PSYCHIATRY IN SCANDINAVIA

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Working as a Psychiatrist in Sweden

The number of practising psychiatrists in Sweden has increased by nearly 30% between 1995-2009; however, the profession has suffered from serious recruitment difficulties. The Swedish National Board of Health and Welfare estimated that about 5-10% of the population requires psychiatric treatment, but only 3-4% seek psychiatric care. Among patients who receive psychiatric care, approximately 47% are treated with psychopharmacology, 13% are treated with psychotherapy and 40% receive both treatments.

There are still challenges facing Swedish psychiatry: reduction in waiting times for psychiatric care, broader accessibility of evidence-based treatment methods for all groups of psychiatric patients both in rural and urban areas, and targeting the needs of immigrants and refugees. The allocation of resources to psychiatric research and the development of novel treatment methods are crucially needed. The Swedish government is strongly committed to decreasing the number of suicides, as there are approximately 1,400 individuals lost to suicide every year in a country with a population of around 10 million. Given that nearly 20% of all suicides are amongst psychiatric inpatients, a regulation has been passed regarding the analysis of all completed suicides in the healthcare system. Results from these analyses can be used for increasing treatment quality.

Working as a Psychiatrist in Norway

Psychiatrists’ tasks in Norway include investigation work/diagnosis, and management of psychological interventions in patients with mental disorders.

Processing occurs either at a mental hospital, the District Psychiatric Center (DPS), in the Municipal Service or privately. The trend in recent years has been to avoid institution if possible. Integration into the community has been the main objective. The Coordination Reform emphasises increasing responsibility on municipalities and correspondingly less on hospital and specialist health services.

The organisation and the framework for the psychiatry profession in the Norwegian healthcare system is regulated by the law on municipal health services, law on special health services, law on patients’ rights and the law on the establishment and implementation of mental health services dated 2. July 1999. This replaced the previous law on mental healthcare.

Doctors, and in Norway also psychologists, are the only ones who have formal competence to examine, diagnose and treat mental disorders in humans. The Mental Health Act of 1999 gives psychiatrists and specialists in clinical psychology special rights (and duties) within the practice of psychiatry. In Norway, “mental health” is the official term for mental health services. Both psychiatrists (medical specialists) and psychologist specialists can be professionally responsible for the decision of the Norwegian psychiatric care, by the Mental Health Act.

Working as a Psychiatrist in Denmark

Denmark is currently experiencing a shortage of psychiatrists with up to 25% of specialist posts vacant, and the National Board of Health estimates that this percentage will increase until 2020.

Danish psychiatry has gone through profound changes over the past two to three decades, reducing inpatient-based treatment and increasing outpatient treatment markedly. The number of patients treated has almost doubled, and the diagnostic profile has broadened, now including a substantial number of common mental disorders, in particular depression and anxiety. Furthermore, ‘new’ diagnostic groups are represented in the treatment statistics with steeply increasing incidences, e.g. attention deficit hyperactivity disorder (ADHD) and eating disorders, especially in the outpatient part of the statistics. Over the same 30 years, the number of available beds has decreased by 60-70%; however, as the length of stay of inpatients has declined markedly, the departments are still able to treat a high number of patients. The financial budgeting of psychiatry is not increasing equivalently to the somatic specialities, thus handicapping development in psychiatry.

Action has been taken to increase research activity in psychiatry. This is facilitated by an increasing interest among medical students and young graduate physicians attracted by the neuropsychiatric paradigm, rapidly implemented in Danish psychiatry.