institutes that were created by the four currents since there was no framework in the law.

They have done a great job to be able, just, to be sure of having quality psychotherapists. What will happen to these private institutions? These are arguments that we have widely developed.

Madame Muylle, you have received thirty psychotherapists, which is very good. Personally, just before, I was with sixty psychotherapists of various obedience: psychiatrists, others who did not have this training and did not meet the criteria of the law but who believed that with this bill, it was psychotherapy in its essence that was attacked.

Colleague Onkelinx, I want to conduct the debate with you in a serene way. I have been very involved in the preparation of this legislation. In addition to a number of concrete questions about the statute and training, I have heard questions and concerns from psychotherapists and psychologists, from the training centers, the universities and colleges, on the Flemish side, but I have especially also felt a positive dynamic with regard to this bill.

You wonder what will all happen with those therapeutic training courses. I already see a full movement towards cooperation on the Flemish side. This week is again a therapy course with a college to sit together to see how they can organize the business from 2017. There have been contacts between therapy courses and certain universities. The workplace in Flanders is being organized. We don’t wait for months and we don’t launch petitions, we act and ensure that those collaborations come into being.

This is what is happening on the Flemish side today. Those therapeutic training courses will simply continue. They will simply be captured. Colleague Onkelinx, you must explain to me why for a health profession that we recognize here today, it is no longer tolerable that its training programmes are not encapsulated in education. There are some more. You referred to the osteopaths and others. I think we need to find a solution in the field of education. For each recognised health profession, I think there should be a training that is recognised within the education system.

I think it is a good development that these collaborations come into being.

Mr. Thiery, if some are already resigned and adapt, it is their choice. There are sometimes different temperaments: some resign, others get into resistance because they feel that the project is unfair.

I remind you that the first time the minister came with his intentions not envisaged in the government agreement, one of those who were most annoyed in the commission, was you! Because you felt that this was absolutely not in the sense of the history of psychotherapy. And obviously, I can believe it, it is you who have fought and obtained the transitional arrangements that have no sense since they go in a radically different direction from the meaning of the project and do not protect the patient. I find this quite incredible!

To get back to your comments about these formations, remember that psychotherapy is not recognized. The act is recognized. The psychotherapist as such is not included in the 2015 Act, formerly decreed in 1978. And with regard to the old law, we recognized training but not at any cost. These trainings had to be recognized: we had long talked and insisted on the quality of those that were organized and had decided to accept them as quality trainings as long as they met certain criteria and were accepted as such. I think, therefore, that we had done the work in terms of quality of training.

Mrs. Onkelinx, if you had just listened – it was in Dutch – you would have heard that I was angry at the first reading. You look a little down on the transitional measures, but there is also a very large difference between the text originally submitted by the Minister and the text presented today for discussion. There are very strong transitional measures today, giving a future for bachelors, which, by the way, did not exist in the 2014 law. In addition, today we have also taken into consideration the possibility of the supportive mental health care profession. One may, in my opinion, indeed speak of progress with what is now on the table, opposed to the text in first reading, enough to defend the draft today.

It is correct that in the law of 2014 we entered a lot of quality requirements for the training programs, but those are now there. I think of the 70 credits and the collaborations between colleges and universities from 2017. Do you think there are no quality requirements associated with this? Yes, they are there.

I don’t understand you when you’re talking about the Wild West. You say things that are completely untrue. You are constantly twisting things. You do not see what the consequences will be in the workplace. You do not see it.

I think both sides have made their positions clear. I propose that Mr Thiéry continue his speech.

Madame Gerkens, we take our choices. It is obvious. We assume information, but what we do not assume is disinformation. Again, I did not say where it came from but we will find the people who are at the origin of this disinformation. It is easy to scare the people concerned. But from the moment that this fear is not relayed on the basis of a number of tangible elements, this is not acceptable.

Regarding the institutions and the contacts between private and academic institutions, I think Mrs. Muylle has answered clearly. Furthermore, in the committee, we had already had this discussion about the contacts that could be between these different institutions that are not going to disappear. On the contrary! I believe there is a willingness to work together. Compromises have obviously been found a little faster in Flanders and I think some are ongoing on the French-speaking side. Thus it is through dialogue that this problem, as long as it is one, will be solved.

I will not be much longer. However, I would like to return to the whole issue of transitional measures. Here too, I hear that these transitional measures are not sufficiently clear, that they are much too long in time, and that they may not touch the whole of current practitioners. But in these transitional measures, it was clearly specified by Minister De Block that those currently holding a degree were taken into account and that those currently in the study stage would also be taken into account. As for students who will start their studies in September 2016, they will also be subject to special attention. In addition, the Minister submitted a table in the session reviewing these different transitions. I think we cannot be much clearer and more general than this. This means that any person concerned is and will be taken into account.

This was an unavoidable requirement for the Minister. This has been repeated several times. I say this very openly, Mr. Minister. We will be very attentive to ensuring that all concerns that one and the other encounter within the framework of these transitional provisions are taken into account.

Finally, is this project that has been the subject of a number of changes immutable? The answer is of course no. This is also interesting. This is an additional step that allows for a clear position and a law that will be able to enter into force. This law can change and I sincerely believe that the Federal Council for Mental Health will also have its word to say in relation to a possible future adaptation.

Don’t be fooled, to prevent people who practice today from sometimes playing with people’s health and future, we put in place a number of clear tags. Will it all be resolved overnight? No, we know very well that some will still be called psycho-practices, well-being coaches and any other controlled designation. Meanwhile, there is a desire to have a structure, a clear vision, which will not only protect patients but also protect the profession.

In conclusion, our group will support this bill because it lacks the foundations for the exercise of quality psychotherapy. This project has been coordinated, it does not dissolve psychotherapy, it preserves acquired rights and it will develop in coordination with the Federal Council of Mental Health.

Mr. Speaker, Mr. Minister, of course, a lot has already been said, so I will keep it fairly concise and stay with the essence.

The care of mental suffering has become an increasing challenge in recent decades. It is the core task of a government to establish the framework conditions for quality care for patients with mental problems. The contribution of the present draft to this cannot be underestimated. The design creates a robust framework for the recognition of healthcare providers in mental health care. Contrary to what some colleagues say, after the law comes into force, there will still be a very wide diversity of healthcare providers.

First and foremost, we have the arrangement for the future. Clinical psychologists, clinical orthopedagogues and doctors who have completed an additional psychotherapy training for this purpose will be able to apply psychotherapy in the future. In addition, we provide ⁇ extensive transitional measures for those who work today, for those who study today or begin their study psychotherapy in September and even for those who begin a pre-training as a professional practitioner within the meaning of the law of 10 May 2015 or another bachelor's degree in September. Anyone who is a professional practitioner will be able to exercise the profession of psychotherapist autonomously. Anyone who holds another bachelor’s degree as a pre-education will exercise his profession under the responsibility of a psychotherapist.

The draft law also provides for the possibility of admitting other professional practitioners to the psychotherapy training. There is still room for more diversity. Completely new is the fact that we provide the legal basis for creating supportive mental health care professions.

In this way, in the future, bachelors will also be able to take their place in the care of people with a mental illness.

We see that doctors and dentists today are the demanding party for supporting professions because the workload is too high. The same applies to mental health care. There are also large needs and therefore also the demand for supporting professions that can take on certain tasks.

