You can claim the £230 cost of the NuTron diet as a tax-deductible medical expense, if your doctor recommends it. But you cannot claim the cost of psychological counselling, even if your doctor thinks you need it.
It's bizarre that a controversial diet is recognised by the State as a legitimate medical expense, while therapy - which is of proven value - is not.
BUPA Ireland and VHI are also behind the times in their refusal to cover therapy. Outpatient psychotherapy is covered by insurance plans in Switzerland, Finland, Germany, Italy, Netherlands and by BUPA UK - which would make you think BUPA Ireland shouldn't need convincing.
Although BUPA Ireland covers fashionable forms of alternative medicine such as acupuncture, chiropractic, osteopathy and homeopathy, psychological counselling, with its scientifically proven benefits, remains the Cinderella therapy. The VHI doesn't cover counselling, either - and moreover, if it finds out your GP is counselling you for a family problem, it won't reimburse you under outpatient expenses. GPs all over the country are taking counselling courses, but the VHI, when questioned by this article, was surprised to hear it.
The policies of the Irish health insurance companies and the Revenue Commissioners are symptomatic of a greater, insidious problem which the medical establishment is finally beginning to address - the artificial divide between body and mind which prevents us from treating illness holistically. More and more, scientific evidence shows that a healthy body relies on a healthy state of mind (see panel).
To treat the body while ignoring the mind is beginning to look like Dark Ages medicine. BUPA Ireland partially acknowledges the mind/body link in its coverage of psychological counselling for cancer patients and their families as part of hospital treatment programmes. BUPA says other than that there has been no patient demand for insurance cover for counselling. Clinical psychologist Eileen Colquhoun of the Psychological Society of Ireland (PSI), however, insists there is indeed patient demand - but that the stigma of therapy is so strong that many people are afraid even to tell close family members, much less engage in a public campaign for insurance cover. In a submission to the Department of Health concerning the Government White Paper on private health insurance, which is to be published shortly, Colquhoun and her co-author Eva Doherty, chair of the health insurance committee of the PSI, argue that recognition by private health insurers of the mind/body link is essential for the common good. Citing international research, they claim health insurers could reduce medical costs in the long run, while enhancing the quality of patients' lives. They also say that in a European context, Irish citizens have a right to therapy if they need it.
Increasing numbers of people are paying privately for therapy through which they are dealing with childhood trauma, sexual and physical abuse, bereavement, depression, anxiety, sleep disturbance, stress, phobias and panic attacks. But therapy doesn't come cheap. Typical charges would range from £25 to £50 for each fortnightly session over six to 12 months, bringing the total bill to between £800 and £1,200 for a year. For many, the choice between therapy and a family holiday - or between therapy and car payments - is a real dilemma.
But those who can afford to pay are fortunate compared to the many people with psychological problems languishing on public waiting lists. "Because of the scarcity of psychologists in the public service, people are forced to look for private treatment and many cannot afford it because it is not covered," says Colquhoun. "This isn't the case in the UK, where psychology has been upgraded because psychologists' role in diagnosis is recognised as being more important than just being part of a treatment programme."
"For many people covered by VHI, it's completely prohibitive for them to spend £35 to £40 a week for a year on therapy," says Doherty, who lectures on psychology to medical students at the Royal College of Surgeons, as well as counselling in private practice. "The sad thing about it is that if you get a young adult who has panic attacks and is treated right away, the prognosis is excellent. If that same young adult has to go on a public waiting list for six months to a year while the problem festers, he or she will be harder to treat. The GP may have prescribed hypnotics or beta blockers and the young person may use alcohol to control their symptoms, so that by the time they reach a psychologist for therapy, they may have to deal with pill addiction and alcohol abuse as well as their original problem."
If the same young person becomes ill enough to need psychiatric care, then the VHI and BUPA will cover in-patient psychiatric treatment. But this means the patient has to reach crisis point before being given financial help - and it encourages the use of prescription drugs to deal with problems, as opposed to therapy which looks for the environmental roots of problems rather than the quick-fix. While health insurance is the crucial issue on which the PSI will be campaigning, the need for tax relief cannot be ignored. The Revenue Commissioners allow tax relief only for the services of medical doctors (including psychiatrists) and the diagnostic tests which medical doctors order (which is why the NuTron diet, which involves a blood test, is eligible for tax relief). Psychologists are not covered for tax relief because they are not medical doctors. At the coalface of medicine, however, there is a growing view that psychology is complementary to medicine on the most profound level, making sick people get better faster and live longer. Cardiac treatment in the Republic already incorporates a multi-disciplinary approach focusing on patients' attitudes and behaviour. The largest US insurer, Blue Cross-Blue Shield, is engaged in a study designed to show that increased mental health services can help breast-cancer patients better fight the disease. "The future of health care is an integrated model of care, looking at the psychological aspects as well as the physical and even social aspects," says Nancy Langman-Corwart, director of mental health for Blue Cross-Blue Shield.
An enlightened attitude to therapy is also desperately needed by medical card patients availing of the GMS. GPs, who are in the front line of medical care, have long recognised that they need their listening skills as much as their prescription pads and their stethoscopes. Dr Brian Coffey, chairman of the Irish College of General Practitioners, says that if a GP listens for 30 minutes to a medical-card patient and sends the patient away feeling better able to cope, the GP gets no payment under the GMS. But if he or she listens for five minutes and writes a prescription for an expensive, psychoactive drug, the GMS covers it.
According to the American Psychological Association (APA), for every $1 spent on psychological services, $5 are saved down the line on the treatment of heart disease and cancer. Doherty and Colquhoun believe the State and insurers will ultimately be convinced not by the humane argument - which they have so far ignored - but by the promise that psychological counselling will save them money in the long-term by reducing medical costs. Compassion, they argue, can be cost-effective. The PSI has a registered list of psychologists, which requires a third-level qualification from an accredited institution and a minimum of five years supervised clinical experience. A board of professional conduct monitors and enforces its standards, according to the PSI's code of professional ethics. The PSI argues that this register is reviewed annually and could form the basis for a system of health insurance cover by BUPA or VHI.
"I would back up what the PSI are saying," says Coffey. "They have excellent standards in the PSI and it's very important that people who are counselling are properly qualified."
The Fine Gael spokesperson on family, community and social welfare, Senator Terese Ridge, intends to raise the matter in the Seanad. "Psychologists are doing as great a service as psychiatrists and should be recognised as such.
"I have many friends who have been helped by counselling." But, she stresses, "it is very important that we don't let quacks in who call themselves counsellors after courses lasting four weekends." TD Liz McManus is planning to put down a parliamentary question when the Dail resumes on Wednesday. "Therapy is well worth while but there are difficulties concerning who can qualify to be called a therapist. I think it should be very strict and tightly circumscribed, with clearly established standards," she says.
Critics of the PSI's campaign for insurance cover may argue that therapists have a vested interest in the issue because insurance cover would encourage more people to seek their services. However, the long-term problem for society is that psychological services will remain underdeveloped without support from health insurers and the State.
