Healthcare professionals are divided on whether psychiatric counseling should be paid by the National Health Insurance (NHI), as voices calling for expanded coverage grow louder in the wake of high-profile incidents.
The issue was recently thrust back into the spotlight, when a man with schizophrenia, who had long been known have violent episodes, on Sept. 26 attacked a convenience store clerk in Pingtung County, potentially blinding her.
While certainly an outlier, the case has again highlighted the weak spots in mental health coverage.
Photo: CNA
Under the first article of the National Health Insurance Act (全民健康保險法), benefits are to be provided in the event of “illness, injury or maternity,” which excludes non-therapeutic psychiatric counseling.
However, some inroads have been made since a proposal calling for coverage of counseling and psychotherapy was raised earlier this year on the government’s online public policy participation platform.
The petition, which gathered 5,882 signatures, resulted in a forum on Tuesday last week held by the National Health Insurance Administration for experts and the signatories to share their thoughts.
The agency also issued a response on July 13 outlining the steps it has taken since 2013 to address the “major issue” of mental health in the absence of clear legal coverage.
In addition to the 1925 suicide prevention hotline, the agency emphasized the establishment of 385 community mental health centers nationwide, which provide counseling at no or a reduced cost to more than 20,000 people annually.
However, Association of Taiwan Clinical Psychologists member Lin Tzu-yin (林姿吟) said that many psychologists do not see a single patient during their office hours at community clinics, showing that people are unaware of the service.
In 2014, the agency also revised coverage policy for “deep psychotherapy” to eliminate disease discrimination, allowing treatment to be covered regardless of a person’s condition, it said.
Despite these efforts, critics have pointed out that treatment, even when it is covered, often takes months to receive due to limited resources, while other forms of counseling are prohibitively expensive.
The woman who posted the petition, surnamed Wu (吳), referenced her mother’s experience as an example of the need for universal coverage.
Suspecting she had a hoarding disorder, Wu’s mother years ago visited a psychiatric division at a hospital where she was prescribed medication, she said.
As it seemed to have no effect, she wanted to visit a psychologist for counseling, but the NHI would not cover it, Wu said, asking why benefits seem to be available only some of the time.
A signatory surnamed Liu (劉) said he had consulted a dozen psychologists since he was diagnosed with depression more than a decade ago.
Even after finding a suitable one, Liu said that the price was hard to swallow.
Psychiatric treatment covered by the NHI is mainly performed by psychiatrists and clinical psychologists, said Li Yu-chan (李玉嬋), president of the Taiwan Mental Health Counseling and Psychological Association.
However, there are only about 1,800 clinical psychologists in Taiwan, resulting in wait times of three to six months for a consultation, she said.
On the other hand, there are nearly 3,200 counseling psychologists who are only available to those able to afford the sessions, Li added.
The nation has 1,662 clinical psychologists, 1,233 of whom are registered to work in hospitals, Ministry of Health and Welfare figures show. Of the 2,718 counseling psychologists in Taiwan, only 344 are able to work in hospitals.
Taiwan Counseling Psychology Association president Hsu Hsi-sen (徐西森) is a staunch advocate for his colleagues’ inclusion in the NHI system, considering the preventive effect of counseling.
Psychiatric issues involve not just the individual, but entire families and societies, Hsu said.
A lack of coverage harms outcomes by not only keeping patients from treatment that could prevent deterioration into a psychiatric disorder, but also by making psychiatrists less willing to write prescriptions, he added.
In practice, psychiatrists, clinical psychologists and counseling psychologists are hard to differentiate as they all utilize the same psychiatric principles, said Tsai Hsiao-wen (蔡曉雯), a representative of the Taiwan Counseling Psychologist Union.
All three can provide psychiatric counseling and treatment, distinguished only by the recipient, work setting and treatment goal, she said.
However, not everyone agrees.
Psychiatrist Kuo Hsi-ching (郭錫卿), who represents the Taiwanese Society of Psychiatry, said that psychological issues, mental illness and serious psychiatric disorders are separate issues.
Mental disorders are caused by abnormalities in neurotransmitter activity, and are treatable with medication in conjunction with psychiatric treatment, Kuo said, adding that this is already covered by the NHI.
As for mental health counseling, Kuo equated the situation to having high blood pressure, a precursor to a disease, but not yet a medical condition.
“Maybe one day you had a fight with your boss or wife that puts you in a bad mood or you have adaptive or interpersonal issues,” he said.
“These are all a part of mental health, but as it has not progressed into a disease, by definition they are not covered by the NHI,” he said, recommending that it stay that way.
FLU SEASON: Twenty-six severe cases were reported from Tuesday last week to Monday, including a seven-year-old girl diagnosed with influenza-associated encephalopathy Nearly 140,000 people sought medical assistance for diarrhea last week, the Centers for Disease Control (CDC) said on Tuesday. From April 7 to Saturday last week, 139,848 people sought medical help for diarrhea-related illness, a 15.7 percent increase from last week’s 120,868 reports, CDC Epidemic Intelligence Center Deputy Director Lee Chia-lin (李佳琳) said. The number of people who reported diarrhea-related illness last week was the fourth highest in the same time period over the past decade, Lee said. Over the past four weeks, 203 mass illness cases had been reported, nearly four times higher than the 54 cases documented in the same period
A group of Taiwanese-American and Tibetan-American students at Harvard University on Saturday disrupted Chinese Ambassador to the US Xie Feng’s (謝鋒) speech at the school, accusing him of being responsible for numerous human rights violations. Four students — two Taiwanese Americans and two from Tibet — held up banners inside a conference hall where Xie was delivering a speech at the opening ceremony of the Harvard Kennedy School China Conference 2024. In a video clip provided by the Coalition of Students Resisting the CCP (Chinese Communist Party), Taiwanese-American Cosette Wu (吳亭樺) and Tibetan-American Tsering Yangchen are seen holding banners that together read:
Heat advisories were in effect for nine administrative regions yesterday afternoon as warm southwesterly winds pushed temperatures above 38°C in parts of southern Taiwan, the Central Weather Administration (CWA) said. As of 3:30pm yesterday, Tainan’s Yujing District (玉井) had recorded the day’s highest temperature of 39.7°C, though the measurement will not be included in Taiwan’s official heat records since Yujing is an automatic rather than manually operated weather station, the CWA said. Highs recorded in other areas were 38.7°C in Kaohsiung’s Neimen District (內門), 38.2°C in Chiayi City and 38.1°C in Pingtung’s Sandimen Township (三地門), CWA data showed. The spell of scorching
UNAWARE: Many people sit for long hours every day and eat unhealthy foods, putting them at greater risk of developing one of the ‘three highs,’ an expert said More than 30 percent of adults aged 40 or older who underwent a government-funded health exam were unaware they had at least one of the “three highs” — high blood pressure, high blood lipids or high blood sugar, the Health Promotion Administration (HPA) said yesterday. Among adults aged 40 or older who said they did not have any of the “three highs” before taking the health exam, more than 30 percent were found to have at least one of them, Adult Preventive Health Examination Service data from 2022 showed. People with long-term medical conditions such as hypertension or diabetes usually do not