So I am not afraid that these supportive professions will not come out. From the opposition, diversity is often confused with quality.

In physical medicine we find it all evident that there is evidence-based work, that the training is sufficiently solid and that there is a hierarchy in the tasks of the healthcare providers according to their obtained diploma. That line we draw through in psychiatric medicine. Patients with mental needs also have the right to mental health care based on evidence-based practices.

This design therefore sharps a number of quality conditions. The design strengthens the pre-training for psychotherapists because it is essential that the psychotherapist has a broad knowledge and therefore can also recognize underlying problems and appropriately refer to healthcare providers with a different specialty, also to colleagues with a speciality in physical health care.

The design introduces the professional internship for clinical psychologists and clinical orthopedagogues because we have accepted the view that there is insufficient practical experience present in the current training to be able to provide quality care.

We introduce a step-by-step system of who may or may not practice autonomous psychotherapy, taking into account the prior training. Working under responsibility does not require the physical presence of the person in charge of the therapy. It should rather be seen as a multidisciplinary cooperation.

We incorporate psychotherapy into the law of 10 May 2015. That gives the government the necessary tools to get the charlatans out of care. Clinical psychologists, clinical orthopedagogues and doctors are caught by the law on the health care professions and thus also fall under the control and sanction possibilities of this law.

In this draft, we no longer mention the currents within psychotherapy. We think that in a healthcare domain that is currently still in full evolution, it would not be wise to capture currents in a law and consequently pin healthcare providers on a currents. Based on the needs of the patient, the psychotherapist should be able to apply techniques that will have an effect on the patient, regardless of the current to which the technique belongs.

Furthermore, the accusation that no longer work with private institutions is incorrect. By concluding cooperation agreements with colleges and universities, they will be included in regular education. I can honestly only see benefits for these private institutions. Collaboration provides a significant opportunity for upgrading and allows them to offer their students recognized degrees. The cooperation between colleges and universities and private institutions should ensure that the future psychotherapist receives a sound training, both theoretically and practically, which will allow to provide high-quality care to the patient.

This draft also addresses some practical problems arising in relation to the Federal Council. From three councils we go to one council with three banks. We provide for the possibility of a minority viewpoint and solve the problem of the absence of clinical orthopedagogues in Wallonia by working with clinical orthopsychologists.

It is a pity that some of this matter has created a community discussion. However, I note that in the Faculty of Medicine in Flanders and Wallonia this contradiction does not exist. There, the talk clearly won the emo.

I therefore conclude that this design draws the card of the patient in mental health care. From the right of that patient to quality mental health care, the draft creates the necessary framework conditions for the training of clinical psychologists and clinical orthopedagogues and for the pre-training and training of psychotherapists. This case has a long history in Parliament. Today we are finalising the legal framework. Now the way is open for the debate about the repayment.

The present bill fills us with fear, fear that the richness of methodologies of psychotherapy in our country will disappear, just at a time when we still receive a lot of signals from society that psychotherapy and guidance are absolutely necessary and that we need them very much. The narrowing of the mental health care landscape is, according to our group, the biggest problem, especially since the psychotherapist will no longer be a profession as such.

The 2014 law was intended to respond to the widespread influx of psychotherapists and that aspect is now completely eliminated. Mr. Minister, you are planning broad transitional measures, but they do not actually change much. Let it be clear: we also want the charlatans out. But we were and are of the opinion that the law of 2014 provided sufficient guarantees for this. I would even like to emphasize that our group is especially concerned about the quality of care, which the patient has a right to. The quality of care was guaranteed in the law of 2014: after all, the many conditions that were set at the time were undoubtedly a quality guarantee. For each patient there was a personalized care and an offer. The 2014 law guaranteed that.

Now one threatens to cut the healthcare supply on the market, just at the moment we hear more about burn-out, about depression, about suicide. Is that appropriate?

Regarding the functioning of doctors, I refer to a recent press article alleging that 1 in 10 patients do not understand their doctor and that the patient is actually primarily directed to himself.

This bill now stipulates that treating general practitioners, more than what can normally be expected from a general practitioner, will have to act as a psychologist before their patients.

The transitional measures consist of placing the therapists under a form of supervision. These are therapists who often have a lot of experience and a lot of knowledge, through appropriate training. They followed them. They have a lot of concrete experience. Those therapists will now be placed under the supervision of a colleague with ⁇ much less experience in that area. In fact, we find that a bit absurd.

Finally, a bachelor is completely excluded from the profession in the long run, while the current situation shows that it often provides tailor-made care.

The draft law appears to be written for certain occupational groups and for certain interest groups, in order to exclude other groups from the profession. We find this ⁇ regrettable. That’s a bit of throwing away the child with the bath water.

Mr. President, Mr. Minister, dear colleagues, I recently interrupted Mr. Thiéry by telling him that the bill we are going to work on is a ⁇ important topic. And I would like to start from there.

When one addresses professionals or even simply about mental health, one does not address, one is not only interested in someone who has difficulties, and another, an interviewer, who will try to help him overcome his difficulties and start a psychotherapeutic process. It really addresses the foundations of the organization of society.

How will one accept that someone, at a given moment, behaves differently? How will we integrate that our functioning of society also has an effect on how someone feels good in their skin or feels bad? And how will we allow him to continue to participate in our society? How will we accept that people remain different from others throughout their lives without expecting them to conform to an ideal image, a standardized image of individuals? This is also being addressed through a bill concerning psychotherapy.

That is why it is really important, in the discussions that we have had in the committee, as well as those that we have now, to question ourselves also about the foundations, the consequences and the meanings of the measures that are here proposed.

So that’s true, I’ll go back to the 2014 law. Not because a law adopted at a given time must always remain identical throughout all years, but because it was the result of 15 years of reflection, work, sometimes conflicting relationships between different actors, between different currents. And if we came to that law, it is because we managed to identify the elements that could bring us all together around quality intervenants, to help people in a psychotherapeutic process. Fifteen years of participatory work that resulted in a law.

I will not take up all the elements of this law but, nevertheless, some, including Mr. Thiéry I think, said that the white card of the twelve university professors proposed that, even more than a master, one must be a doctoral student in order to be a psychotherapist. In the 2014 law, we required to have a baccalaureate, to have completed a complementary gateway training of at least one year of university level, and at least four years of theoretical training, practical training and supervision. It’s much more than a master’s degree and it’s almost the equivalent of a doctorate. I therefore cannot accept the arguments that the quality and training requirements of the 2014 law were insufficient, that they need to be strengthened and that it is for this reason that we create a new law. The arguments that make sense, even if I do not share them, is to say that we will make a selection of people who will give these training there and that the emphasis will therefore be placed on very specific actors that are the universities and, to the strictest, the high schools, and on how this training will be given. In any case, it is not a better quality, a better level and better requirements.

The other argument used to advance a necessary change to the 2014 law is to say that psychotherapists were actually recognized but not included in the law that contains the list of health professionals. Clinical psychologists and orthopedagogues were there, but not psychotherapists. I would like to recall the precautionary principle that guided this alternative. We were, at the time, with already trained, already recognized professionals, who were doctors, psychiatrists, clinical psychologists, orthopedagogues. Then we were with a new category of speakers: psychotherapists, for whom we put requirements in terms of skills to acquire, in terms of personal development to accomplish, in terms of number of hours, days of supervision and field training.

