Peer-reviewed papers by Kristian Wahlbeck
International Archives of Occupational and Environmental Health, 2024
Objective:
To determine if and which types of organisational interventions conducted in small and... more Objective:
To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.
Methods:
Following PRISMA guidelines, we searched six scientifc databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.
Results:
We identifed 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifcations” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.
Conclusion:
Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.
Journal of Public Mental Health, 2023
Purpose
The purpose of this study is to systematically review how positive mental health literac... more Purpose
The purpose of this study is to systematically review how positive mental health literacy has been conceptualised and measured over the last 20 years. Positive mental health recognises the benefits of feeling good and functioning effectively. Developing clarity around conceptualisation and knowledge (or literacy) of what constitutes positive mental health is an area of continued development, and an important step in measuring the impact of mental health promotion.
Design/methodology/approach
A systematic review of literature was performed to investigate how positive mental health literacy has been conceptualised and measured over the last 20 years. Databases searched included EDS, Scopus, ERIC, PsycINFO, CINAHL and SocIndex with fulltext. Search terms relating to positive mental health were combined with proximity operators within four words denoting knowledge, competence or literacy.
Findings
A total of 464 records were assessed on title level, with six articles included for final review. The final studies included three measures assessing participants’ knowledge of positive mental health, some of which included more distal themes such as awareness of coping strategies and emotional awareness. One measure, the Mental Health Promoting Knowledge – 10, stood out as the most fitting measure of positive mental health literacy.
Research limitations/implications
Our review approaches an under reported area of study, highlighting an area in need for further development with a few limitations. When building the search strategy, care was taken to line it up with literacy around positive mental health and its synonyms. The word “mental health” without positive specification was omitted in the final search strategy, increasing the risk of it also omitting potential articles of interest.
Practical implications
Our findings therefore highlight a knowledge gap in relation to conceptualisations and measures of positive mental health literacy, unfolding an area for further development. A more harmonised understanding of what is meant by positive mental health is an important step towards clarifying the concept and facilitating future study of the topic. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Social implications
New ways of measuring positive mental health literacy can be a useful way to establish benefits of mental health promotion, taking a salutogenic approach to mental health.
Originality/value
These findings expose an apparent knowledge gap in relation to conceptualisations and measures of positive mental health literacy, highlighting an area in need for further development. Measures of positive mental health literacy could be an important indicator for mental health promotion.
PLOS One, 2022
Objectives: This systematic review assesses the scientific evidence regarding the effectiveness o... more Objectives: This systematic review assesses the scientific evidence regarding the effectiveness of organisational-level workplace mental health interventions on stress, burnout, non-clinical depressive and anxiety symptoms, and wellbeing in construction workers.
Methods: Eligibility criteria were randomized controlled trials(RCTs), clusterrandomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic SearchComplete, Psy-cInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO (CRD42020183640).
International Journal of Environmental Research and Public Health, 2022
Mental health is largely shaped by the daily environments in which people live their lives, with ... more Mental health is largely shaped by the daily environments in which people live their lives, with positive components of mental health emphasising the importance of feeling good and functioning effectively. Promoting mental health relies on broad-based actions over multiple sectors, which can be difficult to measure. Different types of Impact Assessment (IA) frameworks allow for a structured approach to evaluating policy actions on different levels. A systematic review was performed exploring existing IA frameworks relating to mental health and mental wellbeing and how they have been used. A total of 145 records were identified from the databases, from which 9 articles were included in the review, with a further 6 studies included via reference list and citation chaining. Five different mental-health-related IA frameworks were found to be implemented in a variety of settings, mostly in relation to evaluating community actions. A Narrative Synthesis summarised key themes from the 15 included articles. Findings highlight the need for participatory approaches in IA, which have the dual purpose of informing the IA evaluation and advocating for the need to include mental health in policy development. However, it is important to ensure that IA frameworks are user-friendly, designed to be used by laypeople in a variety of sectors and that IA frameworks are operational in terms of time and monetary resources.
International Journal of Environmental Research and Public Health, 2022
Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced ... more Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age.
Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables.
Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.
