By Chad Ebesutani



Korea is up against a heated debate over the exclusion of other mental health professionals in the provision of Cognitive Behavioral Therapy (CBT).



CBT is one of the most effective psychotherapy approaches for treating mental health problems such as depression and anxiety. Given that Korea has among the highest rates of suicide and mental health problems, proper regulation of CBT for treating these problems is a critical issue.



A law was recently passed that, starting June 2018, will exclude psychologists entirely from conducting CBT in hospitals ― CBT will only be covered by the National Health Insurance Service, provided that psychiatrists or neurologists, who are members of professional groups, receive a minimum of training in CBT as part of their formal education.



Psychologists are fighting back, arguing that they should also have the right to provide CBT to patients and be covered by national health insurance. Up until the passing of this new mental health bill, clinical psychologists have been members of a professional group receiving CBT training as part of their education and licensure requirements and have been providing CBT across various mental health settings in Korea.



As an American U.S. licensed clinical psychologist myself, living and working in Korea as a professor of psychology for the past seven years, I would like to share some reactions and lessons learned from a similar controversy faced in the U.S., as well as some thoughts for positive directions forward.



We must consider and prioritize the public good: Legislation regarding CBT insurance coverage has the potential to be profitable for select professional groups (such as increasing insurance billing rights among psychiatrists and neurologists). However, in doing so, it also has the potential to have a negative impact on the overall public welfare and good of the country, particular if psychiatrists and neurologists are not adequately trained in delivering CBT. As a licensed clinical psychologist myself, becoming trained and competent in providing CBT requires years of devoted training. It will be important to ensure that the public good is being prioritized when determining insurance coverage rights in this Korean health care law reform.



Need to increase access to treatments for patients by diversifying provision rights to various professionals: It is estimated that approximately 30% of the Korean population will suffer from mental health disorders at some point in their lives, and many of these individuals do not go to hospitals to receive therapy. In the U.S., we realized the importance of increasing patient access to effective services such as CBT by training various types of professionals (such as counselors, psychiatrists, social workers, and psychologists, among others) in effective counseling and therapy skills such as CBT. If psychiatrists and neurologists in hospital settings are the only people Koreans can receive CBT under covered insurance from, this will drastically limit the public's access to this needed form of help, which has the potential to be detrimental to the mental health of Koreans. Training various types of service providers across different settings in CBT can thus help increase needed access to services for the population and best serve the public good.



Clinical psychologists can provide effective CBT: It has been demonstrated and proven in the U.S. (and other countries) that clinical psychologists, as well as other licensed professionals, can provide high-quality, effective CBT, despite not being medical doctors. Thus, there does not seem to be a strong basis for excluding Korean clinical psychologists from this new Health Care Law. Indeed, additional systems and checks may need to be put in place to ensure that whoever is providing CBT is adequately trained (including psychiatrists and neurologists)_ but excluding clinical psychologists from CBT insurance coverage is difficult to understand. Given that CBT was born out of behavioral learning and cognitive principles stemming from the field of psychology, excluding psychologists from delivering CBT in Korea seems misguided and unjust.



Need for integrative health care systems and shared rights: In the U.S., we realized that mental health needs are complex and often require expertise that span various areas, including medical domains (studied by psychiatrists), neurological domains (studied by neurologists), as well as cognitive and behavioral domains (studied by psychologists). Instead of competing for rights, the U.S. has realized the importance of sharing health care rights so that neighboring professionals can more easily co-exist, co-contribute, and provide integrated health care to meet the complex health care needs of individuals.



For the reasons stated above, it seems clear that psychologists should be included in CBT provision rights. Doing so would be best for the public good and also in line with effective health care models as demonstrated in other countries such as the U.S.



Chad Ebesutani is a professor of psychology at Duksung Women's University.