And we commissioned advisory bodies to determine what the criteria could consist of, what we would be based on, to see if a person had acquired the skills. These skills were clearly detailed. Training centers could be universities, high schools and specialized centers. But also in this regard, we had to determine precisely what requirements we had with regard to these training places.

It seemed to me legitimate to say – and it always seems to me legitimate – that it was up to the councils composed of university professors, representatives of the profession and therapists trained in the various disciplines to correctly and precisely define these requirements so that psychotherapists and centers can be approved and recognized. Until this was done, it was cautious to recognize them as professionals but to include them later in the list of health professionals. This did not prevent the reimbursement of mental health care, an argument now advanced to change the law. Another argument is to say that it is thanks to the introduction of psychotherapeutic benefit in the 2015 Act, formerly royal decree of 1978, that things are possible!

In the 2014 law, there were positive and interesting elements, arguments to say that we should change it that I cannot share given what I am developing here.

As for the transition, it is said that there was no transitional phase in the 2014 law. It was organized differently than what is provided for in the current law. But there was a case-by-case review, of each on the basis of criteria that would have been defined. On a case-by-case basis, an assessment would have been conducted to determine whether the candidate was appropriate, had acquired the required skills, had the training been followed in a centre or needed additional training. Not everyone was recognised in office but a trajectory was allowed so that those who did not meet the requirements could comply with it.

Therefore it was not necessary, Mrs. Minister, to change the spirit of the law in order to meet the concerns that you say today want to continue. You can change it because you have a different philosophy, a different orientation. This is your right and I criticize it, but the arguments put forward to say that it should be done are in any case not valid in the review and analysis of this law of 2014.

Another element is to say that nobody wanted to set up the gateway, nobody wanted to set up this academic year or this year that allowed to acquire the skills, acquired and pre-requirements necessary to be able to start the specific training in psychotherapy. The world is a bit in the reverse. There is not always consistency in the attitude we have towards institutions and universities that, sometimes, do training that demands to be recognized. This is still the case with orthopedagogues who existed only in a Community before being recognized.

Your law allows you to assimilate clinicians, orthopedists for a certain time, etc. It also creates confusion. Osteopaths are a problem because some universities do not want to do this kind of training. As a result, osteopaths are not recognized. And then, here, because universities do not want to organize a gateway year, we do not recognize and change the entire device. If there were a clear position on the conditions, they would have adjusted their program.

By the way, many universities allow to follow course modules and complete a basic training, although it is true that some do not respect Bologna or the fact that someone who comes from a high school and who has another training to complete can access a master's year or a finished training without requiring him to rehearse the entire course. But we don’t have to get into that game if we want proper training actors and psychotherapy actors with a social vision and general interest. What we put in the law was serious. It is wiped out as if it no longer makes sense.

The title of psychotherapist as a professional title is removed. There will no longer be professionals who can call themselves psychotherapists.

There is the recognition of the doctor, the recognition of the clinical psychologist, the recognition of the clinical ortopedist. And then, they will specialize and apply a specific treatment from time to time, which will be called psychotherapeutic treatment. Where is the logic? Where is the logic when requiring high-quality training? Where is the logic that the most qualified is ultimately not recognized as a professional?

There is something I don’t understand either. You emphasize basic training and you consider that it is the basic training that will ensure that the psychotherapist will, yes or not, be a quality psychotherapist, rather than putting the emphasis, all the energy and all the requirements, in this specific training, which should be long and accompanied by a work of personal development. Because the psychotherapist obviously cannot manipulate the person who faces him. He cannot be trapped in the relationship, in relation to his own history and his own personal development. This is where the important thing is, that is where the quality requirement of the future psychotherapist should be. And I regret that these quality guarantees are not included in the bill. This confusion between basic training and specialized training in the quality requirement is likely to cause damage.

Similarly, among the requirements cited in the law, without being clearly defined, there is a question of internship, an approved place of internship, rather than ⁇ ining a practical training, organized by a training institute (university, specialized institute or other). The training process would involve supervision, back-to-back between the field and the analysis of what happened, reflections on how the psychotherapist lived and analyzed the situation, return to the field. These are foreign elements to a stage. It is really high-level professional training that must be done by combining a approach of another type. And in your project, you confuse a stage and this approach.

On the other hand, you say in the law that "decrees will define the criteria for internships and master internships". I wish you really good luck in identifying this if it is not linked to a formative approach and training institutes.

In the arguments you advance to justify the interest of this new law, we can join you on the possibility of reimbursing more for mental health care. It is true that the needs of people who are unhappy, living in difficult times, suffering from abuse or suffering at work are increasingly crying out and are not alien to the functioning and way of organizing our society, our economic life and the demands of normalization towards citizens. However, your law does not include a refund mechanism. Therefore, we do not know what will be reimbursed and in what amount.

On the other hand, by reading your project between the lines, we understand that, in order for the benefit to be possible and eventually reimbursed, a journey of care will be required. This will be based on a single method. At some times, you have expressed yourself by specifying a number of benefits for such a situation experienced by people in difficulty. It is therefore another approach to health care, which uses the possibility of reimbursement to organize them in a way that conditiones people to have to respect what is expected of them in exchange for care.

Another way to seduce or, in any case, make the pill pass is the methods you have chosen to recognize the current providers during the transition phase. I will not repeat all the criticisms that have been issued. If I wanted to be cartoonist, I would say that almost anything will be possible for those who already exercise. I regret that no matter how they work, they will be able to continue exercising. It is not that, organizing a transitional phase by guaranteeing quality and fighting against those who would practice dishonestly.

A transitional period is a provision in which the quality of service providers is first recognized and they are then allowed to continue their activities. Here, it is completely different. The massive argument is that of Mr. Thiéry just recently: those who do not have the basic training in the health professions will be put under tutelage and will not be autonomous. This is the guarantee given to patients. At the same time, this supervision will not imply that it will be followed all the time. They will work in multidisciplinary teams. How this will be done is also not detailed.

Obviously, it is interesting to cross eyes, from different formations and approaches. But it is not this that will guarantee the functioning autonomy of the psychotherapist and that will guarantee quality care. There are also confusions, references to modes of practices that are foreign to the content of the text and that are there a little to make it appear that one aims at quality regardless of the requirements that one has regarding the quality of the training and practice of psychotherapy.

I deeply regret the abandonment of references to the four currently recognized frameworks: psychoanalytic and psychodynamic orientation, behavioral and cognitive orientation, systemic and family orientation and person-centric and experiential orientation. This is impoverishment. As things evolve, there might be another framework of reference, but the fact of considering that the current references are outdated and that a good psychotherapist will be effective, able to draw in each orientation and ⁇ still in other things... and to systematize his approach, is banalization, an attempt to normalize people that goes against a psychotherapeutic relationship where one must identify with a person the path he can take to enter the path of change he wants. This is a constantly co-built relationship.

We will be surprised if we follow what comes out of this bill.

Among the last elements I would like to highlight are the references to this famous opinion of the 2005 Higher Hygiene Council. Mr. Thiéry once again gave an example: the first fifteen lines are read, and it is as if the other lines had never existed.

