Gaining health : analysis of policy development in European ...

school nurses. This approach was new in Europe and raised
considerable interest in WHO Member States (31).
During the 1980s, the key aims of mental health policy were
the closing of mental institutions and the creation of new
psychiatric wards connected to somatic hospitals, and the
development of outpatient mental health services together
with possibilities for sheltered housing. A special project
for the early diagnosis and treatment of new schizophrenic
patients raised international interest and has been a permanent
and successful development in their care (32).
Suicide figures in Finland have been among the highest
in Europe. In the mid-1980s, therefore, a special ten-year
project was initiated for the prevention of suicides. During
the first year of the project, the social, psychological,
somatic and mental background of each suicide was very
carefully analysed. Members of victims’ families and other
social networks were interviewed, their latest contacts with
the somatic, mental health and social services were investigated,
and their use of alcohol and drugs was examined
(33). Based on these results, a countrywide action plan
was developed. At the PHC level, the early diagnosis and
effective treatment of depression and better care of alcohol
problems were given priority. The results of the project
were evaluated by an international review group (34). Fifteen
years later, suicide figures were 30% lower than in the
mid-1980s.
As seen above, in the early 1990s, Finland suffered the
most severe economic recession in its history and savings
in all sectors were unavoidable. These cuts hit worst
those not capable of defending themselves, including the
mentally ill. The rapid reduction of mental institutions was
an easy way to make savings in the health budget. Instead
of their planned gradual closing over a period of about
20 years, 15 000 beds were reduced to less than half that
figure – 6000 – over 6 years. The effect of these misguided
savings has had a strong impact on the mental health of the
population, with the growing burden of mental illness being
the main increasing trend in compensations of social insurance
costs during the last 10–15 years. The mental health
services still feel the effects of these severe cuts.
To raise awareness at the European level, Finland chose
mental health as its main public health topic during its first
EU presidency. “There is no health without mental health”
was the main message. Mental health was also the main
topic of the World Health Assembly in 2001 and of The
world health report for that year (35). The WHO Regional
Office for Europe held the WHO European Ministerial
Conference on Mental Health in Helsinki in 2005. The Conference
adopted a political declaration and an action plan to
be followed until 2010, and a network of WHO collaborating
centres was created to monitor and evaluate implementation
of the action plan. In Finland, STAKES, KTL and the
Finnish Institute of Occupational Health together comprise
one such centre, with the primary task of developing mental
health promotion activities for different age groups.
During the last 25–30 years, policy for mental health in Finland
has seen considerable ups and downs. The structure of
mental health services has undergone almost total reorganization.
The stigma associated with mental health and
psychiatric disease, though still prevalent, is much milder.
The incidence of suicide is slowly decreasing. On the other
hand, the burden of mental health problems in younger age
groups is increasing and mental health constitutes a continuously
growing social burden.
As in other areas of NCD policy development in Finland,
recommendations for mental health policy mainly followed
careful research and analysis. In the event, however, certain
of these evidence-based policy recommendations were
overtaken by economic considerations. One of the main
future challenges for NCD policy will be in the mental
health field.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases