As we transition to a national health system under Te Whatu Ora, we need to empower health psychologists to focus on their passions, rather than fighting for their livelihoods
Opinion: Over the past 50 years, a growing body of scientific evidence has confirmed what we have long known intuitively: there is an intricate and interdependent relationship between our physical and psychosocial health.
However, health psychologists face significant systemic and professional barriers within the health system that prevent them from supporting people with physical health problems to the best of their ability. How can we address this deficiency in our public health system and take the psychological components of health care as seriously as we should?
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* Does it help or harm? Our modern conversations about mental health
For conditions such as cancer, diabetes, heart disease and the long Covid, empirical evidence and anecdotal experiences clearly tell us that our physical health has a profound effect on how we think, feel and navigate the world. It is also increasingly apparent that the way we think, feel and walk in the world has a profound effect on our physical health.
For example, studies show that stress can lead to increased cardiovascular reactivity (such as increased blood pressure) which can contribute to the development of cardiovascular disease. On the other hand, by reducing our stress levels—using evidence-based strategies such as exercise, engaging in meaningful hobbies, or spending quality time with loved ones—we could reduce our risk of heart disease. Conversely, recent evidence suggests that physiological processes such as inflammation—a common consequence of viral infections—may play a role in symptoms of depression and anxiety. It is clear that our health includes not only our body, but also our mind, spirit and environment.
Evidence shows that psychological interventions can improve outcomes for patients with a variety of physical health conditions, from allergies to long-term Covid to kidney failure. That is why health psychology – the specialist field of study of how our physical and psychosocial health affect each other – has flourished as a field of research and a discipline of clinical practice, leading to more health psychologists than ever working with patients in our hospitals.
However, for several reasons, health psychology has yet to be a consistent and entrenched part of the health system in Aotearoa, as I outlined in my MSc in Health Psychology, Is there a psychologist in the house?
First, there is a shortage of health psychologists to meet the current and projected future demand for psychological support in the public health system. In 2022, the National Survey of Psychologists in Public General Hospitals (PsychH) found that an estimated 73 new psychologist posts in physical health settings (such as cardiology, oncology, diabetes and so on) are due to open in 13 former district health boards over the next five years to meet future demand. This amounts to almost 60 percent of the growth in the current psychology workforce in these fields.
Second, the zip code lottery still seems to be in full swing when it comes to psychology, with a highly unequal distribution of health psychologists across the country. In PsycH, Auckland District (Auckland, Counties Manukau and Waitematā District Health Boards) reported by far the highest concentration of psychologists, with almost 15 times more psychologists per capita than the districts with the lowest reported concentrations (the Lakes and Whanganui).
Third, in PsycH, many health psychologists reported a lack of organizational support and professional recognition for their work. This includes struggling to secure adequate funding for psychological services or having to fight for their place among the medical staff, rather than being accepted as a key component of holistic multidisciplinary health teams. Psychologists also spoke of a lack of basic resources needed to do the job, such as purpose-built clinical rooms, offices with windows and administrative support.
What can we do about it? First, we need comprehensive, methodologically consistent, and accurate data on the health psychology workforce that we can use to plan for growth and development. We may also use the data to develop evidence-based benchmarks to monitor performance and identify areas that need improvement. To do this reliably and effectively, we need funding to encourage and sustain projects such as Psych which specifically focus on psychologists working in the health system.
It is clear that we need to adequately fund existing health psychology services, enabling them to expand and develop to meet increasing demand, and to empower health psychologists to focus on their passions, rather than fighting for their livelihoods. This will be complex – especially as different health services operate at local, regional and national levels – but we can no longer afford to question the relevance of psychology in physical health.
Similarly, health psychologists can no longer be considered privileged guests in medical institutions, but critical to a modern and holistic health care system. This means increasing the representation of health psychologists at management levels in hospitals, recognizing their expertise and working with appropriate remuneration, establishing pathways for professional growth and promoting professional autonomy.
As we continue to transition to a national health system under Te Whatu Ora, we have a once-in-a-generation opportunity to rethink the way our health system works. Gone are the days when psychological support was just a health care note or ‘mental health issue’. If we are truly seeking to build an evidence-based health care system, then the evidence strongly supports encouraging health psychologists in physical health care settings in public general hospitals.