Ms. Onkelinx cited Mony Elkaïm, who is one of our great masters in system analysis and family therapy, who was part of the Higher Hygiene Council and participated in this opinion. You have read this opinion which stipulates that it is necessary to have skills and pre-requirements of master level and that if you do not have this level at the beginning, it is worth acquiring certain skills, which he cites. What we referred to in the 2014 law was to allow the person to acquire these skills. He insisted on the need to identify and recall the diversity of reference frameworks. He didn’t invent fifty. It took up the four recognized frameworks and indicated the interest that could be in associating in the psychotherapist’s designation and recognition his basic training and his psychotherapist training in such a way that the person who consults him knows exactly to whom he is addressing.

This technique, which consists of using pieces of opinion to justify decisions, you are not the only one in this government to employ it. This is socially speaking dishonest. You could have said that this notice contained other provisions for acquiring skills, that you did not agree and that you took only part of the opinion. It was one thing, and we would not have agreed, but this is not what you do. You say that in this document, it is such an opinion that is given, you use it and you comply with it. It’s to divert, it’s to manipulate an opinion, a study that has been done.

Mr. Borsus, who is here and who accompanies you today, has done the same for the individualized social integration plan. You say you are based on a university study and you take only part of it. Even the study authors rebelled and told you that you are diverting the conclusions of their study.

The recognized psychiatrists and psychologists who have been part of the Higher Hygiene Council tell you the same thing. Personally, I think you are deeply dishonest.

At this tribune, some have come to say that some claim that so many jobs will be lost, that they will identify the people concerned because one cannot disinformation and, ultimately, threaten them by taking in their freedom of speech and reading. If such fears are expressed by some, it is well because they have reasons to do so. However, the role of a parliamentary majority and the minister is to reassure on the basis of concrete elements. People are worried because they don’t know what they’re going to become. Listen to their concerns. Let us answer these people. Let us not say that one will find the one or the one who dared to express his fears in a certain way.

As I said, working on mental health also means accepting that people may think differently from us, interpret things, translate them, and be obliged to accompany them and/or correct the information they have.

The Minister told me that she was quoted in an article or booklet in which the number of jobs is mentioned. As far as I am concerned, I have never talked about the number of jobs since I do not know how many there are psychotherapists and I do not know whether some will lose their jobs.

The [...]

Mr. Thiéry, one of the criticisms I make to the bill relates to the fact that, during the transitional period, it will allow all psychotherapists to exercise their profession, but under this famous non-autonomy status. As far as I am concerned, I prefer a project that clearly stipulates, on the basis of qualities and criteria defined with field specialists, what are the requirements to be met by providing that those who do not meet the latter have the opportunity to train and acquire the skills they lack. I am much harder than you.

Desinformation does not result from disinformation, but from a lack of clarity in the text, from the concerns of some who know their reality and who express their feelings. Try to reassure them instead of setting up a popular court designed to identify who is spreading the rumors in question.

The [...]

I did not understand what you said.

Madame Gerkens, I’m ready to hear everyone’s opinion. From there to that they come to give me lessons in relation to the interpretation of what is sent as a message and which is disinformation, it is a little limit. Let us be clear! Unfortunately, I don’t have the magazine with me. She is in my office. I read your interview.

I’m not talking about numbers, no one. I did this interview.

Mrs Gerkens, when you read your interview, you understand that people can send some disinformation. That was all I wanted to say.

Mr. Thiery, I am not hiding myself for my reading. As I said at the beginning of my speech, I am concerned about this bill. I’m probably more concerned than a lot of people here, even among my colleagues, because I have twenty years of practice in the social environment. I am well aware of the deviations and problems that can arise through interventions and depending on the organization of care, what is expected from these people through their difficulties and the therapies that are applied to them. I am aware of the exclusion phenomena that this can cause. These are concerns I have expressed and I continue to express.

Do you want another example of disinformation? I don’t want to blame this gentleman. I’m not going to quote him, even if he’s one of the people who support your bill. He is someone who dares to say that in educational institutions psychoanalysis is trained in ten weekends a year and that, therefore, it is indispensable to limit psychotherapy training in universities because there at least we will have "x time". In addition, it is expensive: two to three thousand euros for training in these institutes. For this reason, educational institutions are concerned. These are interpretations, ways of expressing realities with your own vision. I disagree with this person because it distorts reality. However, I will not go into a hunt to pursue it and denounce it.

Without entering into all the details, you have thus the analysis and appreciation that I do of this bill. Personally, I am concerned about what this will give in terms of organizing this psychotherapy. I am also concerned about the quality and respect for the patient. I don’t think the patient will be there. Today’s psychotherapists will become non-autonomous psychotherapists. Clinicians will be able to practice as orthopedists. Orthopedics will be able to practice as clinical psychologists. General physicians will be able to do basic psychotherapy, but we do not know what it consists of. If this does not work, the patient will do more specialized psychotherapy with other specialists.

In my opinion, the patient has no clearer information or more guarantee regarding the quality of the relationship he will build and establish with a psychotherapist, which is, however, essential. These are the goals we aim for.

It is true that this bill profoundly changes the approach to psychotherapy and the meaning of the 2014 law. Let us be honest! It can be reassuring for patients that psychotherapy is carried out in a health care framework provided that it is based on a tripod with three major aspects: the first is quality; the second the multidisciplinary approach (but which must not only involve the doctor) and the third aspect, accessibility.

On this third part, Mrs. Minister, I have doubts about the consequences of your project. Recognize it, the findings are worrying in mental health with very worrying trends: the high number of suicides, an alarming increase in the number of admissions to psychiatric institutions, and an increasing consumption of antidepressants. Every year, more than two thousand Belgians commit suicide, which is enormous. Demand for psychosocial assistance continues to grow.

While these findings are alarming for the general population, they are ⁇ alarming for young people, children and adolescents. In the period 2012-2014, it was one in 200 (6-17 years old) young people (i.e. 0.5%) who were prescribed antidepressants; this is considerable.

We are well above the global average and the European average. All these young people under antidepressants, even as we know, psychoeducation and psychotherapy should be preferred to antidepressant drugs in children and adolescents, not to mention obviously all adolescents and all young people who are anxious and depressed, this represents excessively appealing figures.

One of the risks, one of the consequences of your bill in relation to this is that there will be a decrease in the number of providers in psychotherapy since you clearly narrow the scope of the exercise of psychotherapy. So, for corollary, there will be a decrease in the offer of psychotherapy. The risk is then to send these patients, these young people, back to medication treatments.

Probably you will tell me that tomorrow or after tomorrow, the refund of psychotherapy will be an added value for the patient. Yes, it is true: the reimbursement of psychotherapy is an added value for the patient. But I want to answer you, Mrs. Minister, we will see when, we will see how and we will see with what modalities. Because the KCE had looked at how one could consider reimbursing psychotherapy: these were extremely binding modalities. From there to say that, from now on, there will be a clear, rapid added value for young people or less young people followed by psychotherapy and who will be able to get a refund from psychotherapy, there is obviously a world.

Should we also recall, Madame the Minister, that already today psychotherapy in a number of structures and services is offered in an excessively accessible way on the financial level? I think in particular of youth assistance services, family planning, mental health services to take a few.

