Future mental health policies in Europe Kristian Wahlbeck Director of Development Finnish Association for Mental Health Barcelona 15.11.2013
The Finnish Association for Mental Health • The FAMH is an NGO, encompassing almost 60 local mental health associations with almost 5000 individual members • FAMH and the local mental health associations maintain 19 crisis centers, staffed by professionals and volunteers • FAMH works to promote public mental health, prevent mental disorders and help people in crisis • The FAMH is a member of Mental Health Europe (MHE) and European Anti-Poverty Network (EAPN) as well as World Federation for Mental Health
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2 | © The Finnish Association for Mental Health
Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing 2. Shift from systems-based to person-centered care 3. Shift from hospital-based to community-based care 4. Recognition of complexity of mental health 5. Recognition of inequalities in mental health 6. Recognition of the role of stigma 15.11.2013
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3 | © Mielenterveysseura
Mental health has moved into the political agenda • Prior to 1990s, mental health issues were absent from the European political agenda
• Now, importance of mental health for people’s wellbeing and productivity has been acknowledged • Increased interest in mental health promotion and prevention of mental disorders
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http://ec.europa.eu/health/ph_determinants/life_style/mental/docs/consensus_depression_en.pdf 15.11.2013
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We have new mental health policies waiting to be implemented…. • Europe – New European Mental Health Action Plan 2013-2020 • Endorsed by WHO Member States in September 2013
– EU Pact for Mental Health and Wellbeing 2008 • Supported by Joint Action of Member States 2013-16
• Globally – New Global Mental Health Action plan 2013-2020
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New European Mental Health Action Plan: Seven Objectives
• everyone has an equal opportunity to realize mental well-being throughout their lifespan • people with mental health problems are citizens whose human rights are fully protected • mental health services are accessible and affordable, and available in the community • people are entitled to respectful, safe and effective treatment • health systems provide good physical and mental health care for all • mental health systems work in well-coordinated partnerships with other sectors • mental health governance and delivery are driven by good information and knowledge
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WHO: Global Mental Health Action Plan 2013-2020 OBJECTIVES • (1) to strengthen effective leadership and governance for mental health; • (2) to provide comprehensive, integrated and responsive mental health and social care services in community-based settings; • (3) to implement strategies for promotion and prevention in mental health; • (4) to strengthen information systems, evidence and research for mental health.
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Gap between policy and practice
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Gap between policies and practice: Life expectancy for people with severe mental illness in the Nordic countries
Wahlbeck et al, BJP 2011 15.11.2013
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The three eras of mental health care
I
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II
III
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Sales of antidepressants1995-2011 (daily doses/1000 inhabitants/day)
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12 |Vilhelmsson © Mielenterveysseura Source: 2012
The three eras of mental health care
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II
III
UN Convention (CRPD) Fundamental rights
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The three eras of mental health care
User involvement Peer support Recovery concept
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II
III
UN Convention (CRPD) Fundamental rights
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Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing
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New thinking changes our way of working profoundly
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16 | © The Finnish Association for Mental Health
Emerging mental health promotion arenas across the life span • Early parent-baby interaction • Parenting support • Socio-emotional skill training in schools • Control over work llife • An active role in old age
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17 | © The Finnish Association for Mental Health
Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing 2. Shift from systems-based to person-centered care
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Person-centered care • Person-centered and rights based care – UN Convention on Rights of People with Disabilities – WHO Europe: Statement on User Empowerment in Mental Health
• Fundamental Rights • Empowerment • Recovery
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19 | © Mielenterveysseura
What is person-centered care? • Services are designed based on users’ needs • Treatment empowers users • Services aim at individually defined recovery – …”everyone…has access to…..essentials for living, working, learning, and participating fully in the community” US Commission on Mental Health 2003
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Person-centerdness in practice • Users and carers are offered free training and information about mental health care
