A Survey of Hospital Psychology in Canada.

Abstract

Abstract Despite the major advances in health psychology over the past decade and the changes that have taken place in the Canadian health sector, there remains a paucity of information available about the structure of psychological services in Canadian health-care settings. The most current information about psychology in Canada's hospitals was gathered in 1982 - almost 20 years ago (Arnett, Martin, Steiner, & Goodman, 1987). This article updates the previous information, as it presents the results of a survey that was sent to 975 acute, psychiatric and continuing care health facilities with a minimum patient bed count of 100. Detailed information about the number of psychologists and administrative organizations of psychological services in Canada are reported. The range of services provided by psychologists in health-care settings has expanded, and professional autonomy, as shown by the existence of independent departments of psychology, has changed. The implications of these results for the organization and delivery of psychological services in Canadian healthcare, and for advocacy on the part of psychology, are provided. Over a decade ago, Arnett and colleagues conducted a survey of Canadian hospital psychology (Arnett, Martin, Steiner, & Goodman, 1987). Since that time, the role and responsibilities of psychologists in healthcare settings have developed and expanded, and health psychology continues to play a prominent role in health-care systems across Canada. Hearn and Evans (1993) estimated that 17% of registered psychologists are associated with health-care facilities in Canada. Hospital-based psychologists have a prominent role in mental health-care provision and have an increasing role in the realm of general healthcare (Dunn, 1986), even while clinical psychologists have adopted a broader vision of health (Arnett, 2001). It has further been suggested that the potential for clinical psychologists as important contributors to healthcare services outside the area of mental health should be acknowledged and would allow for more public access to potentially beneficial psychological services and academic initiatives (Arnett, 2001; Canadian Psychological Association, 1999). This vision, while admittedly broader than just involving psychologists in hospital settings, would involve more training for graduate students in the area of medical health early on in their graduate experiences to prepare them more fully for predoctoral internship. As the duties of hospital psychologists have expanded, there has also been more movement into disciplines traditionally subsumed by other health professionals (cf. Dunn, 1986). In the previous Canadian survey, Arnett et al. (1987) determined that while psychologists were taking on more active roles in a variety of health-care areas, the predominant influence of physicians was still a major factor in defining those roles. In addition, psychology played only a minor role in administration. For example, few psychologists had voting privileges in medical boards. However, there are many activities in which a psychologist can be involved. Dunn (1986) indicates that in order to fully utilize their training and skills, hospital-based psychologists often try to create a multifaceted professional role (e.g., consultation, teaching, research) with multiple levels of impact (patient, provider, system). Goodman (2000) advocated for a direct access model of psychology (i.e., autonomous psychology departments). he suggests that psychologists have secured positions in hospitals and health-care institutions, but have often lost the administrative structures and supports necessary to carry out all aspects of the professional role (i.e., psychological services, teaching and research). Hearn and Evans (1993) identified a number of developments that have occurred since the publication of the last Canadian survey (Arnett et al., 1987) that have affected the practice of health psychologists. …