Seminar Review: Building Bridges between Psychotherapy, General Practice and PRIMARY CARE

Royal Marine Hotel, Dun Laoghaire – 10 October 2012

by Dr. Coleen Jones

The Conference was convened by Edward Boyne (Psychotherapist and Lecturer) in conjunction with the Tivoli Institute and IAPPC (Irish Association for Psychotherapy in Primary Care). It was chaired by Phil Kearney and the panellists were Professor Bill Shannon (President of IAPPC and Director of Education, Graduate Medical School at University of Limerick) and Brian Huston (Psychotherapist and Actuary). It was attended by the Chairs of IAHIP and IACP, Psychiatrists, GPs, Psychotherapists, Psychoanalysts and Healthcare professionals.

Proceedings were initiated by Brian Huston who presented a current perspective on the insurance industry and the interrelationship between the various health insurance companies. A pilot study had been initiated by one company in order to assess how the cost of providing psychotherapy might be offset against longer term savings. This attempt had been interrupted and halted by challenges to the industry in relation to Risk Equalisation considerations and adjustments required. He stressed the following points and concerns:

• Urgency in relation to psychotherapy organisations making significant and immediate changes in how psychotherapy presents its efficacy and profile to the public.
• Associations need to move quickly on these issues.
• Psychotherapy associations require medical endorsement.
• Associations need to set out a clear and solid set of professional standards.
• It is essential that there is clarity and transparency in relation to professional standards
• Psychotherapy is currently not sufficiently evidence based or research not adequately utilised in presenting the work of psychotherapists to the public and GPs.

• From the point of view of healthcare insurance companies, CBT is regarded as short-term and therefore cheaper and hence more widely promoted, as opposed to longer term therapies which are considered more psychodynamic and therefore longer and more costly.
• Customers are not attracted to mental health cover which may come with a stigma attached.
• The need to have psychotherapy services defined within Primary Care to meet the future requirement of Universal Health Insurance (UHI) which is already in process and will by 2016-19 provide about five sessions of psychotherapy, most likely without the option of seeing the therapist privately thereafter unless the client opts out of UHI.

This presentation was followed by an inspiring and sensitive contribution by Professor Bill Shannon who gave three vignettes relating to patients, in order to illustrate the supportive and key role played by psychotherapists in relation to his work as general practitioner, consultant and head of University of Limerick Medical School. He read an extract by Tony Bates in the Irish Times which underscored the need for people to have access to psychotherapy and its efficacy. He further quoted Einstein as saying that “what’s important can’t be measured and what can be measured is mostly unimportant”. He acknowledged the challenge faced by psychotherapists in order to evidence change and improvement in their clients after a period in therapy. From his experience as a GP facing the challenges of the ‘80’s in order to bring together a disparate band of GP’s into the ICGP (Irish College of General Practitioners) he stressed the following:

• It is vital to find ONE figure to spearhead the promotion and work of psychotherapy and to put a voice to psychotherapy; a person capable of liaising with various healthcare bodies and governmental organisations; a person who can clearly present the work done by psychotherapists to the public. A united front is urgently needed with ONE spokesperson who will be recognisable as representing psychotherapy, for example, Gay Byrne and Road Safety.

• This approach would bring more coordination in order to harness energies and avoid logjams and missed opportunities in responding to unfair criticism in and from the media.
• The need to build bridges between psychotherapy/counselling and GPs.
• He further suggested that therapists consider ways of giving general feedback to doctors in such a way that it conveys general indicators, for example, ‘client is continuing to attend’. Without breaching therapist/client confidentiality, this serves to retain a professional, co-operative relationship between doctor and therapist.

After tea a general discussion took place with a range of ideas being proposed:

• The need for collaboration and affiliation between organisations such as IAHIP, IAPPC, ICP and IACP.
• The importance of collating and assembling a comprehensive research base to promote psychotherapy. This is currently under consideration by ICP.
• The conference was told that €5m has already been set aside by the HSE in order to roll out a six-session model in the North East. It seems that this will establish ten senior managerial positions to oversee the project probably recruiting therapists through CPLs.
• Ed Boyne will issue a press release in relation to findings and recommendations of this conference.
• Further linkage between GP training practices and psychotherapy training practices.
• Have input into GP trainings based on collaborative learning principles.
• Explore the possibility of placing psychotherapy students in GP practices for a part of their practicum.

• The HSE is currently using our ethics and standards to underpin future recruitment of therapists. How can we utilise this recognition?
• Future meetings such as this one urged and perhaps the need to bring a legal expert into the discussion as well.
• In any future research bring the voices of students and pre- accredited members into the discussion.
• Not to remain frozen waiting for statutory registration but instead be proactive; start doing and don’t wait.
• Need to have a recognised role before finding status.
• IACP through its regional centres is supplying GPs with a list of counsellors in their area.
• Do we need collectively to engage an outside ‘figurehead,’ like Gay Byrne, so that we can speak with one voice? Ed Boyne was proposed for this role.
• Access and utilise the research done by Alan Carr.

A vote of thanks was given to Ed Boyne for organising an energetic and significant occasion such as this conference which it is hoped will bring about further collaboration and progress matters.

A podcast of this seminar is now available at <http://www.iappcare.com/documents.php>.