Changing this law for the future is one thing. But where I have a difficulty, dear colleagues – and I think you have said it very clearly in the committee – it is the way in which you take little into consideration the psychotherapists who already practice today by no longer allowing them to practice autonomously tomorrow for those who are not clinical psychologists, who are not clinical orthopedagogues and who are not doctors. I find that the way you take them little into consideration is quite appealing.

Call a cat a cat. You purely and simply degrade the psychotherapists who practice today. They will no longer be able to exercise autonomously. It was as if they were all charlatans.

I think I have to recall here that there are psychotherapists who exercise with quality and rigour. They acquired expertise in the patient’s bed, in his direct contact, without necessarily having a training as a clinical psychologist, clinical orthopedic or doctor.

Because, yes, madam the minister, the expertise that is developed at the patient’s bed is just as important, we know it singularly in health care, as training.

So you’re going to tell me “not the current psychotherapists can continue to exercise, there are many transitional arrangements.”No, they will no longer, Mrs. Minister, continue to practice autonomously, I repeat and repeat, if they are not doctors, clinical psychologists or clinical orthopedagogues.

And better than all theoretical discussions, I would like to illustrate my statement with two realities of the field. This is not fiction, it is experienced situations. I take as the first example the case of a psychotherapist, a woman, who has been working for about thirty years in a cabinet as an independent. He does a high-quality work. She works in close contact with two psychiatrists who refer to her their patients, send her their patients in a number of cases. They trust her more than because they work in interaction with her.

With this bill, everything will change for this psychotherapist. Because on the basis of the law, which I have read, it is repeated in all directions, it will no longer be able to practice autonomously. Imagine it ! While there are two psychiatrists who refer to her patients - so it is not one, a charlatan - she will no longer be able to exercise independently.

You will be able to exercise in a supervised manner. But this law, Madame the Minister, does not provide in any way that this psychotherapist can be supervised by these psychiatrists because these psychiatrists are not psychotherapists and do not want to follow 70 additional credits, as provided in the bill, and to follow a new complementary training as a psychotherapist. So who will be the losers in this story? In this example, of course, it is the patients.

Another example I would like to give you here. Again, it’s a real field, it’s not fiction. These are the situations of the different departments for which psychotherapists work, and I think of the services of youth assistance, people assistance, mental health and sometimes also some hospitals or even family planning. A psychotherapist who works in family planning explained to me its reality. He practices psychotherapy in a multidisciplinary approach. He works in a team, in contact with different realities, whether patients or heavy psychosocial contexts. But none of the colleagues with whom he works in his team is a psychotherapist in the new conditions of your law. and none.

Result: Tomorrow, he will no longer be able to exercise autonomously and will necessarily either be supervised by a doctor, for example, who would agree to train in psychotherapy in a complementary way, which is not necessarily the case, Mrs. Minister; or the team will have to hire a psychotherapist from the outside, or even deprive himself of that psychotherapist to engage another who binds himself to the conditions of the law and can exercise psychotherapy autonomously.

These are two examples. I could give you others. These examples are ⁇ illustrative of the reality that a number of already active psychotherapists are living today, but to whom you bar the autonomous practice of psychotherapy – and I repeat it – despite, very often, a long practice, an expertise that is developed in contact with the patient.

The supervision that you also impose by this bill is absolutely not defined. It is now subject to multiple interpretations. Some have been expressed in the committee. I have heard about it here, not counting, in addition, those we hear in the press. A member of your majority parliament speaks of control. We even talk about multidisciplinary practice, without again knowing what type of practice. We still do not know whether these psychotherapists will be able to continue exercising in the cabinet with an independent status and continue their current practice, not to mention the civil and criminal liability issues that have remained unanswered in the commission. Supervision is not defined. We are talking about an intervention that is not defined either. There is no convention, or anything that allows to establish this supervision. The questions of civil and criminal liability remain full and complete.

I came to the committee and I return to the plenary, because I have re-presented two proposals to make this project evolve on two aspects. The first is to open an additional door for psychotherapists who already practice today and who, on the basis of the bill, will no longer be able to exercise autonomously. This additional doorway, of course, is also so that we can make a difference and that we can recognize that there are differences between charlatans and psychotherapists who exercise with quality. Because, in essence, today, the bill does not make a difference between charlatans and psychotherapists who do not return to the new conditions to practice autonomously, since, tomorrow, it will be enough to "be supervised" to be able to continue its activity. And since supervision is not defined, it opens the door to any type of so-called supervision.

I therefore propose that an individual examination of the dossier, of the initial training, of the continuing training, an expertise, an examination of the experiences of contact with the patient, in connection also with multidisciplinary practices, be carried out. Because, as a reminder, many psychotherapists who will no longer be able to exercise tomorrow in autonomous practice work today with a multidisciplinary approach.

And on the basis of this record review, as was the case in transitional periods for other health professionals, they will be able to be recognized and have an independent practice of psychotherapy. Thus, all those who have been trained and who have this expertise in patient contact would see the quality of their work recognized and would be respected. I know some who have practiced psychotherapy for twenty or thirty years, as I reminded at the moment through an example. This is a minimum in respect of their competence. Transitionally, we should be able to recognize all those who are already exercising today. These are procedures, Mrs. Minister, which are not complicated and which have already been proven both qualitatively and in terms of patient protection.

The second proposal, which I redefine here in plenary session, aims to define what you mean by “supervision”. You will tell me that we will do all this later by stopping. At the same time, nothing is stated in the law in this regard. In my opinion, it is necessary to provide a clear legal basis, not on all modalities – this can be specified by a royal decree – by establishing a convention – I do not stop on the words, because I remain open to any proposal in the matter – between the psychotherapist and the person who will take over the supervision. In this way, in the event that we are faced with a serious situation, such as a therapeutic accident, we must avoid the initiation of large legal proceedings because no one will have defined who assumes civil or criminal liability. Leaving a blur — something I’ve never seen in terms of health care organization — and not putting this supervision on any legal basis could trigger legal proceedings tomorrow.

For all these reasons, we will abstain from this text unless, of course, dear colleagues, if we can rethink the various points that I have mentioned here and that I had already mentioned in committee. You had, Mrs. Minister, in commission, opened the door in the first place to the possibility, on the basis of the individual examination of psychotherapists who are already exercising today, through an examination of their file training, continuous training and expertise in patient contact, to recognize them also access to the practice of psychotherapy in an autonomous manner. Then, for reasons that escape me, and which are in my opinion of the majority, you refused to move forward in this framework. I regret it.

I regret it even more compared to psychotherapists who are not all charlatans, even though they are not clinical psychologists, doctors or orthopedagogues because, yes, there are also psychotherapists who do not have this training at the beginning but who have been exercising for many years, with a practice of quality and rigour. Moreover, those who are often the first to recognize it are also psychiatrists who work in close or more indirect connection with these patients or these young people.

For them, I think it would have been logical, in a transitional way, to allow them in the future to practice autonomously. It is a pity. You are not allowed to move on that path. It was an additional open door because the transitional arrangements you have planned exist, of course, but, unfortunately, do not allow them to be recognized. Above all, it’s up to all of them to downgrade, regardless of the work they do, including quality work. It is the responsibility of all to retrograde them by no longer allowing them to practice this autonomous practice.

