An overview of mental health services in Finland

Up until the end of the 1960s,emphasis in the development of the Finnish mental health service system was rather heavily on hospital care. The number of psychiatric beds per 1000 inhabitants at the beginning of the 1980swas still 4.1. The development of out-patient care got under way during the 1960s and, at present, we have a relatively comprehensive network of mental health centres. Regional shortcomings still exist, however, and we still suffer from a lack of alternative forms of rehabilitation. The most serious difficulties are linked to the shortage of psychiatrists but also to shortages of specialized graduate nurses both in hospitals and in out-patient care.

Preventive mental health work, psychiatric care and rehabilitation has been organized in Finland by dividing the country into mental health care districts. The federations of communes responsible for providing the services in each district maintain (by government financial support) the hospitals, mental health centres and other services needed for out-patient care and rehabilitation. The provision of services is based on the Mental Health Act passed in 1952and amended in 1978which favours out-patient care and rehabilitation. Another Act, the 1972 Primary Health Care Act stipulates that the health centre network, led by general practitioners, should take the first line of responsibility in all health care and so support special services, including those concerned with psychiatric care.

The insufficient resources of out-patient care, the extensiveness of and consequent long distances within the mental health care districts, the fact that psychiatric care has earlier been concentrated in hospitals and that the ideology of sociotherapeutic care is rather recent in Finland, together with the public attitude, all underlie the problems of hospitalization in our country.

The following is an introduction to the situation in one mental health care district, especially in the light of the problems involved in rehabilitation of schizophrenics.

Research as an indicator of the need for development

The mental health district of North Häme covers an area of 8600 km2 and some 321000 inhabitants. There are a total of 1468beds in the four psychiatric hospitals of the district, i.e. 4.5 beds per 1000 inhabitants. Out-patient visits to our mental health centres and psychiatric out-patient clinic total some 30000 per year, i.e. 90 visits per 1000 inhabitants. These are 1982 figures.