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How many psychologists do we need?

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How many psychologists do we need?

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The Irish Psychologist March 2012 • Volume 38 Issue 5
ARTICLES
Introduction
The most recent manpower survey of psychology posts
(Breaden & Woods, 2010) indicated that there were 647.34
Whole Time Equivalents (WTEs) working in the Irish health
services in 2008. However, psychology managers and many
other stakeholders recognise that this level of staffing is
insufficient. The purpose of this paper is to examine the two
not totally dissimilar population- and needs-based methods of
estimating workforce requirements and to outline which might
be the best method to calculate how many psychologists are
needed in Ireland.
Population-Based Estimates
This method estimates the number of required psychologists by
applying to a population’s size recognised ratios that are based
on prevalence rates of psychological difficulties in the general
population. For example, applying a recommended ratio of 1
in 5,000 (Management Advisory Service, 1989; National Health
Services [NHS] Education for Scotland, 2009) to Irelands
population (Central Statistics Office [CSO], 2007) yields a
national estimate of 849 psychologists or a shortfall of 201.66
WTEs on current staff numbers (Breaden & Woods, 2009).
Another example is Carr’s (2000) review of the Midland Health
Board Psychology Service. At the time of this review, the
local ratio of psychologists to population was 1 in 12,000.
Carr based his recommendations for changes to service
provision on what he described as a “conservative view” that
only 10% of the area population required intervention and a
further 10% required prevention services. Proposed service
models in his review report requiring extra psychologists would
have increased this ratio to 1 in 3,000 to 5,000. Some of the
recommendations made in order to improve this ratio included
increased staffing levels, an improved referrals system and
waiting list management, protocols for duration of psychological
intervention, and improved prevention services.
How Many Psychologists
do we Need?
Andrea Branley & Michael Byrne
Andrea Branley is a Research Assistant
and Michael Byrne is Principal Psychology
Manager, both with Roscommon Health
Service Area, HSE West. Correspondence
regarding this article can be sent to
michaelj.byrne@hse.ie
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The Irish Psychologist March 2012 • Volume 38 Issue 5
ARTICLES
The Department of Health, Social Services and Public Safety
of Northern Ireland (2008) reported that staffing levels equated
to 1 WTE per 10,276 general population. It was acknowledged
that this was not an adequate ratio and recommendations were
made regarding how to increase numbers. However, further
detail was not provided including a recommended ratio.
The difficulty with merely using ratios of how many
psychologists are required for the general population is that
individual differences across the population are not accounted
for. For example, a review of the literature on the prevalence of
mental health problems in Ireland shows significant differences
between different age groups. An average of 20.6% of Irish
children (0 to 18 years) are thought to require psychological
intervention (Martin & Carr, 2005), while an average of 12.9%
of adults (18 to 64 years) and 10.2% of older adults (65+ years)
are thought to require psychological intervention (Tedstone
Doherty, Moran, Kartalova-O’Doherty, & Walsh, 2007).
Factors such as socioeconomic status further contribute to
the difference between these prevalence rates. If the number
of psychologists required is based on a general prevalence
rate in the population, the result could be an oversupply of
psychologists working with some age groups and a shortage
with some others.
Needs-Based Estimates
The number of required psychologists can also be estimated
by, using prevalence rates of clinical presentations, first
calculating the number of people likely to require psychological
services and then dividing this figure by the expected workload
of a psychologist.
The British Psychological Society (BPS; 2004) published a
report estimating the demand for psychologists in adult mental
health services. This report included proposed services such as
mental health promotion, mental health services at primary care
level, services for people with severe mental health problems,
and residential, community and specialist services. The
report concluded that 7,300 clinical psychologists and 1,200
counselling psychologists would be required to deliver adult
mental health services based on the existing numbers requiring
psychological intervention. This represented a recommended
ratio of 1 in 5,781. This contrasts with the non-evidence-based
1 in 25,000 ratio recommended for generic adult community
mental health teams in Ireland (Department of Health &
Children, 2006). The number of psychologists working in the
NHS in England was 4,850 WTEs, representing a 1 in 10,131
ratio (BPS, 2004). This represented a shortfall of 3,650 WTEs.
According to the NHS Scotland Workforce Planning report
(NHS Education for Scotland, 2009), there were 537.7
WTE clinical psychologists and 40.5 WTE other applied
psychologists employed in the NHS Scotland in September
2009. This represented a national clinical psychology staffing
level of 1 in 9,008. This composite figure did not reflect variable
staffing levels across the different age ranges, with a ratio of 1
in 8,758 for those aged under 20, 1 in 8,643 for those aged 20
to 64 years, and a ratio of 1 in 26,568 for those aged 65 and
over.
