Deploying care for the mentally ill dominated the discussion. The legislature should therefore help to at least improve the cross-sectoral care of the chronically mentally ill. The reform of the education was postponed again.
Psychotherapist days have their own dynamic, and sometimes an important item on the agenda falls by the wayside because lively discussion breaks out unexpectedly elsewhere. The “reform of psychotherapist training” was on the agenda of the 22nd German Psychotherapist Day (DPT) on April 20 in Berlin. Above all, the discussion about the “need for health policy action in the next legislative period” outlined by the board of the Federal Chamber of Psychotherapists (BPtK) took up so much time that the thorough discussion of the training issue had to be postponed.
The “need for action in health policy” was primarily about the suggestion of the BPtK board, based on To create the new outpatient specialist medical care area (§ 116 b SGB V) further cross-sectoral level for the outpatient care of mentally ill people with complex treatment needs.
Ignoring waiting times
BPtK President Prof. Dr . It was Rainer Richter who got the delegates in the mood for the requirements of the coming legislative period at the beginning of the Psychotherapists' Day. He didn’t dwell long on the board’s main areas of work last year. Much has been initiated, but Germany is still long way from providing satisfactory care for mentally ill people. As result, Richter concentrated on current problems and suggested solutions.
The current main annoyance for psychotherapists is the demand planning recently adopted by the Federal Joint Committee (G-BA). There, the determined levels of supply had almost nothing to do with the real supply situation in psychotherapy, criticized Richter. "It is unbearable with what nonchalance the joint self-administration in reforming the needs planning has ignored the months of waiting for an initial consultation." A needs plan that, in view of such circumstances, assumes that there are 6,000 psychotherapists too many is urgently in need of reform.
However, the BPtK President gave the delegates little hope that the joint self-government was willing to strive to improve this deficiency situation on its own initiative.
Deploying care for the mentally ill dominated the discussion. The legislature should therefore help to at least improve the cross-sectoral care of the chronically mentally ill. The reform of the education was postponed again.
Psychotherapist days have their own dynamic, and sometimes an important item on the agenda falls by the wayside because lively discussion breaks out unexpectedly elsewhere. The “reform of psychotherapist training” was on the agenda of the 22nd German Psychotherapist Day (DPT) on April 20 in Berlin. Above all, the discussion about the “need for health policy action in the next legislative period” outlined by the board of the Federal Chamber of Psychotherapists (BPtK) took up so much time that the thorough discussion of the training issue had to be postponed.
The “need for action in health policy” was primarily about the suggestion of the BPtK board, based on To create the new outpatient specialist medical care area (§ 116 b SGB V) further cross-sectoral level for the outpatient care of mentally ill people with complex treatment needs.
Ignoring waiting times
BPtK President Prof. Dr . It was Rainer Richter who got the delegates in the mood for the requirements of the coming legislative period at the beginning of the Psychotherapists' Day. He didn’t dwell long on the board’s main areas of work last year. Much has been initiated, but Germany is still long way from providing satisfactory care for mentally ill people. As result, Richter concentrated on current problems and suggested solutions.
The current main annoyance for psychotherapists is the demand planning recently adopted by the Federal Joint Committee (G-BA). There, the determined levels of supply had almost nothing to do with the real supply situation in psychotherapy, criticized Richter. "It is unbearable with what nonchalance the joint self-administration in reforming the needs planning has ignored the months of waiting for an initial consultation." A needs plan that, in view of such circumstances, assumes that there are 6,000 psychotherapists too many is urgently in need of reform.
However, the BPtK President gave the delegates little hope that the joint self-government was willing to strive to improve this deficiency situation on its own initiative.“Planning with view to desired care, with view to the health goals to be achieved, carries more risks for the cost bearers and the associations of statutory health insurance physicians than planning that is content with more or less stipulating the status quo,” stated Richter. It will not be easy to encourage politicians to put the reform of requirements planning on the agenda again. But care-oriented further development of psychotherapy requires clear legal requirement. Richter's realization: "Without this 'motivational aid', the common self-administration will do what it has already done in recent years: It fails when analyzing problems and then necessarily also when trying to solve the problem."
