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Training Committee: we remind you that March 7 is the last day for submitting your proposals for conferences and seminars for the next academic year 2004-2005
We remind you about the EFPP congress on Groups in November 2004, in Lisbon.
FEAP: March 13. Extraordinary Assembly in Madrid. Elections for the renewal of half of the Board.
We will send to the FEAP President our thoughts on Law 44/2003 (Ley de ordenación) regulating health professionals approved by the Congress on the practice of Clinical Psychology.
Summary of recent laws and decrees...
Law 44/2003, of November 21, regulating health professions, approved by the Congress [Cortes Generales] (BOE 280) , says in its exposition of motives that
“this law aims to provide the health system with a legal framework that contemplates the different instruments and resources that will allow for a greater integration of health services professionals, regarding prevention and care, both in its public and private aspects, facilitating joint responsibility in the achievement of quality in the health services provided to the people, guaranteeing at the same time that all health professionals meet the qualification levels necessary to continue safeguarding the right to health protection.” (p. 41443).
It later specifies what professions it refers to, by saying:
“this normative applies to two fields: the educative and the one that regulates professional associations. Therefore this law recognizes as health professions those that the university normative (ACPP Bulletin/2) recognizes as degrees in the field of health, and that currently have a professional organization recognized by the government” (p. 41443).
It goes on to open the possibility of new definitions coming from practical experience:
“there is a need to resolve, with inter-professional agreements prior to any regulating normative, the question of the fields of competences of health professions while maintaining the will to recognize simultaneously the increasing spaces of competences shared among professions and the very relevant specific spaces of each profession. Because of it, this law doesn’t intend to determine the competencies of each profession in a closed and concrete manner, but it establishes the foundations for these inter-professional agreements to take place, and for the ordinary praxis of professionals in the increasingly multi-disciplinary organizations to evolve not in a conflictive manner, but cooperatively and transparently instead.” (Idem).
When article 6 names health professions with a University degree, it includes Medical Doctors, pharmacists, dentists, veterinaries; in item 3, it says:
“Those who have an official certificate of Health Sciences Specialist, established in conformity with what article 19.1 of this law provides, for psychologists, chemists, biologists, etc. are also health professionals at the University level. (p. 41446).
Art. 19.1 refers to obtaining the specialty (which will be necessary in order to exercise the profession of specialist – art. 16.3 of this law-). Art. 20, on the system of specialist training, item 2, establishes that
“The training will take place following the system of residency in accredited centers” (p. 41449). Continuing Education is also regulated.
This law derogates all previous rules contradicting it, but when no contradiction exists, the previous rules are still in effect. On October 10 of 2003 the Health and Consumer Affairs Ministry published Royal Decree 1277/2003, which establishes the general foundations for the authorization of centers, services and health establishments (BOE 254). In its considerations it states that
“It is not the aim of this Royal Decree to regulate health professions, nor to limit the activities performed by professionals, but setting the foundations for guaranteeing health care safety and quality. (p. 37893).
Art. 2 defines Health Center, Health Services, health Establishment… When defining health Activity, it says:
“group of actions of promotion, prevention, diagnostic, treatment or rehabilitation, directed towards fostering, restoring or improving people’s health, performed by health professionals” (p. 37894).
In Annex I it classifies health centers, services and establishments differentiating:
C. 1 Hospitals (centers with patient admission) –which includes Hospitals and Addiction Hospitals of Mental Health and drug addiction treatment-,
C. 2 Providers of out-patient health care, and
C. 3 Health services part of a non-health organization.
When Annex I describes health assistance supply it includes Clinical Psychology. Annex II defines health centers, care units and health establishments. Here it differentiates between:
C.2.1. Medical Offices: health centers where a doctor performs health activities ... (p.37897) and
C.2.2. Offices of other health professionals: health centers where a health professional (different than a medical doctor or odontologist) performs health activities...
C.2.3. Primary care Centers: out-patient health centers that care for the individual, the family and the community, developing functions of health promotion, prevention, diagnostic, cure and rehabilitation, through both their basic means and the support systems for primary care…. (p. 37898)
C.2.5.11 Mental health Centers: health centers in which diagnostic and treatment of mental illness is performed in an outpatient system.
Later it defines “the provision of care by health centers previously indicated [which] can consist of one or several of the following services or care units:
U.69 Psychiatry: care unit in which a doctor specialized in Psychiatry is in charge of the study, diagnostic and treatment of mental and behavior disorders.
U.70 Clinical Psychology: care unit, in which a psychologist specialized in clinical Psychology, within the scope of his/her certification, is in charge of the diagnostic, evaluation and treatment of psychological nature of those psychological, behavior or relational phenomena that affect the health of human beings.
U.71 Health care of drug addicts: multi-disciplinary care unit that provides, under the supervision of a health doctor, prevention, attention and rehabilitation services to drug addicts, by means of the application of therapeutic techniques.” (p. 37901).
Finally, and in order to provide an overview of the legal inputs we are receiving lately, I will refer to the Decree bill which modifies the transitory provisions of Royal Decree 2490/1998, of November 20, in which the official diploma of Psychologist specialized in Clinical Psychology is created and which opens a new time period for requesting said diploma. This bill does not consider the conditions for being a Specialist nor does it define the tasks of Clinical Psychologists; it only deals with the deadlines to avail oneself of said law. The COPC complained against this Decree and both the bill and the complaint can be found in the COPC page (www.copc.org).
Considering all what has been stated above I consider that:
1. According to the description of the field of action of the Clinical Psychologist (U 70) this specialist becomes identified as a psychotherapist (independently from the epistemological model maintained by his practice).
2. If the training of the psychotherapist is framed within the residency program in authorized services until now, that is, hospital centers, there is no guarantee of a multi-disciplinary training, instead it is restricted and biased towards a medical (organicist) model that doesn’t qualify to understand “psychological, behavior and relational phenomena that affect the health of human beings “(U 70 of Royal Decree 1277/2003).
3. The Psychotherapists associations of Spain must avail themselves of the spirit of Law 44/2003 and Royal Decree 1277/2003 (from the Ministry of Health and Consumer Affairs) which, according to their statements, do not aim to “regulate health professions nor limit the activities of professionals” (p. 37893 of the Royal Decree), and that through “inter-professional agreements”, “the increasing spaces of competences shared inter-professionally and those very relevant spaces specific of each profession” (Law 44/2003, p. 41443) must be recognized. In this spirit it is deemed necessary that Professional Associations and Associations of Psychotherapists participate in:
3.1 the regulation of the Training of Psychotherapists, redefining the medical model based in residency;
3.2 the definition of the concepts of health and mental illness, in order to determine the suitable training to approach both, far from ambiguous definitions like that of mental disorders (which will be in the charge of psychiatrists) and that of psychological phenomena (in the charge of clinical psychologists).
4. Both the EFPP and the FEAP (and their associations) have responsibility at a State level regarding these issues of such significance.
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