ZONAL SIMILARITIES AND CHALLENGES IN EUROPE III

Prof. Matti Joukamaa Professor of Social Psychiatry Dept of Social Psychiatry, Tampere School of Public Health University of Tampere, Finland Jyrki Korkeila and Matti Joukamaa Mental Health services in Finland: - Problems and challenges Finland Independent since 1917 5,3 million inhabitants (2003) From the population: < 15 year olds 15.6 %, and > 65 year olds 17.6 % Ageing of the population continues. From estimated population in 2020: < 15 year olds 16 %, and > 65 year olds 23 % Finland: The Population’s State of Health The population’s state of health as a whole has mainly improved. Two thirds of the adult population consider themselves to be in a good or fairly good state of health. This proprortion has particularly increased among over-45s. Finland: The Population’s State of Health Some common diseases, such as cardiovascular diseases, occur less frequently than they used to. Ageing of the population gives rise to an increase in other diseases, such as cancers. As a result, the need for medical care is growing. Finland: The Population’s State of Health Mental health disorders are by far the most common reason for retirement on disability pension, followed by musculoskeletal diseases and cardiovascular diseases. Especially the proportion of depression is a common reason for disability pension. Finland: number of physicians Roughly: 1 physician for 360 inhabitants 1 psychiatrist for 5000 inhabitants Finland So, we have high number of physicians and psychiatrists in Finland What is the problem? Let’s go back to history Finland Until 1980 the number of mental hospital beds was in Finland highest in the whole world 4.2 beds for 1000 people The de-institutionalisation process was very quick Now the number of beds is 1/1000 Finland The idea was to increase the resources into out patient care. A very deep economic recession in the beginning of the '90s hampered the development of out patient mental health services. Despite the fact that the number of psychiatric beds continued to decrease, the personnel in outpatient care decreased between 1992 and 1995. Finland A change in legislation twelve years ago allowed the municipalities to self decide how to arrange the health care services to their inhabitants. This has led to a situation, where the public services may be differently organized and provided for the population, and their costs and quality differ from one municipality to another. Large regional differences exist in the use of mental health services. Finland: Burnout of psychiatrists Many psychiatrists feel the work in public outpatient care very hard and even exhausting J Korkeila et al: Burnout and self-perceived health among Finnish psychiatrists and child psychiatrists: a national survey. Scand J Public Health 2003:31:85-91 J Korkeila et al 2003: Results: …Psychiatrists and child psychiatrists reported burnout, threat of severe burnout, depression, and mental disorder more commonly than other physicians. …Lack of possibilities to consult a colleague, and supervision of work, experience of threat of violence, and self-reported depression were significantly associated with overall burnout level and emotional exhaustion. J Korkeila et al 2003: Conclusions: Emotional exhaustion as a symptom of burnout was common among psychiatrists, especially among those working in community care, and child psychiatrists. Problems of general health, as well as mental health, among psychiatrists and child psychiatrists are in need of attention. Finland There is an remarkable lack of psychiatrists and child psychiatrists working in the public health care system and the situation has worsened during the last years. The lack of psychiatrists in public health care in Finland (%) Year 1999 2001 2003 Psychiatrists Child psychiatrists Forensic psychiatrists 28 16 -- 34 33 33 25 36 44 44 36 Adolescent psychiatrists 24 Finland Unfortunately, there are only very few new physicians eager to specialize in the different fields of psychiatry Finland: new challenges for health care Countrywide criteria for non-emergency health care access from beginning of March 2005 common nationwide criteria for healthcare needs assessments. Finland: Access to treatment A major part of health care concerns emergency treatment, with immediate attention in the event of accidents and treatment in cases of serious illness provided as soon as possible. New regulations also set timeframes for access to non-emergency treatment. Finland: Access to treatment Non-emergency treatment refers to a situation where patients' health does not demand immediate treatment. It means that the patient is in a position to wait both for a decision on what treatment is needed and to access treatment by themselves. The principles concern the most common forms of examination and treatment and do not cover all types of treatment provided. Finland: Access to treatment Immediate access to health centres during working hours by phone or personal visit is guaranteed. A patient's treatment needs can often be assessed over the phone and this can be done by health centre personnel other than a doctor. Finland: Access to treatment If the treatment proposed requires the patient to pay a visit to the health centre an appointment will be arranged within three working days of contacting the centre. Usually, the treatment given by a health centre starts with the first visit by a patient. If this cannot be done, treatment has to be arranged within three months maximum. Finland: Access to treatment Hospital treatment requires a doctor's referral, and treatment needs have to be assessed within three weeks of the hospital receiving the referral. Assessments can be made either based on referrals or by examining patients at the hospital. Finland: Access to treatment If a medical examination shows that a patient needs hospital treatment, this treatment must be made available within six months of the assessment. Finland: Access to treatment If a health centre or hospital is unable to treat patients within the set timeframe, they have to have the possibility to receive treatment elsewhere, either from a different hospital district or from the private sector. This is to be arranged at no extra charge to patients. Patients are also entitled to refuse treatment. Finland: Principles of treatment access There is to be a uniform basis of treatment access throughout the country. The Ministry of Social Affairs and Health has put together guidelines on access to treatment based expert proposals. These are used by doctors in deciding on the treatment of their patients. Finland: Principles of treatment access In addition to using treatment guidelines, doctors are always to take account of their patients' individual situation and treatment requirements. A doctor will decide on a course of treatment by agreement with the patient. Patients are not entitled to receive whatever treatment they wish. The 28th Nordic Congress of Psychiatry Tampere, Finland 16-19 August 2006 New Tools for Clinical Practice - Psychiatric epidemiology and case finding - Molecular genetics and clinical descriptions - Neuroimaging and clinical examination - Treatment systems and individual interventions - Evidence-based guidelines and experiencebased clinical practice Tampere: Within Easy Reach • Excellent connections by air and by land • Finnair and SAS offer several international flights every day via Helsinki Stockholm and Copenhagen , Tampere Hall Tampere Hall is the largest dedicated congress and concert centre in the Nordic countries National and international congresses Exhibitions, banquets •Concerts, opera, ballet Specially Designed Congress Facilities Tampere Hall • Modern architecture • State-of-the-art technology • Meeting room capacity for 3,000 delegates • Catering for up to 3,000 guests • Several hotels within walking distance Welcome to Tampere in 2006 Professor Raimo K R Salokangas President of the Congress Welcome to Tampere in 2006 Professor Raimo K R Salokangas President of the Congress Welcome to Finland!