Journal of Community Psychology, 2022
The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital int... more The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital into an open site for mental health promotion. The current study uses qualitative methods to explore how the initiative may promote population mental health. The phenomenological study comprised of data from 7 focus group including 28 parti-cipants. Resulting data were thematically analysed to ar-ticulate how the initiative supports mental wellbeing indifferent ways. Mental health benefits were categorizedinto three themes; mental health value, civil values andcommon values which were comprised of nine subthemes;paradigm shift, social inclusion, personal meaning, re-generation, ambience, stigma, sustainability, democracyand environment. Mental health promotion emphasises theimpact of daily environments in which people live theirlives. Results from this study support the use of broadbased actions which promote different components ofmental wellbeing simultaneously. Psychiatric hospitals mayoffer historically meaningful sites for such actions.
Health Expectations, 2021
Background: Psychiatric rehospitalization is a complex phenomenon in need of more person-centred ... more Background: Psychiatric rehospitalization is a complex phenomenon in need of more person-centred approaches. The current paper aimed to explore how community-based actions and daily life influence mental health and rehospitalization.
Design, setting and participants: The qualitative study included focus group data from six European countries including 59 participants. Data were thematically ana-lysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health.
Results: Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (comple-menting services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning).
Discussion: Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal re-covery. By articulating the value of these facilitators, we highlight benefits of a per-son-centred and recovery-focused approach also within the context of psychiatric rehospitalization.
Conclusions: This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilita-tors, acknowledging the social determinants of mental health and personal recovery.
| 175CRESSWELL-SMITH ETaL.1 | BACKGROUNDThere is a growing interest in how the social, economic and physical environments may support mental health,1-5 with contemporary approaches placing increased focus on the social determinants and the importance providing opportunities for meaningful activities, reducing social exclusion and enhancing community connected-ness.6-9 A well-cited definition by the World Health Organisation (WHO) defines mental health as 'A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community',10 (p.1) underlining the importance of peoples’ everyday actions on men-tal health.Mental health can therefore be promoted both by health-care services and by community-based initiatives, which foster positive mental health, prevent mental disorders and should be included across all policy sectors.11-13 This approach is also endorsed by the WHO Optimal Mix of Services for Mental Health, which emphasizes the need for easily available and balanced mental health services,14while placing considerable emphasis on the value of community and self-care actions.15 Psychiatric rehospitalization is a complex phe-nomenon that has been reported to hamper the recovery process16and be unfavourable in terms of quality and cost of health care.17Psychiatric rehospitalization is a good example where comprehen-sive approaches may be beneficial.17–2 2 These approaches may also be incorporated prior to hospital discharge, for example ensuring access to meaningful activities, and engaging in signposting and planning for community life during the hospital stay.23-25 Such ap-proaches reflect a person-centred ethos where individuals' unique experiences are attended to in a holistic manner and highlight the need for organizing services, organizations, families and communi-ties accordingly.26,27Although a clear definition of person-centred approaches has not yet been formalized,28 it generally reflects health-care practices where the patients’ perspective and a focus on patient-reported out-comes are prioritized.29, 3 0 Person-centred approaches may include recovery-based thinking, which has its roots in service user–led contexts and has gained momentum also within mental health ser-vices.31 The recovery model redefines how we view mental health difficulties, nurturing empowerment and participation in society.32,33Personal recovery can be thought of as a highly subjective experi-ence around goals, relationships and skills that support a positive life with or without on-going mental health difficulties.34 Although not universally defined, the model acknowledges that mental health treatment may at times be necessary, but views it as one building block in the recovery process, which should also support 'everyday solutions to everyday problems'(Slade 2012).35,36The aim of the current paper was to explore how attention to community-based actions may support person-centred approaches in relation to psychiatric rehospitalization using qualitative data from the Comparative Effectiveness Research on Psychiatric Hospitalisation by Record Linkage of Large Administrative Data Sets (CEPHOS-LINK) project (www.cephos-link.org). Previous pa-pers from the project report on psychiatric rehospitalization using quantitative register-based methodology18 and explore meanings and experiences of the phenomenon qualitatively both in general terms24 and more specifically how it can be avoided.23 The current paper furthers this line