In spite of our many advances, it is clear that there are still important gaps concerning the complete development of psychologists as health experts. In the first place, it is absolutely imperative that Clinical Psychologists be included as health professionals with their adequate rank in the new legislation that will affect Health Personnel Specialists. But there are other important aspects, though to a lesser degree. At present, the ratio (among mental health teams) of the number of psychiatrists needed and the number of users is about 1 to 5000, whereas in the psychologist's case, this proportion is twice as large (1 to 10,000). In the Mental Health Units of general hospitals, the proportion is about that of one psychologist to three psychiatrists. Doubtless, the proportion is the same in the case of Infantile Mental Health and Rehabilitation Units. And, finally, it is twice as high, in favour of psychologists, in the case of Therapeutic workgroups and teams. With regard to the average number of psychiatrists in the general population, it is 6.7 for each 100.000 inhabitants, whereas for psychologists it is 2.2 for the same population.
It is difficult to explain and analyze these differences, without resorting to guild hypotheses, together with the already mentioned relative ignorance about the function and training of the clinical psychologist which is still rampant. It is incomprehensible that, at this point in the health reform process, such indicators as we have noted have not been revised, in order to adapt them to the real needs of the population as well as to the professional qualification of the Clinical Psychologist.
On the other hand, the University Reform Law (LRU) in 1984 has established the legal possibility of organising specialization courses in Clinical Psychology. In 1977 there was an enactment of the Spanish Parliament in which Clinical Psychology was recognized as a health specialty, and that enabled the specialty PIR model to get under way. So what is lacking in order that all this should really work? Probably, determination and cohesiveness among Scholars, the Colegio, Scientific societies and journals, Faculties of Psychology and so on to achieve the common goal: the recognition of Clinical Psychology as a Health Specialty.
Furthermore, many Faculties have started Doctoral programs in Health Psychology, and in all of them specialty-related subjects, at graduate level, are taught. But there is still an important pending aspect: our students do not have, at an official level, enough places where they can carry out the practicum which would qualify them to apply their expert-knowledge. Many Universities are overcrowded. Does this mean that no practicum is carried out in the University? The answer is no, but with an important distinction: practice almost always depends on the individual effort of some trainers who share the problem, but who are not rewarded by the decrease of their lecturing duties nor, still less, with a bonus in accordance with this extra effort. The main cause of this absurd state of affairs has already been mentioned: Clinical Psychology is not officially recognized as a Health Specialty. Besides this, there is another cause: the present Law of Compulsory Incompatibilities disqualifies University full-time and tenured professors from practising any other paid task that is not strictly teaching, publishing or doing research. All these tasks should be carried out in the Campus (where, as far as we know, there are no current patients). Therefore, it is essential for Clinical Psychology tenured professors to demand the right to exercise their profession in the public health area. Not only for themselves, of course. We have often pointed out the need to include Clinical Psychology as a health specialty, and, therefore, the clinical psychologist as a health professional. We have reasons to hope we will achieve this important goal in a very short time.
Other, no less important goals are the following: first, to introduce and coordinate the evaluation of undergraduate curricula. Second, to clear ways for the continued upgrading in training of existing professionals. Third, to encourage research in our discipline, at all levels, so that international standards are met. In addition, in order to keep up with new developments in Clinical Psychology in Western Society, Health Psychology must be included in specialist education programs and, as a consequence, in specialist professional occupations. And, last but not least, we must make a collective effort to balance the usefulness and appropriateness of the different intervention and action possibilities, faced with the diversity of demands and situations in which the professional Clinical Psychologist must become involved. Of course, this implies the continual evaluation of the clinical psychologists' actions and of the services and domains where they work. And also, efforts must be made progressively to broaden the fields of action by becoming a significant part of Public Health, Occupational Health, and certain other fields.
There is definitely much to be done. But, given how much has been achieved in these last few years, we cannot but be optimistic.
JOSÉ RAMÓN CORREAS GONZALEZ
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LAST UPDATED Sunday 6 de August de 1995 - -