In 1946, the World Health Organization (WHO) established in its charter that health is not only the absence of physical disease, but also a state of physical, psychological and social well-being.
In 1977, the American doctor Engel published an article in the journal “Science” entitled “The Need for a New Medical Model – A Challenge to the Biomedical Model”, in which he criticized the limitations of the biomedical model of “reductionism” and “mind-body dualism”. He criticized the limitations of “reductionism” and “mind-body dualism” of biomedical model and proposed the concept of “bio-psycho-social medical model”.
Currently in China, physicians are trying to learn how to identify “depression” and “psychosomatic diseases”, so have psychiatric hospitals completed the “paradigm shift in medicine”? Have psychiatric hospitals completed the “paradigm shift”?
Almost all psychiatric hospitals in the country are primarily drug-selling hospitals, with drug revenues accounting for more than 60% of total hospital revenues, and drug revenues are more than twice as high as revenues from other medical services. Revenue from psychiatric medical services, on the other hand, is far less, and is almost the least revenue of all the fee-based programs.
Another scene: patients arrive at psychiatric hospitals and ask around “which doctor can do psychotherapy?”
Patients lining up in front of psychiatric hospitals are always looking at the few doctors who can do psychotherapy in the hospital advertisement. These doctors, who are always the most popular with patients, naturally become the most difficult doctors to register, and the outpatient numbers of these doctors often become the key targets for scalpers.
It is clear that more and more people need psychiatric services in psychiatric hospitals!
There is a very urgent social need for psychotherapy.
Patients often brave the cold winter nights and wait in line all night to get a psychiatric outpatient number. Patients ask, “Why don’t you train more psychiatrists in your hospital?” This comment made me think deeply and left me speechless.
Yes, since the mental health law states that psychotherapy can only be done in medical institutions. Psychotherapy is one of the most important medical services that should be carried out in psychiatric hospitals. Why, in fact, are psychotherapy services hardly ever offered in psychiatric hospitals?
What are the obstacles to the development of psychotherapy, in psychiatric hospitals?
Can psychotherapy be developed in psychiatric hospitals in the future?
Psychotherapy fees are too low.
According to the current fee schedule set by the Beijing Municipal Health Bureau, psychotherapy in public hospitals is 30 RMB per session. Such a low fee is simply not enough to honor the value of a doctor’s labor and professional training. Therefore, if it is not out of personal interest, no doctor will be willing to take the initiative to “hard and unprofitable” psychotherapy as a lifelong career.
Psychiatric hospital management problems.
1. Psychiatrists, by nature, do not do psychotherapy.
Since psychiatric hospitals, at present, mainly diagnose and prescribe drugs to patients, drug revenue is the largest source of total hospital income; we can also say that psychiatric hospitals, at present, are still in the era of “biomedical model”, has not yet completed the transformation to “biopsychosocial medical model We can also say that psychiatric hospitals are still in the era of “biomedical model” and have not yet completed the transformation to “biopsychosocial medical model. Most psychiatrists in hospitals, especially doctors, only diagnose and prescribe drugs, and from their college to residency training, they have not received systematic and formal training in psychotherapy, because their supervising doctors do not know how to do psychotherapy and counseling. In this way, the generation to generation, to their generation, but also only diagnose and prescribe drugs.
2, the director of the psychiatric hospital, also do not know psychotherapy
Generally speaking, the director is promoted from the psychiatrists. Since the majority of psychiatrists have not been trained in psychotherapy, then, after he becomes the director, he is still a “biological” doctor, his mind, there is no concept of psychotherapy expertise, or, even if there is a concept, because he has not been trained in psychotherapy, his passion is engaged in biological psychiatry He naturally does not value and encourage the development of psychotherapy in psychiatric hospitals.
3. Young doctors, in general, do not choose psychotherapy as a lifelong career.
Although they are interested in psychotherapy, they generally do not choose psychotherapy as their lifelong career. There are many reasons for this: first, senior doctors don’t like to see them studying psychotherapy with others; second, they are too busy in the ward to study psychotherapy; third, the training fees for psychotherapy are not reimbursed by the hospital and need to be paid out of their own pockets; fourth, there are too many inpatients and too few doctors. Fourth, there are too many inpatients and too few doctors, and doctors are busy writing medical records, prescribing medical orders, and dealing with various examinations, so they do not have time to sit down and talk with a patient, let alone do psychotherapy; fourth, there is no space and working time for psychotherapy talks in the ward; fifth, young doctors need to promote their titles, need to have research projects and write papers, and if they are engaged in psychotherapy studies, they often cannot apply for projects, and it is also difficult to publish sufficient number of SCI and other papers. Difficult to publish a sufficient number of SCI and core journal papers, which directly affects their own title promotion and salary income; the long-term adverse impact is to delay his promotion to a full senior title or even a doctoral director. Therefore, psychiatric hospitals, even if there are individual old experts enthusiastic about carrying out psychotherapy work, but also facing the plight of the successor.