of enquiry via a secondary analysis looking at how participants relate community-based actions and day-to-day activities to their mental health. By articulating what actions indi-viduals with experience of psychiatric rehospitalization themselves deem useful for their mental health, we not only illuminate these actions but also may promote the development of person-centred approaches in relation to psychiatric rehospitalization.2 | METHODSThe CEPHOS-LINK project studied psychiatric rehospitalization quantitatively and qualitatively in six different countries: Austria (At), Finland (Fin), Italy (It), Norway (Nor), Romania (Rom) and Slovenia (Sl). Ethical approval was sought from leading ethical committees in all participating countries, and informed consent was given by all participants who participated in the qualitative study. A focus group methodology was employed in order to gain insight into lived ex-perience of psychiatric rehospitalization. The reasoning behind this approach related to its suitability for generating insights into experi-ences, views and meanings through the process of shared discus-sion derived from both the individual and the groups.37 Furthermore, focus groups allow for exploring responses to questions not only in relation to the interview guide, but also in terms of digressions and Patient or public contribution: The current study included participants with ex-perience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study
Psychiatria Fennica, 2021
Mental health and substance abuse services (MHS) have gone through major changes throughout Weste... more Mental health and substance abuse services (MHS) have gone through major changes throughout Western countries. In searching for best practices, there is a need for benchmarking data on ways to allocate resources and organize services. In Finland, the closing of psychiatric hospitals during the last 50 years has partly led to transinstitutionalization to non-hospital residential services. We set out to study the provision of beds and personnel resources in non-hospital residential services in southern Finland, and whether the residential services' personnel resources and primary care orientation of services predict the total personnel costs of the MHS. We mapped the MHS with the European Service Mapping Schedule-Revised (ESMS-R). For the statistical analysis, we used the Spearman correlation and linear regression models. There were 333 non-hospital residential service beds per 100,000 adults and 119.5 full-time equivalent (FTE) personnel per 100,000 adults in the nonhospital residential services. The personnel resources in the hospital and non-hospital residential services were both significant predictors of total personnel costs. The association between non-hospital personnel and total personnel costs was not explained by sociodemographic indicators of the need for services. Of the personnel in the non-hospital residential services, 0.8% were physicians, 16.8% were nurses, 0.1% were psychologists, 0.6% were social workers and 82% were other professionals (mostly auxiliary nurses). Non-hospital residential services are a significant part of the MHS in Finland, and special attention should be paid to the coordination and the quality of care in these institutions.
Voluntary Sector Review, 2021
Civil society in general is widely recognised as having an important role in addressing the socia... more Civil society in general is widely recognised as having an important role in addressing the social determinants of health. Non-governmental organisations (NGOs) have a long history of mental health actions, ranging from mental health promotion and advocacy to volunteer work and service provision. An explicit focus on the social determinants of mental health is a more recent development. In this article we review relevant literature on NGO actions on key social determinants of mental health: family; friends and communities; education and skills; good work; money and resources; housing; and surroundings. Searching of relevant bibliographic databases was combined with searching for relevant grey literature to identify relevant evidence and practice on the work of NGOs in this field. We reflect on the inherent tensions involved in understanding the role of NGOs in taking action on the social determinants of mental health and the critical questions raised as a result. Our review highlights a lack of documented evidence of NGO actions, and underscores the significant untapped potential of civil society to contribute to the Mental Health in All Policies (MHiAP) agenda.
Aging & Mental Health, 2021
Objective: The aim of this study is to identify and appraise existing instruments to evaluate men... more Objective: The aim of this study is to identify and appraise existing instruments to evaluate mental well-being in old age.
Method: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell’Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL).
Conclusion: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.
![Research paper thumbnail of Itsemurhien ehkäisy ja itsemurhaa yrittäneen hoito [Treatment of suicidal patient and suicide prevention in health care]](https://attachments.academia-assets.com/105887754/thumbnails/1.jpg)
Duodecim, 2020
[In English below]
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveyde... more [In English below]
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveydenhuollossa on myös monitekijäistä kohdistuen prosessin eri vaiheisiin.
Itsemurhaa yrittäneet tulee somaattisen akuuttihoidon jälkeen arvioida psykiatrian erikoislääkärin tai psykiatriaan perehtyneen lääkärin johdolla. Itsemurhaa yrittänyt nuori kuuluu aina erikoissairaanhoidon arvioon.
