Access to mental health care in Estonia has been a pressing issue for years, and according to family doctors, the situation has reached a point where it is no longer possible to access free psychiatric care.

Elle-Mall Sadrak, head of the Estonian Society of Family Doctors, said it is no longer possible to refer patients to free, Health Insurance Fund-covered appointments. The issue is particularly acute for children.

“I do not even need to issue a referral — the person can go directly — but there’s nowhere to go. No one will take them. The places that are supposed to accept patients even without a referral tell them: Contact your family doctor and have them submit an e-consultation,” she told Monday’s “Aktuaalne kaamera”.

An e-consultation means that the family doctor compiles an initial case summary for the psychiatrist to help clarify the diagnosis. “And then we get a response such as: I recommend going directly to a private paid appointment, or we simply do not have the resources,” Sadrak added.

The biggest problems are in Tallinn. Only those who can afford to pay or travel to the other end of the country can access care.

Anne Kleinberg, deputy chair of the Estonian Psychiatric Association, said that access to child psychiatric care in Tallinn has been in a critical state for years. While the population is largest there, services are the least developed.

“A child psychiatrist working within the Health Insurance Fund system is one of the most overburdened specialists in Estonia. To meet the high demand, people often work double the workload, but that is also why they end up leaving the system,” she said.

Family doctors say the state should cover the cost of appointments when only paid services are available to the patient. Alternatively, a rule could be established requiring all psychiatrists to work under Health Insurance Fund contracts for at least half of their time.

The Ministry of Social Affairs believes this is not feasible, as the state cannot match private sector salaries, and there are still not enough doctors.

“This is a serious concern. Psychiatric appointments definitely do not meet the level of need. But if we look at the data, both the volume of services and spending on psychiatry have actually increased,” said Anne Randväli, head of the Ministry of Social Affairs’ mental health department.

The ministry is also drafting a bill that would require a referral to see a psychiatrist starting next year.

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