Medical model on top

After a period of upheaval in Finnish mental health care policy,
it is now up to workers in the field to move towards more
collaborative methods to achieve results, writes Anna Metteri.

The number of beds for psychiatric patients in Finland has
halved in the past 10 years as the country has de-institutionalised
its services. But community care in mental health has not developed
to take up the slack – economic recession has resulted in
cost-cutting, while social and health care have been
decentralised.

The latest analyses show that the cuts in the community care
budgets have affected mainly people with mental health difficulties
or alcohol problems, those in need of income support and elderly
people who required care. Low-income families with children have
been most seriously affected. The lack of early intervention and
support has contributed to an increased need for services related
to child protection, youth concerns and mental health
problems.

At the same time, medical health has increased its share of the
budget in public institutions and services. The medical model has
also been strengthened within psychiatry. Accordingly, the use of
psychiatric medication increased dramatically in the 1990s, notably
among clients receiving social work services.

Where does this leave community care in mental health today?
Supported housing, social rehabilitation, employment activities and
other community services have been developed, but not adequately in
relation to the new needs. For example, the number of homeless
people with mental health problems in Finland seems to be
rising.

The mental health problems of children and young people have been
publicly discussed mainly in relation to psychiatric medicine –
describing the prevalence of symptoms among population groups and
service queues for psychiatric care. This orientation has led to
calls for more psychiatric services for youth and children rather
than an examination of the problems and context behind the
symptoms. The lack of a social model in mental health has caused
the neglect of preventive policies, early intervention and support
to vulnerable families seen daily by social workers.

The holistic approach to mental health care is mentioned in Finnish
law and in documents guiding our work. Several promising national
and local research and development projects have set out to enhance
early intervention and collaborative mental health care in the
community. Local networking, and interdisciplinary collaboration
and recognition of the experiences of clients and their families,
have proved effective. However, remnants of the old thinking, with
its institutional and medical bias, seem to persist. These shape
and constitute the dominant model in mental health care
today.

Social workers in local social agencies are only now beginning to
recognise their important role in mental health work. Mental health
problems are one of the main reasons for the use of child custody
and child protection services, and for income support.

Collaborative community care becomes possible only when different
actors see their role in our shared mandate, and when the
mystification of mental health problems stops. The power to act in
this process must be taken; it will not be given.

Anna Metteri is assistant professor at the department of
social policy and social work, University of Tampere.

Background

• Finland (Suomi) covers 337,030 sq km – almost one-and-a-half
  times the size of the UK – and has a population of nearly 5.2
  million.
• Ethnic groups: Finn 93 per cent, Swede 6 per cent, Sami 0.11
  per cent, Roma 0.12 per cent, Tatar 0.02 per cent.
• Religions: Evangelical Lutheran 89 per cent, Greek Orthodox 1
  per cent, none 9 per cent, others 1 per cent
• Languages: Finnish 93.4 per cent (official), Swedish 5.9 per
  cent (official), small Lapp- and Russian-speaking minorities.
• Tampere has a population of almost 200,000. For the delivery of
  social and health care services, the city is divided into three
  regional units, each with its own social services and health
  centres.