El trabajo de los psicólogos en los centros de atención primaria del sistema público de salud en Chile

Abstract

Objectives. To define work characteristics of psychologists in public primary health care centers in Chile and the degree to which their functions conform to the standards set by the National Plan on Mental Health and Psychiatry (NPMHP). Methods. From December 2003 to November 2004, a cross-sectional, descriptive study was conducted employing a questionnaire sent to a nonrandom sample of 486 professionals working in public primary care centers of Chile's 29 health districts. The total response rate was 34.4% (167 completed questionnaires). The questionnaire gathered general information and demographics; frequency, distribution, and type of activities performed; the mental health issues treated; personal perspectives on the efficiency of care, factors affecting interventions, and the quality of work conditions; and competence level regarding diagnosis and treatment strategies, as well as the educational background needed to fulfill the role of psychologist at the primary health care centers. Descriptive statistics with 95% confidence intervals were calculated for the quantitative data. Content analysis techniques were applied to the responses to open-ended questions. Results. Considerably more time is being devoted to individual consultations and interventions than to group and community promotion and prevention activities. Over 93% of the survey participants were satisfied with their work and valued their peers; however, more than half gave a negative rating to their work conditions and job security. The majority indicated that preparation for the role must include coursework on the health system, specifically the primary health care setting, and topics such as clinical and group psychology, public health policy, and primary health care management and specifics. Most critical to the work were a knowledge of diagnostic tools and classification systems, i.e., the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders. Conclusions. Contrary to NPMHP recommendations, the primary health care psychologists in Chile's public health care system are dedicating most of their time to individual counseling and therapy, rather than community activities designed to strengthen and promote mental health. In addition, a funding plan that supports NPMHP priorities is needed.