Reimbursement of psychological care is causing an exponential increase in the number of people seeking affordable psychotherapy. However, four in ten people who need help are still unable to access it due to financial obstacles.
Mental health problems have been on the rise in people of all ages in Belgium since the pandemic, when a sharp increase was recorded in cases of depression, anxiety and loneliness. Around this time, the reimbursement system in the country for psychological help was improved, starting with clinical psychology consultations for patients between 18 and 65 years of age in 2019. Since April 2020, reimbursement has been possible for all ages.
This was further expanded last year to include so-called 'first line' psychological care (care that can be accessed directly without a referral), while increasing the number of sessions and no longer limiting it to specific psychological problems. Health insurance companies now reimburse eight such sessions at the psychologist's office per year.
The new reimbursement system is causing an exponential increase in the number of people seeking affordable psychotherapy, a new study by CM Health Fund found. A total of 180,000 people in Belgium went to see a psychologist through this system.
"The number of people going for a reimbursement consultation with a psychologist or psychiatrist, whether or not in combination with medication, doubled in just over a decade, from 2.6% in 2010 to 5.6% in 2022," said CM President Luc Van Gorp.
"In absolute numbers, this is still a limited number of people, but the trend is promising. This confirms the usefulness of reimbursement."
New target group, but some still excluded
The CM survey found that, for almost half of patients (44%), last year was the very first time they were reimbursed for psychological care. "So this is a whole new target group," said Van Gorp. This shows that reimbursement made mental health care more accessible.
The new reimbursement has particularly helped those who are struggling financially. The agreement also makes it possible to organise reimbursed (group) therapy in places where it is needed the most, such as in schools and centres for social services. Here too, the number of sessions is on the rise. "This shows that it pays to bring healthcare to the places where people need it most."
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Despite these positive trends, there is still a long way to go. Of the more than 12,000 Belgians surveyed by Sciensano Health Institute, two in ten said they needed psychological help. Among young people, the figure was 40%. Of all categories, women aged between 18 and 29 have the greatest need for care.
Yet, more than 40% of these people do not receive adequate help. Some 65% of people with lower incomes say they need psychological help, but half of them are unable to access it due to costs.
Further improvements needed
Currently, the co-payment which is covered by the patient is €11 per session (reduced to €4 for those entitled to increased compensation) and €2.50 for group sessions. However, Van Gorp noted that even the reduced prices "cannot ensure affordability" and that "for someone on a low income, €4 is still a reasonable amount."
To make mental health care more financially accessible, CM advocates increasing the number of reimbursed sessions from 8 to 20 per year, abolishing the co-payment for children and adolescents and lowering the co-payment for adults to €6 per consultation and €1.50 for those with lower incomes.
"It is also important that we make further efforts to make therapy more accessible, because the majority of people who rely on mental health care today (66%, among the over-65s even 89%) only take medication (antidepressants and/or antipsychotics), without going into therapy. However, we know that the combination of medication and therapy has a much more lasting effect," Van Gorp concluded.
