According to Laura Oisalu, chair of the Mental Health Nursing Association under the Estonian Nurses Union, 230 mental health nurses are registered in Estonia, but only 125 conduct independent consultations. Oisalu noted that this number is very low given the growing demand. She added that there is also a shortage of nursing educators. Oisalu herself works as a mental health nurse at Pärnu Hospital.

Reigo Reppo, head of the Child and Adolescent Mental Health Center at Tartu University Hospital and a psychiatrist, described the crucial role mental health nurses play in the treatment process. He pointed out that mental health nurses often spend more time with patients than psychiatrists do.

"If we consider that, ideally, treatment teams should include about twice as many nurses as psychiatrists, it's clear that the current number of nurses is far too low. As a result, their potential is not fully utilized," Reppo said.

"Additionally, psychiatrists and psychologists often end up taking on roles that mental health nurses could fulfill," Dr. Reppo added.

Reppo, a member of the Estonian Psychiatric Association, noted that according to the organization's data, 313 psychiatrists currently work in Estonia, although some are likely not practicing actively.

Since the 2022 consensus agreement, the Tartu and Tallinn Health Care Colleges have admitted a total of 700 students annually into their basic nursing programs. Afterward, candidates must pursue a master's degree specializing in mental health nursing. Tartu Health Care College admits 14 students per year into this program, while Tallinn admits around ten students annually. The standard time required to qualify as a mental health nurse is five years.

The Estonian Nurses Union believes that more training positions for specialist nurses are needed. According to the union's president, Laura Keidong, the minimum should be 120 slots per academic year. This would mean that at least 15 students would be admitted into mental health nursing programs each year in both Tallinn and Tartu — a total of 30 annually.

The government is planning a new consensus agreement to increase the number of training positions in mental health nursing, as well as in other specialist nursing fields such as intensive care nursing.

As with the previous agreement, the Ministry of Social Affairs is leading the effort, working in cooperation with the Ministry of Education and Research and the Tartu and Tallinn Health Care Colleges. Leena Kalle, health services adviser at the Ministry of Social Affairs, confirmed that a new agreement is in the works, although no specific details have been finalized.

The Ministry of Education and Research, which would fund any new training positions, has not yet taken a position on how many could be added. According to their data, mental health nursing is currently not as popular as other specialist nursing fields.

However, psychiatrist Reppo pointed out that training a mental health nurse is less expensive and takes half the time compared to becoming a psychiatrist, which requires ten years of study.

"Perhaps it's difficult for some decision-makers to recognize that mental health nurses possess very specific skills and make a concrete contribution," Reppo observed. "Their role is sometimes viewed as theoretical or abstract — much like the broader field of psychiatry," he said.

Oisalu, from the nursing association, explained that ideally, a mental health nurse would be the first to assess a patient by listening and performing an initial evaluation, then either continuing treatment or referring the patient onward. Kalle from the ministry agreed: "Not everything has to be on the doctor's desk. It doesn't have to be that the doctor orders, judges and executes — nurses, even general nurses, can take on a great deal of the work," she said.

Reppo added that he envisions an even broader role for mental health nurses, such as the opportunity to train as psychotherapists. Currently, nurses can pursue additional studies in family therapy and various behavioral therapies.

A 2024 study by the National Institute for Health Development found that nearly 30 percent of adults in Estonia experienced more serious mental health issues in the past year. Among young people, 40 percent reported persistent stress, anxiety or depression. According to Peaasi.ee, the waiting time to see a psychologist can range from two to six months.

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