Itsemurhaa yrittäneen kanssa on syytä käydä läpi koko itsemurhayritykseen johtanut tapahtumaketju. Itsemurha-ajatuksista kysyminen ei suurenna itsemurhan riskiä. Itsemurhaa yrittäneet kärsivät yleensä mielenterveyden häiriöistä ja päihdeongelmista.
Itsemurhayrityksen jälkeisen hoidon tulee olla aktiivista ja viiveetöntä. Sen intensiteetti perustuu huolelliseen tilannearvioon niin ajankohtaisesta itsetuhoisuudesta kuin akuuteista psykiatrisista ja psykososiaalisista tarpeista. Itsemurhaa yrittäneen psykiatrinen jatkohoito voidaan useimmiten toteuttaa psykiatrisessa avohoidossa. Psykiatrisen sairaalahoidon tarvetta arvioitaessa huomioidaan psykiatrisen häiriön vaikeusaste, erityisesti mahdollinen psykoottisuus, syvä toivottomuus tai tilan hallitsematon epävakaus, välitön itsemurhavaara ja mielenterveyslain mukaisen tahdosta riippumattoman hoidon tarve.
Itsetuhoisuuteen kohdennetut hoitointerventiot voivat merkittävästi pienentää itsemurhayrityksen uusimisen riskiä. Tutkittuja interventioita ovat kognitiivis-behavioraaliset itsetuhokäyttäytymisen ehkäisyyn suunnatut psykoterapiat, turvasuunnitelmainterventio, Linity/Assip-lyhytinterventiot ja dialektinen käyttäytymisterapia epävakaan persoonallisuuden yhteydessä.
Terveydenhuollossa on syytä kehittää itsemurhaa yrittäneiden arviointia ja lisätä tutkittujen interventioiden saatavuutta. Mielenterveyden häiriöt, sisältäen päihdehäiriöt, tulee hoitaa hyvin itsemurhayritysten ja itsemurhien ehkäisemiseksi.
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This guideline focuses on the assessment and treatment of suicidal patients and describes current knowledge on the prevention of suicides by health care interventions and in health care settings among youths, adults and the elderly. Comprehensive assessment and evidence -based interventions such as safety plan and CBT focused on suicidality are recommended. Easy accessible diverse evidence -based treatment of psychiatric disorders is essential, a majority of suicidal patients suffer from psychiatric disorders. Recommendations of pharmacological treatments with e.g. lithium, clozapine or ketamine relate to concurrent psychiatric disorders.
![Research paper thumbnail of Itsemurhaa yrittäneen psykiatrinen hoito -kysy, kuuntele ja hoida perussairaus [Psychiatric assessment of suicide attempters – ask, listen and ensure appropriate care]](https://attachments.academia-assets.com/66131955/thumbnails/1.jpg)
Lääkärilehti, Sep 18, 2020
• Suomi on kansainvälisesti verrattuna suurten itsemurhalukujen maa, vaikka viime vuosikymmeninä ... more • Suomi on kansainvälisesti verrattuna suurten itsemurhalukujen maa, vaikka viime vuosikymmeninä kuolemat ovat pääsääntöisesti vähentyneet.
• Itsetuhoinen käyttäytyminen liittyy useimmiten psykiatriseen sairauteen tai päihdeongelmiin.
• Itsemurhayrityksen jälkeen keskeisiä ovat strukturoitu psykiatrinen arvio, turvasuunnitelman tekeminen ja aktiivinen perussairauksien hoito.
• Lääkärin lakisääteiset velvoitteet ja läheisten tilanne tulee huomioida.
• Psykososiaalisia, muuhun hoitoon liitettäviä lyhyitä erillisinterventioita tutkitaan aktiivisesti
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This review focuses on the assessment and treatment of suicide attempters in line with the national evidence-based draft Current Care guideline on the assessment and treatment of suicidal patients. Internationally, Finland has been a country of high suicide rates, though during the last two decades the number of suicide deaths has greatly diminished. Among women the Finnish suicide rates are currently close to those of other Nordic countries and among men slightly higher. Suicide risk is elevated in some psychiatric disorders, especially major depression, bipolar disorder and schizophrenia. Thus, easily accessible evidence-based mental health services are part of effective suicide prevention in health care.