Although no recommendations were given in this 2009 NHS
Education for Scotland report as to how many psychologists
were required (to address psychological needs), previous
reports (e.g., NHS Education for Scotland, 2002) had
suggested that each WTE psychologist needed to process
a caseload of 86 service users annually. While the NHS
Education for Scotland (2009) report did not recommend a
caseload throughout figure, it indicated that psychologists
spent 63% of their time in direct service provision, 10% in
the clinical training/supervision of others, 9% in management
activities, 5% in research and audit, and the remaining time in
their own professional development activities or other activities
(e.g., travelling to clinics). A relatively low median caseload size
and a relatively low figure of 36% of time engaged in direct
work among a sample of Irish psychologists (Dowd, Sarma &
Byrne, 2011) may partially reflect a decreased emphasis on
direct work with service users and a small but welcome shift
towards a shared care or consultant role model (Management
Advisory Service, 1989).
This second method of estimating the number of psychologists
required involves taking consideration of a number of different
issues including individual differences in the prevalence of
mental health problems across demographics of the population,
as well as the workload of a psychologist. Hence, an advantage
of this method is that it gives service providers a better idea of
how staffing levels need to be organised across different care
groups in the population, depending on individual need.
Conclusion
The population- and needs-based methods of estimating
psychology staffing requirements do not yield significantly
different findings. For example, the recommended 1 in 5,000
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The Irish Psychologist March 2012 • Volume 38 Issue 5
ARTICLES
ratio by the Management Advisory Service (1989) does not
diverge significantly from the 1 in 5,781 ratio recommended
by the BPS (2004) that was based on individual need across
different service areas. In Ireland, the 647.34 WTE psychologists
(Breaden & Woods, 2010) represents a ratio of 1 in 6,546 of the
general population, or a shortfall of 201.66 WTEs based on
the above 1 in 5,000 ratio. To the best of our knowledge, no
Irish study has yet calculated a recommended ratio based on
individual need across different service areas.
Perhaps the reason for the similar estimates produced by the
population- and needs-based methods is that the two methods
are actually not distinct from one another. The former provides
a recommended ratio, that although more general, is still based
on prevalence rates in the general population. The needs-
based method is also based on prevalence rates, although as
it is based on more in-depth investigation of the population, it
may yield slightly more accurate findings that take into account
the demographics of a given population.
Both methods have their own use at different levels of
management. Population-based ratios will provide similar
recommendations for the total number of psychologists
needed as ratios that are based on individual needs of different
clinical cohorts. The former may be useful at a higher level of
management in providing a recommendation of how many
staff are required for a given population size. At a lower level
of management (e.g., within the profession of psychology itself
or at a local level) ratios based on individual service needs
will assist in the distribution of staff numbers across different
service areas and in different locations, depending on the
identified needs of those areas.
Even in a context of having one psychologist per 5,000 general
population, taking a “conservative view” that only 10% of
the area population requires psychological intervention (Carr,
2000), psychologists might need to carry a caseload of up to
500. Clearly, the latter is not feasible. Going forward it would
be useful to examine current workloads of psychologists in
Ireland, and to explore the possibility of other disciplines and
mental health professionals providing some of the services in
consultation with, or under the supervision of, psychologists
(e.g., shifting towards a shared care or consultant role model;
Management Advisory Service, 1989). The latter could lead to a
more effective utilisation of psychologists’ time and experience.
Indeed, the BPS (2004) made suggestions regarding how other
healthcare workers could be involved in providing the services
currently carried out by clinical psychologists. These included
health promotion officers, health psychologists, counsellors,
primary care mental health workers, voluntary services
coordinators, as well as assistant and associate psychologists.
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Workforce planning survey report
  • C Breaden
  • K Woods
Breaden, C., & Woods, K. (2010). Workforce planning survey report 2008. The Irish Psychologist, 36(11), 257-265.
Review of the Midland Health Board Psychology Service
  • A Carr
Carr, A. (2000). Review of the Midland Health Board Psychology Service. Tullamore: Midland Health Board.
A survey of psychologists' workload in Ireland
  • H Dowd
  • K Sarma
  • M Byrne
Dowd, H., Sarma, K. & Byrne, M. (2011). A survey of psychologists' workload in Ireland. Clinical Psychology Forum, 223, 42-46.
Review of clinical psychology services: Activities and possible models
Management Advisory Service (1989). Review of clinical psychology services: Activities and possible models. London: Mowbray.
Clinical psychology workforce planning group. Edinburgh: NES, Primary Care Sub-Group
NHS Education for Scotland (2002). Clinical psychology workforce planning group. Edinburgh: NES, Primary Care Sub-Group.
Workforce planning for psychology services in NHS Scotland-characteristics of the workforce supply in
NHS Education for Scotland-Information Services Division (2009). Workforce planning for psychology services in NHS Scotland-characteristics of the workforce supply in 2009. Edinburgh: NES-ISD.