A new one § 116 c in SGB V
So it is not surprising that Richter relies on politics or the legislature in solving further supply problem - the care of mentally ill people with complex treatment needs. Since the psychiatry questionnaire, there have been attempts in this country to develop integrated outpatient care for these patients, he explained. “It is about care coordinated between different professional groups and about continuity of treatment between phases of outpatient and inpatient care.” Neither psychiatric outpatient clinics nor selective contracts have led to success and will not do so in the foreseeable future. A sufficient bundling of competencies for the outpatient and inpatient area does not take place. The care is either planned and implemented from the inpatient area or is focused on the outpatient area, Richter criticized. “We know, however, that phases of inpatient and outpatient care alternate with these patients. It is about continuity of treatment, the avoidance of breaking off relationships, about vertical integration as well as about horizontal integration, thus about an appropriate coordination between the professional groups. ”
According to Richter's opinion, the legislature should with new § 116 c in the SGB V create the conditions for better care for these mentally ill people with complex treatment needs. "Without question, we need new approach, and we want to propose such an approach to health policy." On legal basis, the Federal Joint Committee should define minimum standards for this new area of care based on the implementation of outpatient specialist medical care (§ 116 b SGB V) . Those who meet these requirements can provide services that are neither subject to requirement planning nor to any other permission restrictions that apply to outpatient care. "We are calling on politicians to interfere," emphasized Richter.“Planning with view to desired care, with view to the health goals to be achieved, carries more risks for the cost bearers and the associations of statutory health insurance physicians than planning that is content with more or less stipulating the status quo,” stated Richter. It will not be easy to encourage politicians to put the reform of requirements planning on the agenda again. But care-oriented further development of psychotherapy requires clear legal requirement. Richter's realization: "Without this 'motivational aid', the common self-administration will do what it has already done in recent years: It fails when analyzing problems and then necessarily also when trying to solve the problem."
A new one § 116 c in SGB V
So it is not surprising that Richter relies on politics or the legislature in solving further supply problem - the care of mentally ill people with complex treatment needs. Since the psychiatry questionnaire, there have been attempts in this country to develop integrated outpatient care for these patients, he explained. “It is about care coordinated between different professional groups and about continuity of treatment between phases of outpatient and inpatient care.” Neither psychiatric outpatient clinics nor selective contracts have led to success and will not do so in the foreseeable future. A sufficient bundling of competencies for the outpatient and inpatient area does not take place. The care is either planned and implemented from the inpatient area or is focused on the outpatient area, Richter criticized. “We know, however, that phases of inpatient and outpatient care alternate with these patients. It is about continuity of treatment, the avoidance of breaking off relationships, about vertical integration as well as about horizontal integration, thus about an appropriate coordination between the professional groups. ”
According to Richter's opinion, the legislature should with new § 116 c in the SGB V create the conditions for better care for these mentally ill people with complex treatment needs. "Without question, we need new approach, and we want to propose such an approach to health policy." On legal basis, the Federal Joint Committee should define minimum standards for this new area of care based on the implementation of outpatient specialist medical care (§ 116 b SGB V) . Those who meet these requirements can provide services that are neither subject to requirement planning nor to any other permission restrictions that apply to outpatient care. "We are calling on politicians to interfere," emphasized Richter.This is not reprehensible if the self-government has reached the limits of its regulatory capacity.
Resolution on care
There were differing views among the delegates of the Psychotherapists' Day about whether it was fundamentally sensible to call on the state to solve such problem, and whether this could be done, as in the The resolution submitted by the BPtK board should combine with explicit proposed solutions. The constructive discussion led to an agreement on common version via the submission of an alternative resolution. Politicians are no longer asked to set specific requirements for joint self-administration, but rather the Psychotherapists Day lists in the resolution what it considers necessary for the further development of psychotherapeutic care, namely:
- Reliable acute consultation hours to anchor and appropriately remunerate
- to broaden the group therapeutic care
- to reduce the bureaucracy of the application and review process and to make the psychotherapy guidelines more flexible so that the concerns of different patient groups are better taken into account can
- support psychotherapists with regional networking so that patients receive faster and needs-based access to care.
The resolution is limited with regard to patients with complex treatment needs to the basic requirement that “specifications for the development of cross-sectoral supply g ”would have to be developed -“ for example with new § 116 c SGB V ”.
As before, psychotherapists complain about poor income situation - compared to doctors. However, this aspect was not the focus of the 22nd German Psychotherapists' Day. Rather, the resolution was about significant expansion of competencies. The power restrictions for psychotherapists according to § 73 SGB V are to be lifted after the vote of the delegates. Psychotherapists should be allowed to issue certificates of incapacity for work, to admit them to the hospital, to prescribe rehabilitation treatment, to refer to other specialists and to prescribe remedies. In addition, medical care centers for mental illnesses are to be made possible.
The resolution also claims more competencies at the professional level. The participation rights of the BPtK in the deliberations of the G-BA must be expanded, it says there. To be examined is an admission to the supporting organizations of the G-BA.This is not reprehensible if the self-government has reached the limits of its regulatory capacity.
