Friday 9 November 2018

Navigating Swedish health care system as an expat

This week I've for different reasons realised how incredible challenging it can be to navigate the Swedish health care system as an expat. Having said that it is a challenge even if you are a Swede. Even for me who has a good idea of how it works I find it daunting to say the least.

So how to go about it if you need help with mental health issues?
Health care is divided into primary care and specialist care. The primary care is suppose to function as the portal into the specialist care (in reality it more often become the bottle neck). So if you have mental health issues you should first enlist with a 'vårdcentral' and get an appointment with a GP. The GP can then refer you onto a specialist unit if that is what you need. The GP can also write you a referral for therapy if that is what you need. There are two types of referrals, one for short-term therapy (6-10 sessions) and one for long-term therapy (15-20 sessions). You need to choose who to see from a list of accredited therapists and inform your GP. They will then send the referral to that therapist. The therapy sessions are funded by the healthcare system and will cost you 160 SEK/ session.

Can I see you based on a referral from my GP?
No, I do not take referrals out of principle. I am all for therapy being widely available but the system has been shaped so that the system determines how many sessions you should have and what kind of treatment you should have. I do not find that ethical. Also, once you've used you number of sessions then you cannot get a new referral for another year. On a positive note you don't have to get a referral to see me and I normally can see you within a couple of weeks time. Check my website for available appointments.

I have medication that needs to be monitored by a psychiatrist
There are two ways to go about that. One is to go the route through the healthcare system and start with your GP and get referred into the specialist care/psychiatric care. There are benefits and downsides with this depending on your mental health status. You can also choose to go privately to a psychiatrist that is affiliated with the healthcare system. I used to have a psychiatrist I cooperated with and am currently trying to set up a cooperation with someone new.

I urgently need help
For urgent mental health issues you need to contact the psychiatric emergency. Psychiatric emergency Malmö. Psychiatric emergency in Lund. 

I am looking for a private alternative
Most private health care providers are still affiliated with the public system and so the difference between private and public health care providers is quite limited. There is no big difference between going to a private vårdcentral and a public one.

If you have a private health insurance you might be able to get quicker and easier access through a special CAPIO clinic that only serves patients for insurance companies:

I cannot get an appointment with my vårdcentral
Unfortunately the entire Region is understaffed with GPs and so it can sometimes be a nightmare to get an appointment with GP which is often the way access point to further health care. You can now also get appointments with an online doctor instead for certain conditions. You can get quick and easy access if you have a Mobile bank ID. Here are links to the major ones:

I want to see a doctor in English
While it is impossible to go through medical school in Sweden without knowing English (as much of the literature is in English) not everyone feels confident to speak English. Make sure you inquire about an english-speaking doctor when making the appointment.

Funding therapy
Many home insurances grant their clients 8-10 sessions of psychotherapy and most of the times you only need to provide the receipts. Some international insurances have the same policy but with some you need to get pre-approval. Check what the rules are for you insurance.

Some Swedish employers offer their employees "friskvårdsbidrag" psychotherapy is not covered under those rules but stress treatment is so in certain cases you can get a contribution from your employer to cover your sessions. You will need receipts stating it is stress treatment however.

Thursday 1 November 2018

Compassion in practise

Many clients ask for exercises they can do between sessions. Experiencing and embodying compassion is an importat feature of the therapy and I always encourage my clients to work some form of self-practice between the sessions. It can look very differently but I was myself helped, in my self-practise, by having audio meditations I could follow. My mind tends to wander off very easily and unless I keep it tethered by either a yoga position and someone's voice I find it hard to stay with the practise.

The Compassionate Mind Foundation in the UK has released a number of different meditiative practises tailored towards working with Compassion. I warmly recommend you to try them and just notice what happens. What comes up? Sometimes it is not what we expect, sometimes it can help us get in touch with blocks and fear. So keep an open mind and just allow what comes to come.