Conférence EAOF

Ladies and gentlemen, dear Ronny, I want to express my gratitude for your generous introduction.

 

Today, I will discuss the topic of health, a matter of great concern for many of you gathered here today. It encompasses not only the mental well-being of your patients but also, and importantly, the mental health of the general public.

 

Currently, we are making significant investments in bolstering mental healthcare. However, it's crucial to emphasize that these investments must go hand in hand with substantial reforms. Mere financial infusion isn't enough; it should serve as a catalyst for change. This is easier said than done. In this brief opening, I'll touch upon the challenges of reform and what we can anticipate.

 

Reform is a formidable challenge because, in any policy-making process, we grapple with what political scientists refer to as 'path dependency.' We're on a historical trajectory, and while we must build upon it, we also need to adapt and transform. In Belgium, summarizing broadly, we carry two historical legacies.

 

The first legacy is our long-standing history of robust and institutionalized psychiatric care, especially in the Flemish region. Around two decades ago, we initiated a shift away from this institutionalization. By 2010, we formalized the move towards community-based care through our mental healthcare networks. Presently, we have 32 territorial networks for adults and young people, encompassing the entire country. So these networks where in charge of the institutionalization. 

 

 

Secondly, as a corollary to institutionalization, hospital settings tend to be more stressful, necessitating more intensive treatment and handling of complex cases. Hence, in this journey initiated two decades ago and led by these care networks, we confront the dual challenge of establishing organized primary mental healthcare while concurrently intensifying services within institutions.

 

The second legacy stems from the historical roots of the Belgian healthcare system, which began as a Bismarckian insurance system. This system revolved around reimbursing patients for medical treatments provided by doctors. It operated primarily on a fee-for-service basis. While responsive, this model posed challenges, particularly for chronic care and multidisciplinarity, and also led to overconsumption.

 

Over the past 25 years, we consciously deviated from this pure fee-for-service model, particularly in general medicine, where we introduced a more hybrid funding approach and strengthened organization. This shift was essential as it fostered a move away from the solist, fee-for-service mindset.

 

The challenge lay in convincing stakeholders, notably clinical psychologists, that the integration of clinical psychology into our collective healthcare system and reimbursement structure wouldn't resemble the traditional fee-for-service model. Rather, it would demand collaboration, multidisciplinarity, and innovative methodologies such as group sessions. The focus shifted towards early problem detection and prevention, along with outreach to sites where early issues might surface, such as youth centers, social services, or general practitioner practices.

 

Building on this historical trajectory, we fortified our primary mental healthcare system with a €165 million investment. This funding supported territorially-based care networks responsible for studying their environments, identifying needs, and engaging clinical psychologists and related professionals who embraced this collaborative mission. This wasn't the fee-for-service approach clinical psychologists might have anticipated, but it was necessary for the reform we envisaged.

 

We now have approximately 3,000 clinical psychologists enrolled in the system, working with controlled fees and providing the first session free of charge. The emphasis is on early detection, empowerment, and guiding individuals towards a healthier path. Already, around 200,000 people have benefited from these services, but it's a gradual process, not without its challenges.

 

Policymakers face the difficulty that the results promised by these reforms aren't immediately apparent. Patience is required both from colleagues and the public. Initial assessments indicate positive short-term impacts, including increased resilience, reduced problems, improved daily functioning, and decreased absenteeism from work. Importantly, it's also reducing what I'd term a "hidden waiting list" - the time between the onset of mental issues and seeking help. While it's not a metric policymakers typically use, it's a significant step forward in public mental health.

 

Moving on to the second aspect of reform, we recognized the need for intensification. We strengthened mobile teams to address complex cases and enhanced coordination. Additionally, we expanded High & Intensive Care (HIC) units from nine to 28 across the country, investing €15 million in this endeavor. HIC units focus on one-on-one supervision in a humane environment, fostering collaboration with mobile teams and hospital emergency services. This model aims to de-escalate crises quickly, ensuring continued care through follow-up units, day hospitalization, or patient consultations. Involving patients' relatives and external care providers in coordination is crucial.

 

The architectural design plays a pivotal role in creating a healing and non-coercive environment. This initiative, while not without its challenges, is vital for enhancing care.

 

In conclusion, we face a dual task: strengthening preventive primary mental healthcare for public mental health while addressing complex cases and crises with intensified services. We acknowledge the need for further investment and ongoing reform, which should be guided by evidence and a long-term perspective.

 

I extend my heartfelt gratitude to all involved, from researchers and teams to practitioners in the field. Your dedication, commitment, and patience are crucial in shaping the future of mental healthcare. I wish you a productive conference, and thank you for your attention.