Denmark

Country

• Approximately 5.5 mill. inhabitants. Density 128 persons per square kilometer.
• Expenditures on health amount to about 10% of the GDP and about 85 % are financed by the public, the rest is privately financed.

Psychotherapy in the health care system

• Psychotherapy is offered to patients at psychiatric hospitals/departments, some somatic departments (especially for cancer-patients), via Public Health Insurance, private health insurance and at a less degree by the municipalities. Treatment at hospitals is free. If treatment is done with reference to the Public Health Insurance, the patients pays one third of the expenditures.
• Indication for treatment:
  In the agreement between DPA and the Public Health Insurance, 10 groups are defined, which can be treated with reference to public insurance. The groups cover mainly persons, who have experienced serious crisis (fx traffic accidents, victims of violence, serious illness), but also include people with light to moderate depression. The DPA is ongoing working for having anxiety and OCD patients covered by this agreement.
• Preconditions:
  All psychologist have to be authorized by a national authority (see below) to be able to work independently for the Public Health Insurance. A majority of the private psychologist practitioners working with reference to the Public Health Insurance are specialists.
• Quality management requirements:
  All authorized psychologists are subject to the law of psychologists administered by the Danish Supervisory Board of Psychological Practice (national authority). The Supervisory Board functions as authorization body, complaints board and supervisory board.
• Patients access:
  All citizens have free access to treatment at hospitals. In relation to the agreement with the Public Health Insurance patient are allowed treatment only after reference from a general practitioner.

Psychotherapeutic Professionals

• Professions, qualifications etc.: In Denmark the title “psychologist” is protected by law, while the title “psychotherapist” is not. For psychologists you have to be authorized before any specialization. In order to be authorized you have to graduate both as bachelor and master in psychology (in line with the EuroPsy). Furthermore the psychologist shall document at least two years of supervised practice to be authorized. On top of the authorization it is possible to be trained as a specialist. In Denmark we have two by public authority recognized specializations for psychologists in psychiatry (adults and child/youth). The DPA has 10 different specializations, where psychotherapy is one of them. The DPA recognize 4 different treatment approaches:
  - existential/humanistic
  - cognitive/behavioral
  - psychodynamic/psychoanalytic
  - systemic/structural
   
• Requirements for providing services within the health care system:
  Beside the requirement of being an authorized psychologist you have to be assessed and evaluated on different professional criteria in order to be accepted to provide services for the Public Health Insurance. For this purpose an evaluation board meets twice a year. 

Psychotherapy for Depression

• Special concepts:
  Severe depression is treated in hospitals (inpatients). Treat¬ment of light to moderate depression is offered via the Public Health Insurance for people between 18 and 37 years old after psychometric test. (The DPA is ongoing working for expanding the age limit to all adults.) The visitation incorporates 12-24 hours of treatment.
• Best practice models:
  The DPA has accepted the APA definition of evidence and is working with implementation of an extended version of this definition.
• Shortcommings:
  It is estimated that about 20 % of the population has non-psychotic dysfunctions (something between 700.000 and 800.000 inhabitants.) About 300.000 of these citizens do not receive treatment, partly for economic reasons, partly manpower shortage.

Desirable Changes to Health Policy

• The vision would be to develop a system which could offer treatment to all citizens in need of psychological treatment. Especially psychological treatment to people with non-psychotic disorders like stress- related disorders, anxiety states, somatoform disorders, which are causing a lot of absence due to illness in Denmark.

Author
Yvonne Kronberg, Clinical psychologist, Representing the DPA in EFPA Standing Committee on Psychotherapy.
The Danish Association of Psychologist
Convenor of EFPAs SC-Psychotherapy

The text above is an excerpt from the paper "Psychotherapy in Europe – Disease Management Strategies for Depression. National Concepts of Psychotherapeutic Care".

You can download the paper here.