Collaboration entre médecins généralistes et psychologues en libéral

Abstract

Psychologists and general practitioners (GPs) are the stakeholders most consulted by patients with psychological difficulties. They each have their own professional identity, their own working framework, references, and language. In France, interactions between them seem limited in private practice. The importance of developing collaboration between GPs and psychologists is supported by data from collaborative mental health practices developed in various countries. Such practices have shown significant improvement in health care, and benefits for patients’ health, as well as for GPs’ and psychologists’practices, and for the community. In 2018, the French National Authority for Health published an overview of the situation and recommendations to improve the coordination between GPs and other healthcare actors concerning adult patients with mental health disorders. The review invites healthcare actors to work with better conviction, involvement, and shared culture, as well as to recognize each other's roles and competences. The professionals interviewed in this article, three psychologists and three GPs, outline the current state of collaboration between psychologists and GPs in France and in Belgium, reviewing professional identities, barriers to interactions and organizations. Interprofessional collaboration in mental health involving these actors is formalized and developed in several countries, unlike in France where work and experimentation are rare. The role of each is not well known, and few opportunities are offered for interprofessional practice and education. The authors report on their experience in the field, and on initiatives that have been implemented in a Southern France region. Several actions are reported: joint professional training evenings, “public cross-consultations” and “joint case studies” (with patients’ agreement), working group between faculties leading to a joint Study Day, programming paired cross-consultations in the practice of each, as well as exchanging medical and psychology students. This experience allowed for constructive meetings, exchanges within “professional couples” on common patients, and opportunities to expose medical and psychological views. It also enabled the authors to observe their different professional language and tools used, to break the isolation of mental health care actors, to accelerate the understanding of patients’ situations, and to mutually enrich professional knowledge and practices. This feedback from field experience, which is not representative or generalizable, shows that it is possible to take advantage of interprofessionality in the field. When the actors know each other, working together in the interest of the professionals and of the patients shows better results. Finally, the authors question what desirable directions should be adopted–particularly concerning the institutional frameworks recently implemented in France, and the need for shared professional training–and interrogate the definition of “collaboration” itself.