For suicide attempters, a psychiatric assessment is advised as soon as physical and cognitive recovery is sufficient to allow a comprehensive psychiatric examination. This includes careful assessment of psychiatric and substance-use disorders and their current treatment, risk and protective factors for a new suicide attempt, and current major life-events. In addition to other psychiatric treatment, use of a safety plan is recommended, and especially for adolescents it is important to include parents or close ones in preparation of the safety plan. Non-suicidal self-injury should be noted. Among the elderly, increasing limitations related to illnesses and ability to function, and loneliness need to be taken into account. Psychosocial interventions such as cognitive-behavioural therapy (CBT) focused on the suicide attempt are advised in addition to good clinical care of psychiatric disorders. Bereaved close ones and all those involved may need support after a suicide death. Psychosocial care and support is available through several providers including non-governmental organizations, and for some CBT-based psychosocial group interventions may be beneficial.
Duodecim, 2020
(English below)
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisill... more (English below)
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisillä esiintyviä mielenterveyden häiriöitä, jotka tulee tunnistaa kaikkialla terveydenhuollossa.
– Laajamittaisen järkyttävän tilanteen jälkeen niitä voi esiintyä runsaasti. Psykososiaalisen tuen ja palvelujen järjestämisellä ja aktiivisella seurannalla on merkitystä heti poikkeuksellisen järkyttävän tapahtuman jälkeen.
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The updated Current Care Guidelines for PTSD includes assessment and treatment of acute stress reaction (ASR), acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in all age groups. Psychosocial support and active monitoring are recommended after a potentially traumatic event. If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is effective, but evidence on other pharmacological options and on treatment combinations is limited. Specific groups, such as first responders, military and peacekeeping personnel may require tailored interventions.
Journal of Happiness Studies, 2020
The oldest-old population is increasing in Europe, and greater focus is placed on promoting menta... more The oldest-old population is increasing in Europe, and greater focus is placed on promoting mental well-being (MWB) in this population. The European Welfare Models and Mental Wellbeing in Final Years of Life project aims to develop a better understanding of how best to promote positive MWB in the oldest-old population. Using a resources approach, the present study aimed to provide empirical evidence about the structure of MWB in the 80 + year age group and to compare this with the structure of MWB in the old (65–79 years) and adult (18–64 years) population. Twenty-eight items reflecting a focus on positive aspects of MWB were selected from the European Social Survey data (24 countries). After application of an exploratory approach using Exploratory Structural Equation Modelling, five- and six-factor model solutions were found to be statistically appropriate, and the results are consistent with the most widely studied dimensions of MWB. Despite specific differences in the factor models and item loadings, evaluation of formal invariance showed that dimensions built in the same way are comparable across age groups. Although explorative and not conclusive, the results of this study contribute insights into the multidimensional structure of MWB in the oldest-old population and provide a starting point for further research on promoting MWB in the later stages of life.
Social Psychiatry and Psychiatric Epidemiology, 2019
Purpose The aims of our study are: to explore rehospitalization in mental health services across ... more Purpose The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. Methods The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single-and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. Results The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. Conclusions Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.
Health Policy, Jul 2019
Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality me... more Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperabil-ity of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30-and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in crosscountry comparisons.
![Research paper thumbnail of Potilaan paluu psykiatriseen sairaalahoitoon. Alueellinen esiintyvyys ja sen yhteys avohoitoon. [Regional psychiatric re-hospitalisation rates and their association with outpatient services]](https://attachments.academia-assets.com/58330530/thumbnails/1.jpg)
Suomen Lääkärilehti [Finnish Medical Journal], Jan 2019
[ENGLISH ABSTRACT BELOW]
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta j... more [ENGLISH ABSTRACT BELOW]
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta ja hoitojärjestelmästä. Selvitimme sairaalaan palaamisen esiintyvyyttä ja yhteyttä paluuta edeltävään avohoitoon sairaanhoitopiireittäin.
Menetelmät
Rekisteritutkimusaineisto kattaa 16 814 potilasta (18–97 v), jotka olivat psykiatrisista syistä osastohoidossa v. 2012. Heidän perusterveydenhuollon ja erikoissairaanhoidon käyttöään seurattiin 12 kk:n ajan uloskirjauksesta.