We know that psychotherapy, as a specialization, is more developed in the south of the country than in the north. This is not a problem in itself, if consensus is possible when it comes to making common arrangements such as the recognition of professional titles.

We know that compromise is possible in this matter. This has been demonstrated in the previous legislature. The law of April 4, 2014 may not have been technically perfect, but it at least had the merit of resulting from a consensus. Even before it entered into force, this consensus was breaking apart. It is now no longer a question of recognizing the title of psychotherapist, but rather of reducing psychotherapy to a strictly medical act.

In reality, the majority aligned with what the N-VA wanted from the start. The MR, who voted against the N-VA amendments in 2014, today returns his jacket with a natural disconcerting, so this gesture becomes familiar to him.

Angry psychotherapists recall the remarks made by Mr. Daniel Bacquelaine at the plenary session, while he was still a group leader in January 2014, and I quote: "We accept and we recognize ... "

Madame Caprasse, what you say is very interesting. So you say that a number of angry people remind me ... I actually received these emails. Does this mean, if I understand correctly, that Ms. Onkelinx and Ms. Gerkens did not receive these emails, but that you received them? It is very strange.

I received emails.

and OK. I remain here.

I have received emails from unhappy people, yes.

The [...]

They have the addresses of all members. This is a normal reaction, I think.

We were flooded with emails of dissatisfaction. I think you have a problem with your mailbox.

I repeat my quote. “We accept and recognize that an opening should be considered to allow people who have followed different paths to access psychotherapy training. We insist that persons holding a bachelor’s degree, for example, actually have the possibility to undertake a university-type complementary training program – the law now provides for it – prior to a specific training in psychotherapy.”

And I now refer to the statement of Mr. Thiéry, who now represents the MR group in the Public Health Committee. I quote an excerpt from the first reading report of this bill: “An opening had been considered during the previous legislature to allow people who have completed a course other than a master’s degree in psychology or a doctorate in medicine to be able to access a training in psychotherapy. In the absence of political consensus to follow this path, the speaker’s group took note and defended the legislative guarantees of a rigorous, transparent and controllable training.”

Of course, Mrs. Minister and dear colleagues, we agree that it is indispensable to protect people in psychological distress from charlatans of all kinds and that the quality of therapeutic care must be guaranteed. But do psychotherapists who have undergone eight-year training not offer a quality guarantee? Making psychotherapy a medical act, as promoted by this bill, is it really a guarantee of quality? We seriously doubt this. The introduction of psychotherapy into evidence-based medicine dehumanizes this therapy that nevertheless heals the human.

Taking care of the psychism implies not only acquiring knowledge of the psychic mechanisms and its pathologies but also, according to the chosen therapeutic option, to train in the techniques of intervention of it. On the other hand, becoming a psychotherapist implies personal psychic work, which obviously cannot be demanded by a university open to all.

It is the various responsible training institutes that select candidates for training, based not only on their academic degree but also on their personal abilities to address the human psyche in all its complexity. In an open letter to the Prime Minister, more than 250 professional training institutions, as well as university and high school teachers, denounce the reductive vision of mental health that you want to impose today.

They explain in particular the importance of ⁇ ining the four psychotherapeutic currents recognized by the Higher Hygiene Committee: psychoanalytic and pschodynamic orientation, behavioral and cognitive, systemic and family or humanistic, person-centered and experiential orientation. They explain this diversity of approaches and specific training that better meet the personal needs of patients and that the complementary training of psychotherapists often lasts at least four years in addition to basic training. They also denounce the absence of consultation or rather the targeted consultation on only a part of the professionals and the rejection of the consensus obtained in 2014. We support their call and form the hope that the government does not simply reject the wealth that a diversified mental health care offer can offer at a time when burn out and other disorders generated by an increasingly anxious society explode.

We will resolutely vote against this bill.

Mr. Speaker, Mrs. Minister, I have a few points of criticism on your proposal.

My first point of criticism, ⁇ the most important, is the lack of dialogue with the different groups linked to your proposal. I later heard that Mr. Thiéry’s mailbox fortunately has a spam function, allowing him to immediately classify all emails vertically.

This is a letter signed by 250 associations active in the sector. You can’t look at that, right? What do they say about the lack of dialogue? I quote from their letter, which they otherwise directed directly to the Prime Minister because, in their opinion, it still made little sense to address the Minister of Public Health: “The Minister’s bill is drafted in a discrete, not to say, secret way. Only a part of the professionals seem to be heard, while the others always found a closed door in their way. As an example, we can refer to the fact that no response was given to the 70 representatives of institutions who addressed the minister in February with a memorandum for a rigorous psychotherapy concerned with the patients.”

22 000 signatures were also collected to call for dialogue.

I quote the Platform of Mental Health Professionals in French: “Minister’s cabinet members received members of the French-speaking psychotherapy coupole only once. They asked which associations the persons present were affiliated with and the minister considered that these associations had been consulted while these persons did not represent them and were not mandated."

My first point of criticism, Mrs. Minister, is, therefore, that I think there has been too little dialogue with the various interest groups on this difficult issue.

I come to my second point of criticism. Let me first be clear, we are in favour of a scientific training for psychotherapists. Nowadays it is often impossible for patients to know who to choose and what to expect, and that often leads to misprints. There is also a lot of uncertainty among professionals. All kinds of courses are offered. There is even one that promises a recognized diploma through distance learning. The enrollment costs for such courses are up to thousands of euros, without the students having a vision of what they get back for it. I think it is important to separate the grain from the grain.

I will now talk about the bill itself. Many low-threshold professions are excluded from recognition as a psychotherapist. I think that is a problem. I think of psychiatric nurses or social assistants. Usually they are more familiar with the subculture of various population groups and with the social problems that can form the background of many psychological problems.

We think it can be perfect that someone with an evidence-based bachelor’s degree, for example for social nursing, combined with the right therapy training, can give a good therapy. We have, by the way, many of them in our medical practices of Medicine for the People. Now all those people are excluded in advance.

Evidence-based research, and this is my most important point, shows that the relationship between the patient and the caregiver is crucial.

This relationship between the patient and those who help them is really crucial.

This relationship is crucial for a better therapeutic effect. The better that relationship and the more confidence there is, the better the health effect, regardless of the form of psychotherapy, whether it is cognitive therapy, system therapy or psychoanalysis. What is important is the relationship.

These are studies that demonstrate, even in evidence-based, that the link is at least as important as the type of degree. Here, everything is reduced to diplomas. And there are evidence-based studies that can show this. Behind an evidence-based approach, everything is being standardized on two or three types of degrees. This does not seem to be the right approach.

From the evidence-based findings, it should be possible to determine, in dialogue with the professional groups, when a psychotherapist is eligible for a refund. For example, those who have more than ten years of professional experience can be said to have good patient-helper relationships. As a transitional measure, psychotherapists should also be eligible for reimbursement, even if they do not meet the basic condition, such as a basic training as a physician or clinical psychologist.

I come to my third point. Mrs. Minister, she was not discussed today, but the refund, also an important element, borders this file. There remains much uncertainty about whether the refund remains in the same envelope. We are now facing the demolition of many beds in mental health care. It may not be the intention to give the money with one hand, and with the other to take it away from the mental health care. Our society is facing huge challenges in this area and we will need to invest in this.

The PTB will not vote on this bill. I see that it affects you. This is also my case.

