"If a family physician submits an e-consultation to a psychiatrist and it becomes clear that the person truly needs specialist care, then they will be able to see a psychiatrist," Anne Kleinberg, member of the Estonian Psychiatric Association, explained about the new system.

"But if it turns out that the family physician can help the patient themselves or that the patient should instead receive help elsewhere — for example, in the case of a child, by making certain changes within the education system — then the family physician will receive good guidance and can begin helping the person right away," he added.

According to Kleinberg, experience shows that a very large share of people who go directly to a specialist do not actually need a psychiatrist.

"I've been responding to e-consultations for years. We take over about 60 percent. In child psychiatry, that percentage is definitely higher, but roughly half of the people who come to us should not actually be seeing us and could resolve their concerns with their family physician. That's quite a large number," Kleinberg said.

People should trust family physicians and mental health nurses

The psychiatrist said people should not be afraid of primary care medicine.

"If you look at the numbers, our people have in fact trusted their family physicians for years and that figure continues to grow," she said. "There is good reason to trust family physicians because they are very capable, very compassionate and very practical — they do not abandon their patients," Kleinberg said.

Kleinberg also highlighted the role of mental health nurses working in family medicine centers.

"Mental health nurses are incredibly important people and fortunately many family physicians already work alongside them. I very much hope there will be more of them working alongside all of us. They are very knowledgeable and it is simply wonderful to watch them work. The way they interact with people, make decisions and give recommendations is yet another reason to trust them," Kleinberg said.

In Kleinberg's view, reorganizing the system is unavoidable.

"There are too few psychiatrists and specialist care must be reserved for those who truly need it," she said. "The situation will improve for people who may not themselves be as capable of finding options, but whose concerns are serious enough that they really do need to see a specialist. It is very important for the system to function properly so that conditions of varying severity can receive the best possible solution," Kleinberg said.

For emergency situations, such as psychosis or suicidal thoughts, nothing will change and people should continue to go to psychiatric emergency care or call an ambulance.

Speaking about the shortage of child psychiatrists, Kleinberg expressed optimism about the future.

"We have many wonderful young colleagues who are studying, in residency or have already started working. This bottleneck will gradually pass, though it will still take time," she said.

Kleinberg also said it was normal for specialists to be divided between the private and public sectors.

"This system consists of both private practice and the public system; they are parts of one whole and people genuinely work in both. It should not be seen as something so dramatic — the two sides balance each other quite well. The important thing is that psychiatrists are here in Estonia and working for the people of Estonia," the psychiatrist said.

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