2023-10-07 06:29:00
Oscar, 15, went through a difficult year last year in a class where there was so much violence that several of his teachers were on the sidelines. In particular, he had almost no math lessons even though he had to take CE1D. He began to miss work himself. Two psychologists from the psycho-medical-social center (CPMS) came to try to calm this crisis situation. Their intervention was effective. The class calmed down… for a few weeks. “But for me, the psychologist listened to me for two minutes”, confides the teenager who could no longer get up to go to school. Since this start of the school year, the Minister of Health Frank Vandenbroucke (Vooruit, Flemish socialist) has opened the possibility of involving, on the advice of the PMS center, a first-line psychologist approved (therefore “free”) within the walls of the ‘school.
Oscar would thus have been able to meet Émilie who has already been called several times by PMS centers for children requiring individual monitoring. “Until now, I have mainly supported primary school children to work on managing emotions and relationships with family. Those I followed had quite serious problems”, testifies Émilie. For her, it is important to involve the parents in one way or another, at least to have contact. But the cases she followed were sent by institutions like the SAJ (Youth Assistance Service).
Émilie is convinced. She has worked for fifteen years, initially for CPMS, in schools “to make children into fulfilled adults”. She works with teachers, from a systemic approach angle. “CPMS are overloaded. External help is precious. I go concrete, I give tools, I don’t do great psychoanalysissmiles the psychologist from Namur. We do not do the same work as the CPMS. We do more and more often, taking our time. A consultation at the office costs 60 euros. So this agreement system is close to my heart. I have a lot of people who don’t know how to pay. We don’t have to choose between eating and feeling better.” Émilie, very involved, reports that precariousness, in fact, generates a lot of loneliness, depression, anxiety and worries which end up becoming chronic.
Real support on the front line
Since the start of the school year, schools have been better equipped to avoid leaving children and young people in distress behind. That’s because a lot of young people are doing badly. The school dropout rate, which doubled after Covid, remains very high. Students completely disappear from the radar. At the same time, more and more medical certificates are being issued, and the use of psychotropic drugs, which has exploded among the population, also concerns younger people. The PMS centers, which were no longer able to absorb the distress of young people during the health crisis, took care of a lot of problems, receiving European aid. But this aid has ended.
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The PMS centers instead provide support to the student in a multidisciplinary manner (social worker, nurse, psychologist and speech therapists) and can redirect if therapy is necessary, reports Sandra Conti, director of CPMS. “Our job is to ensure the good education of students. This ranges from detecting a vision problem to family problems. We do prevention and guidance but not therapy. We always redirect towards services that can help, such as in the event of financial problems towards the CPAS or with vision towards an ophthalmologist. But we run a lot. In this context, front-line psychologists can be of interest. In our center, we worked with a front-line remedial teacher who helped teenagers with their working methods to pass the CE1D. We are really trying to take the best of the federal proposal.”
Treating… the image of the psychologist
The agreements established between Minister Vandenbroucke, Inami and the FPS Health come into this context. They predate the health crisis and initially concerned 18 to 65 year olds; Covid hastened the process of implementing the system among young people. And for good reason. “During the pandemic, particularly in its second phase, significant psychological suffering was observed among young people and young adults.”, underlines Fabienne Glowacz, professor of psychology at ULiège. She carried out a very exciting study with the KUL on the results obtained following interventions using approved psychologists. “Seeking psychological help is often difficult. Access to care is often late compared to the first symptoms. These new front-line psychological care offers aim to promote rapid, accessible intervention as close as possible to the patient; our research has highlighted a reduction in delay and rapid effects on the patient’s progress.”
Because the waiting lists for psychologists are endless. This new front-line care is part of an early and preventative approach. “The sooner we see a psychologist, the less burdensome this intervention will be and the less will be the need for medication and hospitalization. Quality of life is regained much more quickly”, supports Fabienne Glowacz. This prevention also aims to counter a belief that is still too deeply rooted that we can cope alone. “We have mainly observed this brake among young adults, but it is also parents of children who have problems. The image of the psychologist remains associated with stigmatizing representations and there can be shame”, reports the expert.
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PMS Centers must move
For psychologists, it is also about being able to intervene outside their office, in schools, youth centers, families. This is a new positioning. “The school can be a place of contact which facilitates the meeting and allows us to be as close as possible to what the patient is experiencing, while reimbursement is assured. Shortening intervention times is particularly important for teenagers because too often we let it slide by blaming it on an adolescent crisis. This front-line care also makes it possible to meet a vulnerable population. This is a major change in mental health care in a context other than that of repeated consultation and high prices for the patient. The effectiveness of the interventions of approved psychologists has been proven. But it also takes time to implement this project throughout the country and mental health networks”, defends Fabienne Glowacz.
For Sandra Conti, director of CPMS, the health of young people is (still) not going well, with hospitals and youth support services overwhelmed. “We make a great job but with bits of string. We try to be creative. Our advantage is being in the schools. With the educators, we are as close as possible to the students. But we are also the first to delegate.” She sighs. The controversy surrounding Evras has been added to the mountain of problems on the ground. “We have been doing these courses for thirty years, just like family planning. Evras starts with simple questions like why do I have hair or periods…” And Sandra Conti recalls that the CPMS framework was created in… 1962 and has barely been modified since then.
Until now, the CPMS already referred them on a case-by-case basis to these approved psychologists, but they were not free. Beneficiaries of an increased intervention paid 4 euros per session and others 11 euros. Minister Vandenbroucke removed this quota. But the CPMS must establish an agreement with front-line mental health services. A certain number have not yet moved. Considering themselves to be the school’s experts, or simply not being in a region where approved psychologists work, they did not view Minister Vandenbroucke’s new provision favorably. Others, like Namur or Verviers, have resolutely committed to the path. Charlotte Guiot, psynam coordinator who works with the Kirirkou health network, testifies to this. “That works well. We are removing a significant financial barrier. And since 2022, those who need a psychologist no longer have to be referred by a doctor to have access to approved care.”
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