A bit of history: remember that Bill 21 adopted in 2009 aimed to guarantee the competence, accountability and integrity of mental health and human relations professionals, as is the case in the field of physical health. Bill 21 established professional acts reserved for high risk of harm and psychotherapy.
Posted at 12:00 p.m.
Choosing to practice psychotherapy involves consciously knowing that there are risks of harm. But accountability weighs heavily in the health network.
Many psychologists leave the network, it is known. Those who remain are entrusted with the care of the most vulnerable users. Their problems are complex, often chronic. Given the ever-decreasing number of psychologists in the network, the references entrusted to them are therefore scrutinized and combed through to ensure that no other profession can meet the needs of the user. It is the last link in the chain of public services, the specialized service, even over-specialized, the one we ask for after having tried everything, the one we count on. It is also the one to whom we attribute the evolution of the user.
In the network, responsibility means that we must justify the evolution of the user. But with great blows from a framework of practice limiting the number of meetings, episodes of brief services, an impersonal “turnkey” program and budgetary restrictions preventing the meeting of continuing education requirements at the OPQ, the challenge is almost insurmountable. How can the most vulnerable clientele progress in such a restrictive framework?
Is it beneficial or detrimental for a user to be able to treat only one symptom, because tackling the underlying problem takes too much time? What psychologist has the taste to justify the unacceptable? Who has the taste to bear the weight of aberration?
The network’s psychologists working within an interdisciplinary team enjoy the work of collaboration and consultation. They can then take advantage of a holistic vision and understanding of the user. The other side of the coin is that this team relies on psychological or neuropsychological assessment and psychotherapy to ensure the user’s progress. When evolution stagnates or regresses, the psychologist must justify it. To the user himself, to the team, to the superiors, to the doctors, to the paying agents. He must propose solutions, an intervention plan. It must be fair and fast. It’s demanding. It’s heavy.
Psychologist in remote area
Working in a remote region represents an additional challenge, as the labor shortage is more prevalent there and access to specialized medical services is difficult. The teams therefore count devilishly on the involvement of the psychologist in the evaluation and care of the user. And the psychologist, on which colleague can he count for a psychological opinion in support of his? There are so few psychologists in remote regions that we too often find ourselves alone. Alone in the face of the user’s situation, in the face of the team’s expectations, even in the face of the medical profession, which no longer knows which intervention to adopt.
It is not surprising that psychologists desert the public network to go to work in the private sector, when they have the freedom to govern their practice. They can practice according to the high standards of the profession, in all coherence and with all respect for their clientele and themselves.
They can take the time and let the client walk at their own pace. They have the freedom to accompany their client until the end, to experience professional success simultaneously with the recovery of the client, in harmony with the client. They have the freedom to train on topics of their choice, to afford professional supervision.
The private clientele is different: less complex, less chronic and more mobilized in the therapeutic process. Yes, the private psychologist is responsible and practices according to the high standards of the profession. But responsibility has a value, the salary value. To this salary is added professional accomplishment, which is experienced without undue pressure.
In private practice, responsibility flows more smoothly. It even has a positive connotation; it refers to the therapeutic success and the recovery of the user.
And if we monetized responsibility in the public network, would that increase its value? Would the weight go down? I believe it’s worth a try.
Recognition, first through honorable and respectful financial compensation, of all the involvement that practice requires in the public health network will allow the retention of the profession in the network.