Resolution on care
There were differing views among the delegates of the Psychotherapists' Day about whether it was fundamentally sensible to call on the state to solve such problem, and whether this could be done, as in the The resolution submitted by the BPtK board should combine with explicit proposed solutions. The constructive discussion led to an agreement on common version via the submission of an alternative resolution. Politicians are no longer asked to set specific requirements for joint self-administration, but rather the Psychotherapists Day lists in the resolution what it considers necessary for the further development of psychotherapeutic care, namely:
- Reliable acute consultation hours to anchor and appropriately remunerate
- to broaden the group therapeutic care
- to reduce the bureaucracy of the application and review process and to make the psychotherapy guidelines more flexible so that the concerns of different patient groups are better taken into account can
- support psychotherapists with regional networking so that patients receive faster and needs-based access to care.
The resolution is limited with regard to patients with complex treatment needs to the basic requirement that “specifications for the development of cross-sectoral supply g ”would have to be developed -“ for example with new § 116 c SGB V ”.
As before, psychotherapists complain about poor income situation - compared to doctors. However, this aspect was not the focus of the 22nd German Psychotherapists' Day. Rather, the resolution was about significant expansion of competencies. The power restrictions for psychotherapists according to § 73 SGB V are to be lifted after the vote of the delegates. Psychotherapists should be allowed to issue certificates of incapacity for work, to admit them to the hospital, to prescribe rehabilitation treatment, to refer to other specialists and to prescribe remedies. In addition, medical care centers for mental illnesses are to be made possible.
The resolution also claims more competencies at the professional level. The participation rights of the BPtK in the deliberations of the G-BA must be expanded, it says there. To be examined is an admission to the supporting organizations of the G-BA.
Problem of training
The still pending reform of psychotherapist education is another problem that concerns psychotherapists. The professions of psychological psychotherapist and child and adolescent psychotherapist are still very attractive, said Richter. According to the Federal Conference of Psychotherapists in Training (PiA), around 13,000 qualified psychologists and educators are currently undergoing such training. But the longer the reform of training is postponed, "the greater the risk of dequalification due to the bachelor's and master's degree". Reason: In several federal states, bachelor's degree is recognized as access to training as child and adolescent psychotherapist.
The grievances in the remuneration of the practical work during the training as psychotherapist in psychiatric and psychosomatic clinics urgently required reform. The national PiA conference again drew the delegates' attention to the existential needs during the practical year with short, very well-made film spot (can be seen at www.youtube.com/watch?v=KMw1nhP4VoU). 20 percent of the apprenticeship candidates receive no remuneration at all during the practical year; around 25 percent only 390 euros month. These figures - albeit not representative - determined the IGES Institute, Berlin, as part of the "survey of the employed members of the psychotherapist chambers". The average age of the approximately 1,000 trainees surveyed was 34 years.
"From year to year we are promised to solve the problem," criticized President Richter. At the moment there is not even concrete time perspective. A reform of training will no longer be possible during this legislative period. Federal Health Minister Daniel Bahr had to admit this at the festive event for the tenth anniversary of the BPtK (box). "Hopefully in the next", he laconically added.
Apart from that, models of direct training, i.e. course in psychotherapy as in medicine with subsequent further training, are increasingly being discussed as solution to the problems of today's training structure. The board of directors of the BPtK and the regional council of the chambers, however, consider it necessary to come to an understanding about the future professional profile of psychotherapists. Because: “So far there is no consensus profile, only an implied one,” explained Richter.
Develop competence profile
A draft for such job description was available to the delegates in writing. Some delegates would have liked to have discussion on this paper, but the time left for this final item on the agenda did not allow it.
Problem of training
The still pending reform of psychotherapist education is another problem that concerns psychotherapists. The professions of psychological psychotherapist and child and adolescent psychotherapist are still very attractive, said Richter. According to the Federal Conference of Psychotherapists in Training (PiA), around 13,000 qualified psychologists and educators are currently undergoing such training. But the longer the reform of training is postponed, "the greater the risk of dequalification due to the bachelor's and master's degree". Reason: In several federal states, bachelor's degree is recognized as access to training as child and adolescent psychotherapist.
The grievances in the remuneration of the practical work during the training as psychotherapist in psychiatric and psychosomatic clinics urgently required reform. The national PiA conference again drew the delegates' attention to the existential needs during the practical year with short, very well-made film spot (can be seen at www.youtube.com/watch?v=KMw1nhP4VoU). 20 percent of the apprenticeship candidates receive no remuneration at all during the practical year; around 25 percent only 390 euros month. These figures - albeit not representative - determined the IGES Institute, Berlin, as part of the "survey of the employed members of the psychotherapist chambers". The average age of the approximately 1,000 trainees surveyed was 34 years.
