Liu Ting/text From November 1, 2022, Jiangsu Province will formally implement the "psychological treatment" project into the scope of Jiangsu medical insurance payment, and the whole province will implement it uniformly. As soon as the news came out, all parties were excited.
The psychological treatment costs borne by Jiangsu Province's medical insurance are divided into three levels: 200, 180 and 160. This is another major local action since medical insurance covers more than 80% of the treatment costs of psychiatric patients across the country. The high cost of psychological treatment or consultation has always been a hidden pain for many groups of mental illnesses. On the one hand, psychological treatment has a significant effect on people who are troubled by depression, anxiety, social interaction, intimacy and personal growth; on the other hand, the monthly fee of at least 1,000 yuan makes ordinary families sigh. Therefore, the cost of psychotherapy is greatly supported by medical insurance subsidies to groups in need. It can be foreseen that once this government is released, the group that hopes to receive psychological treatment services will definitely exceed the 170,000 people reported by Jiangsu Province at the end of 2021.
Mental health is increasingly attracting social attention, which is the result of the development of the times. From the 686 plan for taking medicine for mental patients first launched by the National Health Commission to the implementation of , the first mental health law in 2012, to the establishment of the National Center for Mental Health and Mental Disease Prevention and Control in 2020, the author and his colleagues, as practitioners, can deeply understand the booming trend of China's mental health cause in the past decade. These macro and local policies in the field of mental health provide important guidance for the public to popularize mental health knowledge and promote scientific and effective treatment plans.
However, as a practitioner of psychological clinical and mental health policy research, I would like to remind you not to ignore a reality, that is, the serious shortage of psychotherapy practitioners.
Jiangsu Provincial Government Website shows that at the end of 2020, the population of Jiangsu Province was 84.7726 million; in 2019, Professor Huang Yueqin, a famous mental health expert, concluded in China's first national epidemiological survey of adult mental disorders , project, that the prevalence rate of any mental disorder in China (excluding Alzheimer) in December was 9.32%. Based on this data, it is roughly estimated that there are 7.82 million people in Jiangsu Province who need psychological treatment. The "State of Mental Health-related Work in my country" released by the National Health and Family Planning Commission on the Chinese Government Website in 2017 showed that as of the end of 2015, there were 5,000 certified psychotherapists, 27,733 psychiatrists and about 900,000 psychological counselors nationwide. This data also echoes Professor Huang Yueqin's estimation in the survey report that there are 2.4 psychological counselors per million people.
, but please note that the medical insurance payment policy in Jiangsu Province clearly stipulates that psychiatrists who receive standardized psychotherapy training or health technicians who have obtained professional and technical qualifications for psychotherapy. If psychiatrists who have no time to take into account psychological counseling due to high-intensity work are eliminated, within the scope of Jiangsu Province's medical insurance policy, the number of psychotherapy professionals enjoyed by one million may be far less than 2.4. The training cycle for psychotherapy majors is long (4-6 years), and it will take time to train a large number of psychotherapists in the short term.
At the same time, psychotherapy has the characteristics of long time, slow onset and complex effect evaluation. This is also reflected in the proposal of Jiangsu Provincial People's Congress representative Zhu Jinsong: "Psychological treatment is usually once a week, and patients often need multiple consecutive treatments, and some courses last for several years." Taking short-term psychodynamic treatment as an example, it takes at least 16-20 weeks to solve a psychological disease issue. Moderate and severe patients who require a combination of psychiatry and psychological counselors often take longer. In light of the current situation of serious supply and demand ratio of psychotherapy professionals in Jiangsu Province, the waiting time for psychotherapy to obtain psychological treatment through medical insurance payment in the future will inevitably be very long. Taking the , the Hong Kong Special Administrative Region of China, which has been using the UK NHS medical insurance system as an example, the average waiting time for psychiatric departments in Hong Kong reported in 2018 was 127 weeks, which is also because the problem of the decrease in psychiatric practitioners in public hospitals in Hong Kong has not been solved.
Jiangsu Province attaches great importance to mental health work and its demonstration role as a local leader, but the long waiting time for services caused by the shortage of professional staff may reduce the fairness and accessibility of this service.The stones of other mountains can be used to polish jade. The UK, which implemented universal health insurance, had a serious shortage of mental health services as early as the 1990s. Therefore, in 2004, the document "Organization and Provision of Psychological Therapy" was formulated, expanding psychotherapy services from hospitals to communities and various institutions. The personnel providing professional services include psychiatric nurses, psychotherapists, qualified clinical psychologists, art/music or theater therapists, qualified occupational therapists and qualified social service personnel. Funding for medical insurance costs has also expanded from simple tax and fiscal payments to social financing, insurance and other channels. For Jiangsu, which has 7.82 million psychological treatment needs and China, which has 140 million psychological treatment needs, it is only the beginning to actively solve mental health issues.
(the author is a psychological counselor)