The most important message we wanted to convey is that a huge number of people today practice psychotherapy with, undoubtedly, results.

If your goal is to work with evidence-based medicine, you are right. But, in this case, all psychotherapies should be involved. And don’t rely on a priori to rank people who, today, do services!

We are in favor of a more systematic approach. Indeed, we cannot allow the charlatans, the first to come, to declare themselves psychotherapists. But to do this, rely on evidence-based medicine and not on an a priori that, in fact, centralizes everything at the university level of our country and does not allow a plurality of therapies.

In conclusion, the PTB will vote against this bill.

There are no more speakers. The Government has the word.

First of all, I would like to thank all the members of the Committee on Public Health for the more than thorough discussions over more than twelve hours in two sessions, which we have devoted to the present draft. I also thank Mrs. Muylle for her more than thorough report of those two lectures.

During the drafting of this bill, I have also repeatedly pointed out that the 2014 law has made a major step forward in the recognition of the health care professions concerned.

However, some adjustments were needed to enforce the law. There were also – this is my responsibility – additional adjustments made, just to guarantee the quality of care for the patient.

What is positive for the patient? What has this law changed for the people on the ground now?

After seventeen years there is the long-awaited but above all necessary recognition of clinical psychologists and clinical orthopedagogues. This is about twenty thousand people on the ground. There is also the recognition of the doctors, who, subject to additional training, have chosen it as a health care profession.

This ensures a more quality mental health care tailored to the care demand and tailored to the patient.

Of course, this is accompanied by better accessibility. The existing visibility of those recognised groups in the workplace, the extensive expertise and the daily professional commitment that they have been giving for many years without recognition, is now finally validated.

The definition of the competence of clinical psychologist and clinical orthopedist is fully in line with the existing care models in the facilities, both federal and within the Communities.

It also gives the various governments an opportunity to really think about how they can pursue a lower threshold affordable mental health care. Without recognition, we cannot go to a refund. This is the next step.

The next step is the refund of mental care. We have already invested a lot in mental health care. This was also necessary, because it was a very undervalued area. We will continue in this and will look for the means in the long term, if everything gets arranged after this law has been approved.

The law also finally provides a framework for supporting professions in mental health care. The provision in the law allows, in fact, to give professional bachelors, who are currently situated outside the law on the exercise of the health care professions but in the psychosocial domain, a place within the mental health care.

This is a real valorization for all sorts of people with titles touched here, all sorts of bachelors in the sphere of psychology and pedagogy.

Indeed, and Ms. Muylle has pointed out, the law provides for very broad transitional measures for persons who already practice psychotherapy and even for students who pursue psychotherapy with their studies.

By way of derogation from the principle that psychotherapy can be practiced exclusively by a physician, a clinical psychologist or a clinical orthopedic, the design provides very broad acquired rights for the already existing practitioners of psychotherapy.

I have cited all these positive points to say, like some members, that it is actually a law that is made to obtain an improvement in the quality of mental care for the patient. I think that is why it all revolves.

Changes have been made to the original design. This was necessary because there was, among other things, a procedure before the Constitutional Court, which was rightly initiated by the orthopedagogues.

We have remediated that. Amendments were also needed, as the Federal Council, as defined in the original text, was not encompassable at all. Parity could not be guaranteed because there are no titles of orthopedagogy in the French-speaking region. That Federal Council is very important, because it will be given a lot of tasks. We want to compile them very quickly.

In addition, psychotherapy remains an important part of the treatment of the patient. She gets a well-defined place in the law on the exercise of the health care professions, which at the same time increases the value of psychotherapy. Previously, the profession was not recognized, but the practitioner was given a permit. What an authorization was, however, was not known and could not be given. Curriculums were described in the form of circuit programs, but they have never been put into practice; specialisations were described, but the universities have never come to offer them.

Now we choose more evidence-based mental health. Evidence is indeed becoming increasingly important for mental health care. Treatment choices may be made on the basis of available scientific information taking into account the patient’s request and the expertise of the therapist.

The fact that the law on the exercise of the health care professions did not apply to psychotherapy was contrary to the whole reform, of which you, by the way, implemented part, Mrs. Onkelinx. I place psychotherapy precisely within the law on the exercise of the health care professions, where it belongs.

It remains an important and well-defined part of psychology, pedagogy and psychiatry. It is what it is, a form of treatment. This is also stated by the Knowledge Centre.

Indeed, we have not followed all, but the most important opinions of the High Council. We have consulted with a lot of people. The text is also in accordance with European directives. Furthermore, the State Council has not made any comments on this subject.

I have already said that it is a good thing for the patient, because this will require compliance with the law on patient rights. The provincial medical committees will be able to act effectively against practices that harm the patient. They could not do that before. Accessibility is improved, as well as the quality of care. Mr. Hedebouw, when you reach out to someone, you can trust that he has the right skills. The kaf is separated from the wheat.

As Ms. Hufkens stated, the 2014 law was inapplicable for more than one reason. That is remediated.

As for the discussion of supervision and whether or not to function autonomously, it is clear that we do not really see supervision as a mere physical relationship. This has been said several times in the committee. Supervision can also mean that a patient has been referred, that a staff meeting on a case is held, or that a backlink is held. That is the reality, Mrs. Fonck, on the ground. The work is already multidisciplinary. If you say that it does not exist, then you ignore the reality on the ground.

It has also been said repeatedly that the ultimate responsibility always lies with the supervisor because he must ensure that the law on the exercise of health care professions is properly respected.

It is a surprise to me that the opposition wants to sow so much concern on the ground and is against a huge improvement in the organization of mental health care. Some have really worked for it before. But it can be.

Ms. Somers points out the added value of this draft in terms of the quality of health care and cooperation in the field with regard to education in institutions, colleges and universities. Mrs. Mueller also mentioned this. This collaboration provides academic support. That did not exist before. If an institution provides a degree and there is no link with a college or university, there is also no academic support in that degree. This is essential because psychotherapy is an evolving form of medicine.

This design rightly puts the patient at the center. When I hear that there is fear and uncertainty, I ask what fear and uncertainty there was in a field where all men have worked hard for seventeen years and where there has never been a recognition of the fact that clinical psychology, psychotherapy and orthopedagogy were within healthcare.

Mrs. Gerkens, you said you would be a caricaturist. That’s your right, but I think it’s too important to make a caricature.

Of course, the relationship between the caregiver and the patient must always be professional. You can talk with a lot of emotion and empathy, but nevertheless it must always remain a professional relationship and that is known to everyone who engages in that field.

What are additional values for the patient? In addition to improved accessibility, there will now also be a continuity of care. A continuity of care will need to be organised and there will also be waiting services where the patient can go if he suddenly feels worse. In the future, there will be a refund for psychological concerns.

How can a better accessibility be achieved than by the recognition of these care professions which, due to various circumstances, have been waiting too long for themselves? When I came into this Chamber in 1999, they were already working on this. That is 17 years ago. I was very pleased to see that this could have been arranged much earlier.

I think, Mr. Speaker, that a lot has been said and a lot has been built. There have also been many mistakes. Mr Hedebouw, for example, pointed to a letter from 250 associations, while in fact it is a letter from 250 professionals. I do not lay down that letter beside me, but I have not read any new element in it. Also in the mailboxes a lot of untruths have fallen. I can understand that some people would rather treat this as spam.