4, hospital management, everything to the money, hospital leaders do not have the enthusiasm to focus on the development of psychotherapy discipline.
Psychotherapy department, will not get the leadership’s attention, will not be as a key department to grow and develop, the most direct reason is: psychotherapy professional outpatient, do not earn money!
Psychiatrists who are diagnosed to prescribe drugs, a morning can see more than ten patients; psychiatrists who engage in psychotherapy, psychological talks are both hard and time consuming, a morning can see up to four patients, but also often do not prescribe drugs, no drug income.
5. No psychologists are willing to go to psychiatric hospitals to engage in long-term psychotherapy work.
Psychiatrists do not carry out psychotherapy themselves, so can we bring in psychology professionals to psychiatric hospitals to engage in psychotherapy work? This is almost impossible!
The reasons are as follows.
First, in hospitals, the rates for psychotherapy are so low that a psychologist working in a psychiatric hospital cannot support himself and has to rely on other psychiatrists to support him.
Second, in the biological model of psychiatric hospitals, psychologists belong to the “minority” and are pushed aside by psychiatrists in terms of applying for projects or title promotion, and are seriously marginalized in the long run, unless they also take a medical license and become psychiatrists, and also act like psychiatrists to He will be able to survive in the psychiatric hospital only by diagnosing and prescribing drugs.
Third, according to the existing medical administrative regulations, those who engage in psychotherapy must be “psychotherapists,” and those who are certified as psychotherapists must first be “qualified as professional physicians,” so psychologists entering psychiatric hospitals, directly Therefore, psychologists can not find the “door” to enter the psychiatric hospital, the psychiatric hospital is closed to the door of psychologists.
Since the mental health of the public requires psychiatric hospitals to provide psychotherapy, and since the mental health law requires hospitals to provide psychotherapy services to the public, how will psychiatric hospitals develop in the future? So, how can psychiatric hospitals develop and expand their psychotherapy teams in the future to take up their social responsibility and serve the public?
1, the public hospital psychotherapy fees, must be raised! This is a policy bottleneck, this problem is not solved, almost all other problems are difficult to solve. (Note: this issue is too complex, not I can say clearly, so, for the time being, not to discuss)
2, the director of psychiatric hospitals, to strengthen the professional study of psychotherapy, to strengthen the strategic awareness and the overall concept, and effectively assume social responsibility for public mental health, not only the concept of “biological psychiatry”, only to encourage staff to diagnose and prescribe drugs, the exclusion of dissidents, the doctors engaged in psychotherapy as a minority, or as The “unprofessional” and “side-track”.
The fact proves that if the director has a high level of mental health professional concept and strategic awareness, psychotherapy can fully develop and grow in psychiatric hospitals, and the Shanghai Mental Health Center is a good example, because the director, Professor Xiao Zeping, is himself a famous Chinese psychoanalyst, and their hospital opened a separate “psychological consultation clinic ten years ago Therefore, the psychotherapy outpatient work carried out by their hospital has been at the forefront of the country.
3. Strengthen the standardized training of psychiatric residents. In the future, when training psychiatric residents, must significantly increase the training of psychotherapy theory and skills, including case practice and supervised teaching of psychological talks.
4, psychiatric hospitals, in the outpatient and ward, to open a special area for psychotherapy, from registration, to the layout of the room for psychological talks, to case management, etc., should meet the standards of professional settings for psychotherapy talks.
5, in the hospital economic accounting, in terms of the current psychotherapy fees, psychotherapy outpatient clinic, belongs to the policy of loss, these losses, should not let the individual doctors engaged in psychotherapy, but should be subsidized by the hospital from the collective income or average bonus.
6, in the promotion of titles and scientific research project applications, priority should be given to promote the subject of psychotherapy specialties and to promote the titles of doctors engaged in psychotherapy.
7. Psychologists, psychological counselors and social workers should be introduced into psychiatric hospitals to provide psychotherapy and counseling services to patients and provide social services.
The doors of psychiatric hospitals should be open to psychologists, psychological counselors and social workers. This would require amending the current Mental Health Law, focusing on the need to amend the following entry.
”Article 23 Psychological counselors should improve their business quality, comply with the practice norms, and provide professional psychological counseling services to the public. Psychological counselors shall not engage in psychotherapy or the diagnosis or treatment of mental disorders.”
I suggest that the entry be amended to read, “Psychological counselors, may carry out psychological counseling work for patients with mental disorders in medical institutions; psychological counselors, outside medical institutions, may simultaneously provide psychological counseling services for patients with mental disorders while they are receiving medication from psychiatrists.”
The year 2015, with the steps of spring, comes to us. I fervently hope that the development of the professional discipline of psychotherapy, in psychiatric hospitals, will also usher in a “scientific spring”!