An increase in the number of people seeking psychological assistance, coupled with a shortage of psychologists in the public sector, is adding to the strain on the professionals offering the service while at the same time discouraging people from seeking assistance, given that private clinics are costly, The Malta Independent on Sunday has learnt.

Answering questions, Betapsi, the psychology students organisation, said that even though there is an increase in recognition of the importance of mental health, the psychology profession in Malta still encounters certain challenges.

It said that as more individuals seek therapy, the waiting lists for psychological services have extended, placing additional strain on the already limited human resources available. In fact, psychologists in the public sector often find themselves handling a heavier case load than they would be comfortable with, it added.

This increased workload could lead to psychologists working longer hours, Betapsi said, making them more easily susceptible to burnout, especially considering the demanding nature of the work and the frequent exposure to clients’ distressing narratives.

It said that a critical issue is the shortage of psychologists, specifically in the government sector where they are most needed, as those who require the most support from society often cannot afford to pay for private therapy sessions. Consequently, state-provided therapy options are struggling to meet the high demand, leading to long waiting lists for clients in need and professionals who are overworked, it said.

For its part, the Malta Chamber of Psychologists’ (MCP) said that the psychology profession in Malta has been growing steadily over the years, and now there are approximately 250 warranted psychologists covering different fields. It said that the need for psychological services by the general population has been growing at a faster rate due to several factors including increased awareness, the fast pace we are living and the effects of the Covid-19 pandemic.

The MCP believes that as a nation, our focus should shift from solely addressing needs as they arise, to implementing more preventative measures, and it said that many mental health issues develop gradually over time. Furthermore, it said that apart from providing treatment, psychologists could also lend their expertise to developing preventive strategies.

“We believe that psychoeducation is key to prevention and early intervention. Additionally, we advocate for increased accessibility of general mental health services, independent of specific affiliations,” the MCP said.

Betapsi said that addressing such shortages requires a multifaceted approach and there is no singular clear-cut solution. It said that there are various potential solutions that can be pursued to try to attract more people to the profession, such as improving pay and work incentives, better work conditions and increasing training opportunities. 

With regard to a potential solution to the psychologist shortage, the MCP said it would be “ideal” if the government provided more opportunities for training and specialisation to attract more individuals to work in government services rather than in private practice. It said that one of the challenges associated with an increasing number of psychology graduates is the shortage of placement and supervision opportunities afterwards. When asked if the shortage of psychologists in the public sector led to a growing need for private services offered by psychologists, which some people cannot afford, the MCP said that while the private sector in healthcare is always going to be active, whether for physical ailments or mental health, it agreed that it is the case that several individuals may not be able to afford it. Nevertheless, it has been noted that numerous organisations are significantly aiding individuals in need, such as victim support, kellimni.com, crisis resolution services, the Richmond Foundation, and various others.

Betapsi said that rather than the government shortage having created a “need” for private therapists, it believes that the shortage has created a demand for private therapists as more people are resorting to the private sector to bypass the public sector’s long waiting lists and get the help they need. From its point of view, the poor working conditions provided in the government sector have led to more therapists moving to the private sector.

It elaborated that if conditions were improved, psychologists would be more inclined to continue working in the government sector, thus leading to shorter waiting lists, making therapy more accessible to those who cannot afford a private therapist.

Betapsi recognised the negative impact which the government shortage is having on those who wish to seek therapy but are living in relative poverty conditions. Furthermore, it said that this is the population of people who might most desperately need therapy services as they are more likely to be exposed to physical, emotional and psychological hardships as a result of their situation.

The MCP said that the University of Malta is not in a position to accept many students for the Master’s course due to several factors.

Betapsi stated that insufficient funding prevents certain Master's programmes in Psychology from opening each year. Furthermore, it added that there is also a lack of professional supervisors who help support Master’s students.

The MCP said another problem with post-graduate training in Malta, specifically, is the difficulty in students finding supervisors for their clinical work and, tying in with the shortage of psychologists, those employed in the national health system are already managing substantial caseloads and have limited time available to follow the trainee psychologist. Consequently, the number of places available locally for training placements is limited, it said.

There appears to be a trend of psychology post-grads going abroad to do their Master’s but the MCP said that not everyone can afford to study abroad. Furthermore, post-graduate training in psychology is rather challenging, the MCP said, as both locally and abroad, most training courses are provided on a full-time basis, meaning that most young individuals aiming to become psychologists have to pause their working career for the duration of the course, which is a minimum of two years, thus posing a financial burden. 

The MCP said it would help greatly if the government offered scholarships to individuals wanting to study for a Master’s in Psychology as the high costs of such a course are a burden on young individuals who haven’t as yet started working.

Furthermore, the MCP said that any individual who wants to work as a psychologist in Malta is required to complete a Master's degree and then work an equivalent of two years full-time to be eligible for a warrant. Additionally, it emphasised that while students may choose to pursue studies abroad, it is crucial for them to verify that the course they intend to undertake is equivalent to the one offered in Malta. Those opting to study abroad might not automatically qualify for accreditation in Malta and are encouraged to consult the Malta Psychology Profession Board before enrolling in any psychology-related Master's programme overseas.

Betapsi said that they are aware that some psychologists opt to get their warrant from abroad and that several factors might contribute to this trend. Firstly, the inadequate funding leads to limited opportunities in Malta, so more people end up seeking education from abroad.  Another factor is that in Malta, to be eligible to study psychology at a postgraduate level, work experience is required. So, many go to study abroad in order to bypass the working experience to become professional psychologists in a shorter amount of time, it said.  

Betapsi also said that the University of Malta offers training for students in several different modalities or approaches, like CBT and psychoanalysis, meaning that if a student already has a clear idea on what modality they would like to specialise in or if they would like to receive further training, they may choose to go study abroad to find a course better fitted to their interests.

It added that this also applies if students wish to study a stream of psychology that is not offered at the University of Malta, such as sports therapy.

Betapsi acknowledged that every individual should have the opportunity to pursue the education they desire, however, limitations within the education system in general exist and such limitations do not just exist within the psychology department. It added that psychology students do not necessarily need to go abroad to obtain a warrant in Malta and that there are still opportunities locally for a warrant, including options that do not include getting a Master’s with the University of Malta.

The MCP said that the workload guidelines of psychologists are set by the Malta Psychology Professions Board and the function of such guidelines is to ensure the wellbeing of the psychologist and the value of the level of care given to our clients. Furthermore, the increase in demand for the service of psychologists makes it paramount to continue to increase their employment to ensure that the best service possible is given.

During the signing of the sectoral agreement on 7 February, the Minister for Public Health and Active Aging, Jo-Etienne Abela said that the agreement will see improvements in the conditions for psychologists working in the public sector with an enhancement in the services provided to the public. The MCP said that the agreement did not address the workload but rather aimed to improve current working conditions for psychologists, most especially in terms of making it more attractive for psychologists to seek and retain employment in the public service.

The MCP said that one of the aims of the new sectoral agreement was to improve work conditions and prevent government psychologists from getting burnt-out but reaping the benefits of such changes takes time.  However, the Chamber said it persists in supporting the needs of its members as it continues to observe how the professional landscape is changing. Furthermore, it said that having psychologists in top positions such as managing and principal psychologists supervising individual teams will help in this aspect.