"From year to year we are promised to solve the problem," criticized President Richter. At the moment there is not even concrete time perspective. A reform of training will no longer be possible during this legislative period. Federal Health Minister Daniel Bahr had to admit this at the festive event for the tenth anniversary of the BPtK (box). "Hopefully in the next", he laconically added.
Apart from that, models of direct training, i.e. course in psychotherapy as in medicine with subsequent further training, are increasingly being discussed as solution to the problems of today's training structure. The board of directors of the BPtK and the regional council of the chambers, however, consider it necessary to come to an understanding about the future professional profile of psychotherapists. Because: “So far there is no consensus profile, only an implied one,” explained Richter.
Develop competence profile
A draft for such job description was available to the delegates in writing. Some delegates would have liked to have discussion on this paper, but the time left for this final item on the agenda did not allow it.For example, the German Psychotherapists' Day accepted the board's proposal to develop competence profile that future therapists should have based on the draft and the previous DPT decisions on training. To this end, “structured dialogue” is to be held with training institutes and health policy committees on how these competencies can be acquired in the context of future training and further education, both in modified postgraduate training and in the context of direct training. In the dialogue, it should also be considered how further training following direct training could be financed.
In press release, the German Psychotherapists' Association expressly welcomed the decision of the 22nd DPT to "open up to direct training". The results of the dialogue are to be presented at the 23rd Psychotherapists Day, which will take place in Kiel in November.
Petra Bühring, Thomas Gerst
Ten years of the Federal Chamber of Psychotherapists
This year the Federal Chamber of Psychotherapists (BPtK), the working group of the regional chambers, is ten years old. "Since then we have been able to speak with one voice," emphasized Prof. Dr. Rainer Richter, President of the BPtK, at festive event for this anniversary on the roofs of the German Bundestag. "The care of the mentally ill has to be even better," demanded Richter. In no specialist group would patients have to wait as long for treatment place.
Federal Health Minister Daniel Bahr pointed out that the BPtK had made constructive contribution to many laws. And: "You are very valued discussion partner for politics." He compared the now ten-year-old member of the health service, which is often referred to as shark tank, with shark. "These animals usually become sexually mature at the age of ten," explained Bahr. This analogy was interpreted with the request to become bit more “snappy” or more demanding from now on.
The Federal Minister of Health pointed out the more than 1,300 new admission options for psychotherapists in rural regions that the new requirements planning guideline created Has. "The new practice should be occupied as soon as possible," he demanded. BPtK President Richter also welcomed the additional seats. Nevertheless, many mentally ill people remained untreated. It was "unbearable" how in the reform of the needs planning over the waiting times in psychotherapy, he criticized.For example, the German Psychotherapists' Day accepted the board's proposal to develop competence profile that future therapists should have based on the draft and the previous DPT decisions on training. To this end, “structured dialogue” is to be held with training institutes and health policy committees on how these competencies can be acquired in the context of future training and further education, both in modified postgraduate training and in the context of direct training. In the dialogue, it should also be considered how further training following direct training could be financed.
In press release, the German Psychotherapists' Association expressly welcomed the decision of the 22nd DPT to "open up to direct training". The results of the dialogue are to be presented at the 23rd Psychotherapists Day, which will take place in Kiel in November.
Petra Bühring, Thomas Gerst
Ten years of the Federal Chamber of Psychotherapists
This year the Federal Chamber of Psychotherapists (BPtK), the working group of the regional chambers, is ten years old. "Since then we have been able to speak with one voice," emphasized Prof. Dr. Rainer Richter, President of the BPtK, at festive event for this anniversary on the roofs of the German Bundestag. "The care of the mentally ill has to be even better," demanded Richter. In no specialist group would patients have to wait as long for treatment place.
Federal Health Minister Daniel Bahr pointed out that the BPtK had made constructive contribution to many laws. And: "You are very valued discussion partner for politics." He compared the now ten-year-old member of the health service, which is often referred to as shark tank, with shark. "These animals usually become sexually mature at the age of ten," explained Bahr. This analogy was interpreted with the request to become bit more “snappy” or more demanding from now on.
The Federal Minister of Health pointed out the more than 1,300 new admission options for psychotherapists in rural regions that the new requirements planning guideline created Has. "The new practice should be occupied as soon as possible," he demanded. BPtK President Richter also welcomed the additional seats. Nevertheless, many mentally ill people remained untreated. It was "unbearable" how in the reform of the needs planning over the waiting times in psychotherapy, he criticized."We have far too few psychotherapists, but also too few psychiatrists and psychiatric nurses." pb
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