Tulokset
Potilaista 40 % palasi psykiatriseen sairaalahoitoon. Sairaanhoitopiirien erot olivat suuret (28–53 %). Terveydenhuollon avohoitokäynti viikon kuluessa uloskirjauksesta oli 51 %:lla potilaista (34–69 %). 8 %:lla ei ollut avohoitokäyntejä sairaalajakson jälkeen, ja heillä riski palata sairaalahoitoon oli suurin.
Päätelmät
Alueellinen vaihtelu paluussa sairaalaan voi selittyä osin hoidon järjestämisestä ja toteutumisesta uloskirjauksen jälkeen. Jo yksi avohoitokäynti liittyi merkitsevästi pienempään paluuriskiin. Sairaalaan palaavien osuus ja avohoito uloskirjauksen jälkeen kuvaavat palvelujärjestelmän laatua.
ENGLISH ABSTRACT
Background. Psychiatric re-hospitalisation is dependent on patient level factors as well as health system level factors. Low re-hospitalisation rates are often considered a positive quality indicator in terms of mental health services. This study sets out to investigate psychiatric re-hospitalisation and its predictors on hospital district level in Finland.
Methods. The register-based study consisted of nationwide data on 16,814 adult patients (18–97 years of age) hospitalised with a psychiatric diagnosis (ICD-10 categories F2–F6) for a minimum period of 24 hours in the year 2012. Health service use was followed for 12 months, starting from date of discharge. Data were obtained from the Care Register for Health Care (Hilmo) and the Register of Primary Health Care Visits (AvoHilmo). Specialised and primary care outpatient contacts were examined. Statistical analysis was performed as frequency analysis and logistic regression with re-hospitalisation as the dependent variable.
Results. A total of 40% of patients were re-hospitalised into psychiatric inpatient care within a year (re-hospitalisation rate varying between hospital districts from 28–53%). Altogether 51% of patients received an outpatient appointment within one week from hospital discharge, while 8% received no outpatient contact at all during the 12-month follow-up. Typically, those who received outpatient care had 2.3 visits per month. The rate of psychiatric re-hospitalisation was highest for those who received no outpatient contact at all.
Conclusions Regional differences in psychiatric re-hospitalisation rates can to some extent be explained by health service organisation. Health services should direct more attention to the early weeks following hospital discharge. Even one contact with outpatient services resulted in a decreased risk of re-hospitalisation. Low levels of unplanned psychiatric re-hospitalisation rates, together with a seamless transition to outpatient services following discharge are both promising health service quality indicators. These indicators could benefit from regular regional follow-up.
European Neuropsychopharmacology, 2019
As part of the Roamer project, we sought to have a picture of the available mental health researc... more As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis ®, On- Course ®and Meril® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced rec- ommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommenda- tions. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.
Annual Review of Public Health, 2019
Poor mental health has profound economic consequences. Given the burden of poor mental health, th... more Poor mental health has profound economic consequences. Given the burden of poor mental health, the economic case for preventing mental illness and promoting better mental health may be very strong, but too often prevention attracts little attention and few resources. This article describes the potential role that can be played by economic evidence alongside experimental trials and observational studies, or through modeling, to substantiate the need for increased investment in prevention. It illustrates areas of action across the life course where there is already a good economic case. It also suggests some further areas of substantive public health concern, with promising effectiveness evidence, that may benefit from economic analysis. Financial and economic barriers to implementation are then presented, and strategies to address the barriers and increase investment in the prevention of mental illness are suggested.
Epidemiology and Psychiatric Sciences, 2018
Aims. Although many mental health care systems provide care interventions that are not related to... more Aims. Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. ‘Core health care’ refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. ‘Other care’ is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, ‘other care’ does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify ‘core health’ and ‘other care’ services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services.
Methods. The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or ‘Main Types of Care’ (MTC) as the standard for international comparison, following the DESDE-LTC system.
Results. In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as ‘other care’, significant variation was found in the typology and characteristics of these services across the eight study areas.
Conclusions. The functional distinction between core health and other care overcomes the traditional division between ‘health’ and ‘social’ sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
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Peer-reviewed papers by Kristian Wahlbeck
To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.
