1. Mental health promotion and prevention in Finland
Kristian Wahlbeck National Insitute for Health and Welfare (THL) Nordic School of Public Health (NHV)

2. Scope of the WHO Helsinki Declaration 2005
Promotion of mental well-being
Prevention of mental health problems
Care for people with mental disorders
Recovery and integration into society
Tackling stigma, discrimination and exclusion

3. EU Mental Health Pact & Expert Consensus Papers 2008

4. The spectrum for interventions of mental health problems and mental disorders

5. Mental health has strong socio-economic determinants
Mental health is associated with social inequality
Poverty
Unemployment
Low standard of living
Poor physical health
Being a migrant, homeless, ethnic minority person
Fryers T, Melzer D, Jenkins R. Social inequalities and the common mental disorders: a systematic review of the evidence. Social Psychiatry and Psychiatric Epidemiology 2003;38:229-37
Fryers et al. SPPE 2003
Bhugra Acta Psych Scand 2004

6. Risk factors: Findings from cohort studies
Child mental health
Childhood abuse and neglect
Prenatal factors
Birth complications
Postnatal factors
Parenthood characteristics
MINDFUL Project 2007

7. Children at risk: adult mental health is formed during early years
Plenty of evidence from longitudinal cohort studies shows trajectories from childhood risk factors to adult mental health

8. Mental health promotion is a part of the national health strategy
empowerment
social inclusion
The responsibility lies
with the local authorities
Folkhälsoprogrammet

9. Mental health promotion
implies the creation of individual, social and environmental conditions that are empowering and enable optimal health and development. Such initiatives involve individuals in the process of achieving positive mental health.

10. National mental health prevention and promotion programmes
National suicide prevention programme
National early interaction programme
Effective Family Programme 2001-
JOBS Programme
Time Out! Programme 2004 –
Programme to support socio-emotional skills of primary school children is being developed

11. National suicide prevention programme in Finland 1987-1996
Phase 1 ( ): Psychological autopsies
Phase 2 ( ): Programme development (”Suicides can be prevented”)
Phase 3 ( ): Implementation (Stakes)
Network of focal points in local municipalities (n=1152)
Approx local projects (training, crisis services, working across sectors)
Phase 4 ( ): Evaluation
Survey of staff in social and health care, other authorities and religious congregations (n=1700)

12. Suicides in Finland 1980-2003 Män Alla Kvinnor 60 50 40 30 20 1010 20 30 40 50 60
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Självmord /
All
Men
Women
National suicide prevention project
Självmord / pers.
Män
Alla
Kvinnor

13. Suicides in
Finland
France
Denmark

14. National programme for early interaction 1997-2002
Part of the European Early Promotion Project (EEPP; John Tsiantis, Hilton Davis)
Training programme (8 days + 2 y supervision) for staff in child health clinics
Evaluation in controlled study (staff, family and child outcomes at 6 w. and 24 months)
Staff capacity improved
Family satisfaction was higher
Effects on child development ?

15. Effective Family Programme 2001-
To prevent intergenerational morbidity
Parenting support in families with mental illness of parents
Evaluation in randomised trial
More information:

16. JOBS Programme Mental health promotion for unemployed people
Job-search training groups in job centres
Skills training
Peer support
Preparation for setbacks
Evaluated in randomised setting:
higher levels of reemployment and monthly income
lower levels of depressive symptoms and depressio
better role and emotional functionin
larger benefits for those who had initial low levels of job-search motivation and mastery
Mera information:

17. Time Out! Programme 2004- Time Out! Getting Life Back on Track
Case management to prevent social exclusion of young men
Target group: Young men exempted from military service
Implemented at call-ups for conscripts
Evaluation in randomised trial
More information:

18. Key messages Inter-sectoral collaboration is the key to success
Actions should be targeted at vulnerable groups for best cost-effectiveness
Actions should be carefully evaluated
Developing and implementing policies without evidence-based knowledge may be harmful and wasteful
In Finland, the challenges are to prevent alcohol-induced ill mental health and to promote social inclusion of all

19. The new National Mental Health and Substance Abuse Plan ”Mieli 2009”
Within mental health promotion the plan lists three priorities:
Restricting access to alcohol
Minimising generational transfer of mental health problems and substance abuse
Supporting social inclusion