Minister of Health and Labor Peep Peterson (SDE) admits that there are problems in Estonia when it comes to the availability of clinical psychologists, both through the national health insurance system and private practices. According to Peterson, this is a clear sign that the system itself needs to change. He also said, that people need to do more to help themselves.
"Logically, for moderate cases, family doctors should be able to assess the situation and perhaps suggest simpler ways (patients) can help themselves. Of course, the most important thing is, perhaps, that people get help sooner. Someone, who they know recognizes them, says 'here is an evidence-based system, reduce alcohol (intake), sleep well and so on.' This does not really take any form of 'super trick,'" Peterson told morning radio show "Vikerhommik."
According to Peterson, the current shortage of professional psychiatrists in Estonia, is a result of increasing numbers of people wanting to see either a psychiatrist or a psychologist, without first speaking to a GP.
"However, just like when you have a cold for instance, you don't immediately go to a pulmonologist, but instead find the help (you need) somewhere (else) along the chain. Maybe they just tell you the two types of medicine to take," Peterson said.
A separate, but related, issue is the already heavy workload expected of GPs, who may not have time to address patients' mental health concerns in addition to performing their current duties.
"We (also) have a shortage of doctors in many specialist areas, which is why we have no hope of resolving the psychiatry issue quickly, by for example, suddenly training a whole group of doctors to be psychiatrists," Peterson explained.
"However, what we can do is this: now, we are having salary negotiations in the field and clinical psychologists are being brought to the table. In the course of the negotiations, clinical psychologists' rates are going to increase, and they could end up being retained in a more holistic system, whereby family physicians maybe recommend and refer patients (more) wisely."
While some professionals argue that, the shortage of specialists means Estonia is on the brink of disaster when it comes to mental health issues, Peterson remained somewhat skeptical of such claims. "We don't really know whether (the situation) has become much more complicated now. It probably has, but I wouldn't say (it is just) pandemic-related. The pandemic perhaps compounded the situation. There are many, many stressful things in society, so maybe we could start by trying to reduce those," Peterson argued, pointing to the need for employee workloads to be manageable, and the importance of maintaining positive relations with colleagues and family members in order to reduce stress.
"We need to get to the stage where people who are outside the healthcare system can also help (with) their own situations, because the entire population of Estonia can't really all go to the doctor (at once)," Peterson said.
Peterson did concede that, the state has an important role to play in ensuring mental healthcare professionals adhere to the highest standards. Just as professional associations are used to regulate quality amongst doctors, according to Peterson, the psychology field also needs to take similar measures to ensure best practice.
"You have to weed out the number of people who are trying to provide assistance and saying, well, this is evidence-based, (because) it meets this or another standard," he said. "There is work to be done (in this area) and psychologists themselves recognize that."
In the National Audit Office's annual report, which was published on Tuesday, Auditor General Janar Holm pointed out, that there is a significant shortage of healthcare professionals, particularly in the mental health field, which could soon worsen significantly.
More than half of the psychiatrists in Estonia are currently of, or will reach, retirement age in the near future. According to the National Institute for Health Development (TAI), 222 psychiatrists were working in Estonia in 2021, including 18 child and adolescent specialists. This means, there were approximately 15 psychiatrists per 100,000 people in Estonia, significantly fewer than in the Nordic countries, for example. In comparison, according to OECD figures from 2019, Norway had 26 psychiatrists, Finland 24, Sweden 23, Lithuania 23 and Latvia 16 psychiatrists per 100,000 people.
According to the development plan for the specialty of psychiatry drawn up by the Estonian Psychiatric Association (EPS), an additional 30-40 psychiatrists and 130-160 clinical psychologists are required in Estonia to meet current demands for first contact care. Estonia is also facing an ongoing shortage of school psychologists and mental health nurses.
Editor: Michael Cole