This is the first study to estimate the workforce required in Clinical Psychology to offer adequate psychological treatment to the population in the Spanish public health system. In particular, this work proposes three predefined treatment scenarios based on theoretical-technical criteria, estimating the total number of clinical psychologists ranging from 31,620 (the protocolized scenario) to 5,530 professionals (the adjusted scenario).
Considering the current situation in the Spanish health system, the adjusted scenario would be a sustainable and feasible solution. Several managerial and clinical explanations have been provided. First, the adjusted scenario is the most cost-effective in terms of human, time invested, and ultimately, financial resources to be injected into the Spanish healthcare system. Second, this scenario allows the treatment of patients who really need it, thus avoiding the inverse care law. In particular, for the treatment of depressive and anxiety disorders, interdisciplinarity may be advisable but not obligatory if the use of available professionals is optimized. However, in the care of severe mental health disorders, this interdisciplinarity is not only advisable, but also an essential way of working [20, 34]. In this way, resource allocation is optimized, ensuring that more and better mental health care is provided to those most in need. In contrast, the protocolized scenario, besides being costly, implies several risks due to the huge amount and sudden incorporation of clinical psychologists in the Spanish public system. In this sense, according to our clinical experience, a massive number of clinical psychologists may also imply a greater likelihood of overtreatment and psychopathologizing people’s normal functioning [36]. There is still debate regarding a universal approach to treatment versus value-based care for the very few who really need it [37]. However, the adjusted scenario still requires significant financial investment, given the need for approximately 5,530 professionals in Clinical Psychology, which doubles the number of clinical psychologists currently available in the NHS [6].
On the other hand, although four main forecasting methods for healthcare workers supply have been proposed, there is no a single accepted approach [38]. This study used a needs-based model, which allowed us to consider inequities and inefficiencies in the estimation. In our view, the benefit to the policymakers of a needs-based strategy, proposing three treatment scenarios, is that it provides insight into the current need for clinical psychologists and an increase in PIR positions to achieve the recommended standard of care for people living with mental disorders in a given period of time. Consequently, depending on the degree of institutional awareness of the problem, different policy decisions may be made by competent authorities.
According to the clinical criteria, it is also essential to be very cautious regarding the estimates calculated in this study. On the one hand, because using the three ENSE categories represents high internal heterogeneity about the severity of the psychological disorders suffered by patients, above all regarding the “other mental disorders” category. On the other hand, due to the variability in each professional’s expertise level, the quantity and quality of available resources in each healthcare center, and the type and complexity of evidence-based psychological treatments.
This study has some limitations. First, although the present study used data from multiple sources, including national surveys and health system reports, the ENSE survey relies on self-reported data rather than diagnostic interviews, which can result in biased estimates [39]. Second, these estimations are based on data from 2017, and a future update of the ENSE survey will be released in May 2025 [40]. The use of the most updated European Health Survey in Spain (EESE) [41] was disregarded because it was conducted during the first wave of the COVID-19 pandemic, in 2020, which poses significant risks of inadequately reflecting current prevalence figures [18]. Third, this study did not consider socioeconomic differences between the diverse geographical areas in Spain. Fourth, the group treatment modality has not been contemplated, nor has the work that, under supervision, can be carried out gradually by residents in Clinical Psychology. Moreover, these estimations were based on the prevalence for the population aged 15 years or older (the minimum age of the ENSE survey). Therefore, childcare needs were not covered in this work, which warrants future studies to justify a new and independent specialty, Clinical Psychology for Childhood and Adolescence. The estimations utilized for this forecast were derived from the ENSE survey, which sets the minimum age at 15 years.
This study is relevant because it provides valuable insights into the workforce required in Clinical Psychology for the Spanish public health system. This pioneering study is important as it addresses a significant gap in the literature and has the potential to inform policy and clinical practice for mental healthcare systems in Spain. Future studies should consider the influence of Spanish regions (i.e., Autonomous Communities) to assess the availability and potential inequities in access to mental health care services due to geographic proximity issues [37]. This research is a matter of equity in access to psychological treatment. This research is also a matter of fostering a sustainable and public mental health system that adds value to people in real-world scenarios.