07.05.09 1 kristian wahlbeck national insitute for health and welfare (thl) nordic school of public...
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07.05.09 1
Kristian WahlbeckNational Insitute for Health and Welfare (THL)
Nordic School of Public Health (NHV)
Mental health promotion and prevention in Finland
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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
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EU Mental Health Pact & Expert Consensus Papers 2008
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The spectrum for interventions of mental health problems and mental disorders
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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 et al. SPPE 2003Bhugra Acta Psych Scand 2004
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Risk factors: Findings from cohort studies
– Child mental health– Childhood abuse and neglect– Prenatal factors– Birth complications– Postnatal factors– Parenthood characteristics
MINDFUL Project 2007
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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
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Mental health promotion is a part of the national health strategy
• empowerment• social inclusion
• The responsibility lies
with the local authorities
Folkhälsoprogrammet
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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.
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National mental health prevention and promotion programmes
• National suicide prevention programme 1987-1996• National early interaction programme 1997-2002• Effective Family Programme 2001-• JOBS Programme • Time Out! Programme 2004 –• Programme to support socio-emotional skills of
primary school children is being developed
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National suicide prevention programme in Finland 1987-1996
• Phase 1 (1987-1989): Psychological autopsies• Phase 2 (1989-1991): Programme development
(”Suicides can be prevented”)• Phase 3 (1992-1996): Implementation (Stakes)
• Network of focal points in local municipalities (n=1152)
• Approx. 2000 local projects (training, crisis services, working across sectors)
• Phase 4 (1995-1997): Evaluation• Survey of staff in social and health care, other
authorities and religious congregations (n=1700)
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Suicides in Finland 1980-2003
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All Men Women
National suicide prevention project
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Suicides1980-2005inFinlandFranceDenmark
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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 ?
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Effective Family Programme 2001-
• To prevent intergenerational morbidity• Parenting support in families with mental
illness of parents• Evaluation in randomised trial
More information: [email protected]
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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: [email protected]
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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: http://info.stakes.fi/aikalisa/EN/[email protected]
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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
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The new National Mental Health and Substance Abuse Plan
”Mieli 2009”
Within mental health promotion the plan lists three priorities:
1. Restricting access to alcohol2. Minimising generational transfer of mental health
problems and substance abuse3. Supporting social inclusion
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