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Mental health promotion and prevention in Finland

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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 10
10 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


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