Patients have the right to go to a well-trained healthcare provider. I think we have done a lot of work with this bill.

I would like to thank everyone who has made a constructive contribution. I think this is an important step forward.

Mr. President, I will be brief. First of all, when you tell us that, thanks to this project, you will be able to invest for the reimbursement of psychotherapeutic care, I ask to see! But from what I see, in healthcare budgets, you are currently constantly busy making savings. This is the truth! And it does not seem to me that this will stop, given the budget debate we had just before it and the austerity orientation of this government.

Secondly, you are talking about the value of the profession. You say, “It’s still nice, we’ll value the profession.” This is still strange, it is almost funny, since the profession no longer exists, since the profession of psychotherapist is no longer recognised. These are acts that are recognized and that will be practiced by three professions. You need to be precise and say that you no longer recognize the profession of psychotherapist. You do not know how to value it.

Third, you say that we will improve the quality. I think this is really going against the realities of the field. As if the vast majority of men and women who practice this profession had not already organized themselves to impose a quality, after years of studies and training, organized by the associations themselves. To say that we’re going to improve the quality is a blow to all those professionals who didn’t wait for you to do so.

You have not given an answer as to the long-term decrease of a diversified offer, while all scientific studies show that what is needed in this matter is a diversified offer according to the specificity of psychotherapy itself.

Certainly, in the transitional period, you organize it in a strange way. It will last for decades.

Students in training will be part of this transitional period. This simply confirms the existence of some difficulties within your majority and that you have found a ⁇ cunning compromise. Certainly, given a transitional period of this magnitude, it is necessary to be precise on how to organize it. And on this subject, several speakers talked about this transitional period and the protection of the patient during this transitional period. We have not received a concrete answer. You talked about evidence based, but explain why you believe that evidence based should also apply to the particularity of psychotherapy! I have not heard any arguments.

You no longer recognize the profession. You have a few small problems with this. This is more important, and the Council of State also emphasizes this. And by that fact, there is no way to impose, as we can do when we recognize a profession, a protection for patients. You say that provincial medical commissions could eventually intervene in case of complaint, for example. But there is not only that. I have often given the example of a doctor who has undergone training to become a psychotherapist. By the very fact that you do not recognize the profession, he can do a psychotherapy once in a while, it is enough. He does not need to have regular practice, with continuous training. This obviously goes against the quality of the offer in psychotherapy.

Finally, you tell us that you are really disappointed, because the opposition has, in some way, used the professionals, disinformed them. That is why they disagree!

You are infantilizing the associations. Take them for what? It is contempt for them that to believe that they are ignorant and the reality of their profession and what you propose for the future. What is this? This shows that you should have been more personally interested in this subject. You should have received them personally, dared to discuss with them and listen to their arguments, which you did not do. I said it, just recently, in my speech: you were extremely disappointed in this matter and I can tell you that you confirmed it in your response.

Among the elements that the minister cited and of which we have not or little talked, some concern the bacheliers. It is true that in the bill, a small article stipulates that these bachelors may eventually be recognized as mental health support professionals and perform certain acts that will be prescribed to them by other professionals that will meet the criteria of the law.

I think this is not knowing the reality of those bachelors called assistants in psychology. And since in this matter, the evil is not yet done, it will be important that you see with them how to characterize the interest of their profession, their contributions, their way of exercising, so as to recognize them in their abilities and to be able to conceive a job within care teams without necessarily creating a hierarchy between these professionals. This is something you have repeatedly mentioned in the committee.

Even if there are autonomous and non-autonomous, I do not create a hierarchy: multidisciplinary work is a work between different partners, there is no one that is hierarchically superior to the others. That said, in some interventions of members of the majority, I heard the word "hierarchy", saying that it was logical to make a hierarchy, since it is the one with the strongest competence that is situated at the top of it.

Interpretations, readings, ways of translating this project are multiple and diverse because there is not enough clarity. If it were a 100% readable text, there would be no such different interpretations.

As far as evidence-based medicine is concerned, the element that most disturbs me, Mrs. Minister, are the current abuses of this concept. How is it built? How are these practices considered to be scientifically proven on the basis of international literature, on the basis of combined practices, the most numerous, that reach the right results? Even the founders of evidence-based medicine are beginning to question themselves. It is known that it is obviously those who are the most organized, the most powerful, the most productive who will produce you the references that will become the most numerous and who will tell you what the best practices are.

This goes against a work that obviously is based on criteria and references. Psychotherapy even from the beginning is scientific but it is human science. It is neither chemistry nor biology. Human sciences have their specifics and interests. By working and building in a structured, thoughtful, intelligent way, it is possible to have quality care without trapping them into a definition, a concept, a way of doing that will be the one of the most dominant who, therefore, often, do not want to change their practice.

With regard to patient law and provincial control commissions, if the fact that the patient understands what happens to him, understands with whom he is in relationship, depended solely on this ability to control through provincial commissions, it would be really easy to settle. We would not spend our time here. It is not at this level that things happen. You know that your bill, or any other, does not protect against abuse of people who become psychotherapists or mental health specialists while they have absolutely no training.

Regarding supervisions, supervisor responsibility, multidisciplinarity, there too, when you hear the different members who defend your project, you realize that the interpretations and descriptions are not the same. The opposition does not feed concern and there is no misunderstanding or interpretation of the texts. There are lectures between us that differ by the values and principles we adhere to. Fortunately, the industry, health professionals, in turn, know how to read and have the ability to analyze and understand texts. They have the ability to confront them and compare them with their field practices and social reflections. It is inherent and inseparable from the exercise of psychotherapy. Therefore, to consider that it is our interpretations that feed the concerns of the sector, it is to ridicule this sector and it is to give us a lot of importance.

You need empathy and professional relationships. Like my colleagues, I have joined you and I have not said anything else. Building a relationship and being able to walk with the person who consults a psychotherapist actually requires abilities of empathy but also requires the ability to remain professional in their relationship. What I reproach you is that you have not put into your bill, for example, as a requirement in the formative course, all this dimension and all that personal work to do so that you can both establish an empathic relationship and not enter into a relationship with an affective dimension, or no longer allowing you to take the necessary distance to be able to analyze and meta-analyze what happens in that relationship and in the process of change.

You say that these care professionals must be recognized but, either, it is said that it is a form of treatment that can be practiced by other health care professionals, or, it is said that psychotherapists are recognized as mental health care professionals and then they are registered as such. But we must stop saying that we must recognize them and then not recognize them. This creates confusion. I am all the more perplexed because you put in your law a requirement for future psychotherapists: they will have to be doctors, clinical psychologists, orthopedagogues. Among the actions that these three professionals can make are diagnosis and treatment. You say that you do not want psychotherapists as professionals because psychotherapy is only the part of treatment and that one cannot diagnose, while those who will be able to practice psychotherapy can diagnose by their basic profession. There are intellectual inconsistencies in your text.

However, there are two positive elements in your answer. You say that all the opinions of the Higher Hygiene Council have not been followed. I am glad to hear you recognize him. Therefore, you cannot say that you rely on the opinion of the Higher Hygiene Council. You said there were many meetings. You say through this that you have not met everyone. I thank you today for acknowledging it.