Clinical psychologists in primary mental health care in Norway - what to do?

Abstract

Abstract Background The past 20 years Norwegian health authorities have put significant effort into increasing the number of clinical psychologists in primary health care. By 2020, all Norwegian municipalities are required by law to have clinical psychologists available. In 2018, only about half of the 422 municipalities had fulfilled this requirement, and the number of vacant positions is growing. The purpose of this study was to investigate the usefulness of clinical psychologists in a primary care setting as perceived from primary mental health care leaders/employees and those who educate clinical psychologists at the universities. Methods We combined the use of open-ended questions in a survey (N = 456) among leaders and employees of primary mental health services in Norway, with data from semi-structured focus group and individual interviews (N = 15) with academic staff at the four universities in Norway that provides education for clinical psychologists. Results The discussion on utilisation and usefulness of clinical psychologists in Norwegian primary care often condensates into weighing time spent on a never-ending demand for individual therapy against time spent on health promotion, prevention and system level work. Traditionally, Norwegian psychologists have received education mostly focusing on treatment methodology and individual therapy most suitable for the specialist services. The curricula are now changing towards more health promotion/prevention in primary care, but still lacks focus on system level approaches like collaboration with and guidance of other professions - which are the qualities asked for from those who hire clinical psychologists in primary mental health care. Conclusions Interdisciplinary collaboration with a wide spectre of professionals and thereby ’working with and through others’ in the health and welfare services, was suggested to be the most efficient way of utilising psychological clinical competence. Key messages The Norwegian clinical psychologists’ education is becoming more primary care friendly. Psychologists in primary care must be part of interdisciplinary teams where they can work with and trough others.