• Users and carers take part in design, provision and evaluation of services • Staff training is done with participation of users and carers • Users are empowered to prepare their own treatment plans
• Use of peer support and expertise by experience in mental health services 15.11.2013
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21 | © Mielenterveysseura
Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing 2. Shift from systems-based to person-centered care 3. Shift from hospital-based to community-based care
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Transformation of mental health services • A clear vision has developed: people with mental disorders should be treated in their own enviroment, based on their personal needs, strengths and aspirations. • The aim has shifted toward social inclusion by community-based provision of treatment, housing, employment and leisure
• Mental health services are increasingly integrated into mainstream health and social care • Increased attention on safety and cost-effectiveness
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Which output really matters? Important objectives of any mental health system:
• Mental health
– psychological wellbeing
• Mortality • User satisfaction • Social inclusion • Equity in health (distribution) • Service user empowerment • Reduction of stigma 15.11.2013
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Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing 2. Shift from systems-based to person-centered care 3. Shift from hospital-based to community-based care 4. Recognition of complexity of mental health
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25 | © Mielenterveysseura
Complexity of mental health • Research indicates that mental health has strong socio-economic determinants • Adult mental health is greatly determined by childhood factors
• Consequently, mental health is determined by actions in many relevant sectors of the society. • Work life stress affects mental health of adults • Spatial and urban planning impacts mental health
• Education sector is crucial in promoting mental health 15.11.2013
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26 | © The Finnish Association for Mental Health
Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing 2. Shift from systems-based to person-centered care 3. Shift from hospital-based to community-based care 4. Recognition of complexity of mental health 5. Recognition of inequalities in mental health
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Time change in mortality due to cardiovascular diseases, men in Denmark
Schizophrenia
General population 15.11.2013
European mental health policy
Laursen & Nordentoft, Psych Res 2010
29 | © Mielenterveysseura
Paradigm shifts in European mental health policy
1. Shift of focus from disorders to wellbeing 2. Shift from systems-based to person-centered care 3. Shift from hospital-based to community-based care 4. Recognition of complexity of mental health 5. Recognition of inequalities in mental health 6. Recognition of the role of stigma 15.11.2013
European mental health policy
30 | © Mielenterveysseura
• Tackling stigma is the crucial component of any public mental health policy • Yet, the impact of stigma is neither widely discussed nor researched • Stereotypes can be changed by social contacts • Successful anti-stigma programmes build on social contact, public education and protest against discrimination
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Mental health care is now loaded with expectations for change…..and we will make it!
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REFINEMENT Project REFINEMENT (Financing systems’ effects on the quality of mental health care in Europe) analyses the effect of financing systems on mental health services. • Nine study areas across Europe, including areas in Catalonia and Finland • Analysis of service structure, financing of services, care pathways, and quality of care • The project aims to identify financing systems which promote a high quality in mental health care. www.refinementproject.eu 15.11.2013
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Percentage of people receiving disability pensions due to mental disorders
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International benchmarking supports local decisions Readmission rates after acute psychiatric hospitalization in the REFINEMENT countries (SMI=Severe Mental Illness)
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Source: Weibold, Katschnig et al. (unpubl.), 2013
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ESMS-R Classification of mental health services MENTAL HEALTH CARE
Salvador-Carulla et al, 2012 15.11.2013
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Case Finland: Distribution of staff resources* in adult mental health and addiction services (%)
Out-patient care Day care Residential care
*Staff resources were measured as full time equivalents (FTEs) 15.11.2013
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Case Finland: Mental health index • To evaluate geographical allocation of resources, local mental health needs must be considered • In Finland, a local mental index was created based on suicide mortality, use of antipsychotic medication, and disability pensions due to mental disorders. • National mental health index = 100 • Indexes for areas studied: – HUS 77.6 – Kymenlaakso 110.8 – South Carelia 104.7
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Case Finland: Are mental health staff resources allocated according to needs? Area
HUS
KYM
EK
Need (Mental Health Index)
77.6
110.8
104.7
Staff/1000 inh.
3.1
3.9
3.2
Needs adjusted staff
4.0
3.5
3.0
Psychiatrists/1000 inh
0.26
0.21
0.10
Needs adjusted psychiatrists
0.34
0.19
0.10
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Thank you!
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