The doctor’s role in the mental healthcare service – a qualitative study

The role of doctors is changing, and mental health care is increasingly dominated by professional groups other than doctors. In this qualitative study, we investigated how psychiatrists perceive their role and position in mental health care.

Seven psychiatrists were given in-depth interviews based on an interview guide. The transcribed material was analysed using systematic text condensation.

The interview material was grouped into four cross-cutting topic categories: Several informants perceived themselves as professional guarantors who step in when other interventions have failed. Many felt like guest workers in the therapeutic pathways of other professional groups, without an adequate framework for following up the patients properly. Some described the health authorities' prioritisation of mental health as a patient pathway bureaucracy, where more stringent demands for control and documentation of treatment and decisions to use coercive measures divert time and resources away from patient treatment. Several psychiatrists felt that unified management led to diffusion of responsibility, with an unclear distribution of professional responsibility between the interdisciplinary head of unit and the specialist.

The psychiatrists in the study appeared to have clear professional authority in the clinic, but their role seems to be under pressure. Interdisciplinary, unified line management, equal responsibility for treatment accorded to specialists in psychology, and the absence of psychiatrists in the management appear to have undermined the psychiatric perspective in mental health care.