Finnish municipalities obliged to improve preventive mental health services for the young

Efforts are being carried out in Finland to strengthen and develop preventive mental health services for children and the young. A key focus of these is the government decree, which fully takes effect from the beginning of 2011, and which encompasses the work of maternity and child health clinics, school and student health care and preventive health care.

The government decree replaces non-binding guidelines and recommendations and represents a more concerted attempt to upgrade child and youth healthcare. It commits Finland's municipalities, which are primarily responsible for organizing social and health services, to arranging regular and scheduled health examinations and health guidance.

"From the start of next year, municipalities nationwide will organise broad medical examinations for all family members during pregnancy, before children are of school age and during comprehensive school," says Maire Kolimaa, Ministerial Adviser at the MSAH.

"Family training and home visits will have to be arranged at least for families expecting their first child. In addition, the support needs of those who are not covered by the health examinations will have to be clarified. School and student health care will have to monitor the health quality and safety of school and learning environment every three years. The correction of the deficiencies that are detected will have to be monitored annually."

Kolimaa says that the aim of such extensive health examinations is to focus attention on parents' support needs as well as those of children.

"The broad health examinations of Grade 8 learners are also important. They will assess the special needs of learners in terms of their further studies and career choice and plan necessary support measures."

Crucially, from the perspective of mental health, the decree binds municipalities to promote the mental health of children, youth and families, to identify deficiencies in this area and to respond with the necessary support or guidance for treatment.

Attention has also to be paid to factors that impact adversely on the mental health of children and the young, such as bullying and violence. The section of the decree concerning student health care specifically mentions the early identification of mental problems and their appropriate treatment and follow-up.

This focus on preventive intervention in child and youth mental health is also a central concern of a range of other interlinked Finnish health and social policy initiatives.

The new Health Care Act includes timeframe guarantees on access to psychiatric treatment for young people. It also deals with the arrangement of medical examinations and health guidance for young people who are not included in student or occupational health care arrangements.

The MSAH has also made mental health problem prevention a special feature of its programme work. From 2008 to 2010 the National Programme for Social Welfare and Health Care - known as the Kaste Programme - has devoted half (€42.3 million) of the state subsidy allocated for the programme to reforming mental health and substance abuse services and upgrading services for children, youth and families. €28 million of this is specifically for revamping child and youth services.

Kolimaa says that the projects involved link up services that support child development across sectoral lines, such as health, social affairs, youth, educational and police operations.

"Special services, such as child psychiatry, child welfare and family counselling clinics are being interlinked to support basic services using different alternatives. Also, services are being taken directly to children's and young people's developmental environments: the home, day care, school, and recreation activities. At the same time, institution-centred activity is being wound down. The experience with these new projects is promising. We now need the courage to learn from these service models and to turn them into permanent practices."

In addition, the Mieli 2009 working group to develop work on mental health and substance abuse to 2015 created a plan for the first set of national objectives in this area. This emphasises the organisation of primary and non-institutional services on mental health and substance abuse for all age groups.

The National Institute for Health and Welfare (THL) has developed support material on preventive mental health work. There is also a range of mental health interventions developed on specific themes: a project on cutting and preventing school bullying, financed by the Ministry of Education and Culture, a working method for supporting families when parents have substance abuse or mental health problems, and a programme of psychosocial support targeted at young men to prevent their social exclusion.

The contexts in Finland of the increasing need for attention to the mental wellbeing and health of children and the young tie in with many of those common throughout the EU, and the responses mirror many of the national concerns of Finland and the other member states.

For instance, since 2007 the EU Public Health Programme has funded work on developing effective policies and practices on child and adolescent mental health in the enlarged EU. Later, the 2009 Swedish Presidency of the EU and the European Commission hosted a conference on mental health and wellbeing among young people. One theme of the conference was the use of multidisciplinary and inter-sectoral inputs for developing prevention and promotion services.

Part of the recommendations of the commission of enquiry into the 2008 school killings in the Finnish town of Kauhajoki - a tragedy preceded by a similar event a year earlier in Jokela - concerned the urgency of dealing with child and adolescent mental health problems and needs. Many of the programmes and other initiatives developed by the MSAH are in part a response to the need to address these issues.

The government decree is no exception. As Kolimaa explains, quoting directly from the decree's explanatory memorandum: "The point of departure in the new decree is the concept of health, which always includes mental health. Similarly, health promotion always includes mental health promotion."

"In their activities municipalities will, under the decree, promote the mental health of children, young people and families, spot shortcomings and provide the support needed or guidance for further treatment," she says.

"When it comes to student health care (from upper secondary level onwards), mental health services will include treatment in addition to the early detection of mental health problems."

Kolimaa explains that though the decree came into force in July 2009, a transition period has been granted for municipalities to organise the system of regular health examinations that the decree stipulates.

"Scheduled health examinations must be dealt with in line with the decree from the start of 2011. The National Supervisory Authority for Welfare and Health and the Regional State Administrative Agencies will monitor this development," she says.

"In total, municipalities receive €18,5 million in state subsidy this year and next year in order to cover the additional costs incurred by implementing the decree. Cost estimates have come from the municipalities, and they take into account such things as recruitment needs for additional employees."

Tero Manninen/ Mark Waller