Availability of psychological treatment in Sweden

Mental illness is increasing! We've heard it many times by now. But how is it, really? And if it is so serious - how does it affect access to treatment as a patient?

Mental illness in Sweden

According to Folkhälsomyndigheten's (the Public Health Agency's) latest survey, roughly between 5-10% of the Swedish population exhibits severe mental stress (Folkhälsomyndigheten, 2022). Across all age categories, however, young adults report almost a doubled prevalence - 10-20%. Women are overrepresented in all categories, but especially women aged 16-29 and aged 85+, the difference is particularly large. An estimate is therefore that around 800,000 people in Sweden report severe mental stress. In the last 8 years, this percentage has risen alarmingly and steadily in the national public health survey.

In Sweden today there are 9,158 employed clinical psychologists (https://www.socialstyrelsen.se). The proportion of clinical psychologists has increased by 14% in the last 8 years. How many patient treatments are completed varies by psychologist, but for a full-time clinical psychologist at the primary care level, an approximate estimate is that one performs approximately 40 full-scale 10-session treatments (KBT i Primärvården) in a business year.

Although cognitive behavioral therapy has robust scientific evidence and is considered the most researched form of treatment for mental illness (Mechler & Holmqvist, 2016), the treatment results for psychological therapy do not praise the market. Approximately one in two patients undergoes treatment without improvement (Hofmann et al., 2012) (David et al., 2018).

Based on these data points, a number of assumptions can be made:

• There are approximately 90 people in Sweden with severe mental stress, per clinical psychologist.

• A clinical psychologist who works full-time with treatment - which not everyone does - probably does not treat more than about 40% of the coverage rate of patients per psychologist.

• Although the number of psychologists is increasing, so is the number of people with mental illness. It is therefore unlikely that the ratio patient: psychologist will change.

• Of the full-scale treatments that are carried out, half of these probably lead to the mental illness not persisting over time. That is about 22% of the coverage rate.

From a purely data perspective, it therefore does not appear that all people with severe mental stress can be treated for their problems with psychotherapy. This doesn't necessarily have to be that remarkable. Some problems can be greatly influenced by either medical or other external environmental reasons, and pure therapy cannot solve it all. At the same time, it is clear that there is a structural problem in both outcomes and availability of what we call evidence-based treatment.

International perspective

If it looks like this in Sweden - what is it like internationally?

In a socioeconomically similar country like Germany, it looks very similar (Bundespsychotherapeutenkammer, 2018). It takes an average of 4.5 months to start psychological treatment and about 50% of patients do not improve after that.

If we broaden our view to developing and emerging economies such as Nigeria, Brazil and Turkey, the picture looks even bleaker. The estimated prevalence of mental illness does not differ significantly, and between 8 - 16% of the total disease burden is made up of mental illness (Rathod et al., 2017). In Nigeria, for example, there is 1 psychologist per 1,600,000 people. With a comparable prevalence of severe mental stress, there is 1 psychologist per 128,000 p