Primary care psychology in Belgium: a public health innovation in the national healthcare reform

Leontien JANSEN1, Erik BOOTSMA1,2,3, Franco GERICKE1,4, Fabienne GLOWACZ5, Wouter VOORSPOELS1, Ronny BRUFFAERTS1

1Center for Public Health Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
2Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium
3VIB Center for Microbiology, KU Leuven, Leuven, Belgium
4Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
5Service de Psychologie clinique de la délinquance Unité de recherche Arch - Adaptation, Résilience et Changement, Université de Liège, Liège, Belgium

INTRODUCTION

Against the treatment gap (60%) and the long delays in seeking treatment for mental health problems in Belgium (on average 10 years), primary care psychology (PCP) was added to the reimbursed outpatient mental health delivery system in Belgium in 2019. This reimbursement measure included both primary and specialized short-term psychological treatment, both individually and in group. The purpose of the EPCAP (Evaluation of Primary Care Psychology) study is to describe the characteristics of patients treated within the measure of reimbursement of PCP.



METHODS

A total of 2,637 patients participated in an online survey at the start of their intervention, with follow-up assessments after 3, 6 and 12 months, across all the 31 mental healthcare networks. Information on sociodemographics, mental disorder status, suicidal thoughts and behaviors (STB), patterns of prior service use, and delays in seeking treatment were collected.



RESULTS

More than 70% of all patients screened positive for a lifetime and 12-month DSM-5 mental disorder, mostly anxiety and depressive disorders. Over 1/3 were experiencing STB in the last 12 months.  For 43.9% of patients, PCP was the first treatment ever. The median delay in seeking treatment was 4 years. The idea of solving the problem yourself was a major reason for delaying seeking help.



DISCUSSION-CONCLUSION

PCP in Belgium serves mostly a clinical population with high proportions of lifetime and 12-month mental disorders and STB; many patients have been in mental health treatment before. PCP was associated with a considerable reduction in treatment delay. These findings raise the question whether PCP can be further optimized and contribute to the early detection and intervention of mental health problems in Belgium.