The current exodus of psychologists from the public network is worrying, and moreover decried by many. The conditions of the public network obviously cannot compete against those of an office in autonomous practice. The professional is entirely in control of his time, his general conditions, the clientele he selects, the approach he favors and above all his fees. It is clear that the power of attraction of public services will always remain limited in this respect.
Insufficient efforts
Several departmental strategies have nevertheless been implemented in recent years to promote the retention of psychologists, with mixed and often disappointing results. The heavy trend of this exodus is increasingly affecting other professionals, who are also seeing the advantages of full autonomy in practice. Being only the tip of the iceberg, this phenomenon should concern us collectively with regard to a progressive deprofessionalization of public mental health and social services.
As a career social worker in the public health system, a university lecturer with the next generation in social work for several years, and a psychotherapist in a private office, I would like to submit an emergency exit in three steps:
1. Make post-graduation public service compulsory for at least three years. The internship or internship in the public services is for many an extremely relevant passage to active professional life. Rich in learning of all kinds, it is the place for the emergence and development of professional identity. It allows a greater understanding of disciplinary issues, in particular by meeting other professionals. Trainees and interns are mainly called upon to intervene in complex situations of very great social vulnerability by offering services to the most disadvantaged populations, among other things. They thus acquire an experience rich in professional skills. This experience should be augmented and consolidated by compulsory post-graduation practice in the public services. There is also an objective of protecting the public, ensuring a solid sampling of diversified situations before any autonomous practice.
2. Legislate on pricing and fees. The need to protect the public is currently paramount. The risk of financial harm is considerable, especially in a context of rampant inflation of fees that follows the explosion of demand and the scarcity of supply. It is not uncommon for newly graduated professionals to impose fees far exceeding those of experienced professionals. It becomes imperative to review the regulation of fees according to graduation, actual post-graduation experience and expertise and specialization, if applicable. This measure, essential to protect the public, would also limit the lavish appeal of an Eldorado of independent practice.
3. Hours of supervision in public services. Several professionals from disciplines other than psychology hold a psychotherapist’s permit. Some are also licensed marriage and family therapists. These professionals are often reluctant to work in public services. Like psychologists, they are jumping ship now, although this exodus is silent. They do so, among other reasons, because they are imposed tasks and responsibilities linked to their disciplinary training, and not to their specialization as psychotherapists. Enhancing their contribution through recognition of their contribution to psychotherapy would ensure the retention of experienced professionals. Above all, requiring that the supervision of the hours of practice of future psychotherapists henceforth pass through the public services would make it possible to complete the training in therapy of a diversified experience of the most vulnerable populations.
From the birth of the asylum to the present day, mental health services have always been characterized by an inequitable coexistence between public services, private clinics and fully independent practices. If we want to avoid the deterioration and erosion of the public system, a serious overhaul is now necessary.