Methods:
Following PRISMA guidelines, we searched six scientifc databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.
Results:
We identifed 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifcations” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.
Conclusion:
Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.
The purpose of this study is to systematically review how positive mental health literacy has been conceptualised and measured over the last 20 years. Positive mental health recognises the benefits of feeling good and functioning effectively. Developing clarity around conceptualisation and knowledge (or literacy) of what constitutes positive mental health is an area of continued development, and an important step in measuring the impact of mental health promotion.
Design/methodology/approach
A systematic review of literature was performed to investigate how positive mental health literacy has been conceptualised and measured over the last 20 years. Databases searched included EDS, Scopus, ERIC, PsycINFO, CINAHL and SocIndex with fulltext. Search terms relating to positive mental health were combined with proximity operators within four words denoting knowledge, competence or literacy.
Findings
A total of 464 records were assessed on title level, with six articles included for final review. The final studies included three measures assessing participants’ knowledge of positive mental health, some of which included more distal themes such as awareness of coping strategies and emotional awareness. One measure, the Mental Health Promoting Knowledge – 10, stood out as the most fitting measure of positive mental health literacy.
Research limitations/implications
Our review approaches an under reported area of study, highlighting an area in need for further development with a few limitations. When building the search strategy, care was taken to line it up with literacy around positive mental health and its synonyms. The word “mental health” without positive specification was omitted in the final search strategy, increasing the risk of it also omitting potential articles of interest.
Practical implications
Our findings therefore highlight a knowledge gap in relation to conceptualisations and measures of positive mental health literacy, unfolding an area for further development. A more harmonised understanding of what is meant by positive mental health is an important step towards clarifying the concept and facilitating future study of the topic. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Social implications
New ways of measuring positive mental health literacy can be a useful way to establish benefits of mental health promotion, taking a salutogenic approach to mental health.
Originality/value
These findings expose an apparent knowledge gap in relation to conceptualisations and measures of positive mental health literacy, highlighting an area in need for further development. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Methods: Eligibility criteria were randomized controlled trials(RCTs), clusterrandomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic SearchComplete, Psy-cInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO (CRD42020183640).
Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables.
Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.
Design, setting and participants: The qualitative study included focus group data from six European countries including 59 participants. Data were thematically ana-lysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health.
Results: Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (comple-menting services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning).
Discussion: Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal re-covery. By articulating the value of these facilitators, we highlight benefits of a per-son-centred and recovery-focused approach also within the context of psychiatric rehospitalization.
Conclusions: This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilita-tors, acknowledging the social determinants of mental health and personal recovery.
| 175CRESSWELL-SMITH ETaL.1 | BACKGROUNDThere is a growing interest in how the social, economic and physical environments may support mental health,1-5 with contemporary approaches placing increased focus on the social determinants and the importance providing opportunities for meaningful activities, reducing social exclusion and enhancing community connected-ness.6-9 A well-cited definition by the World Health Organisation (WHO) defines mental health as 'A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community',10 (p.1) underlining the importance of peoples’ everyday actions on men-tal health.Mental health can therefore be promoted both by health-care services and by community-based initiatives, which foster positive mental health, prevent mental disorders and should be included across all policy sectors.11-13 This approach is also endorsed by the WHO Optimal Mix of Services for Mental Health, which emphasizes the need for easily available and balanced mental health services,14while placing considerable emphasis on the value of community and self-care actions.15 Psychiatric rehospitalization is a complex phe-nomenon that has been reported to hamper the recovery process16and be unfavourable in terms of quality and cost of health care.17Psychiatric rehospitalization is a good example where comprehen-sive approaches may be beneficial.17–2 2 These approaches may also be incorporated prior to hospital discharge, for example ensuring access to meaningful activities, and engaging in signposting and planning for community life during the hospital stay.23-25 Such ap-proaches reflect a person-centred ethos where individuals' unique experiences are attended to in a holistic manner and highlight the need for organizing services, organizations, families and communi-ties accordingly.26,27Although a clear definition of person-centred approaches has not yet been formalized,28 it generally reflects health-care practices where the patients’ perspective and a focus on patient-reported out-comes are prioritized.29, 3 0 Person-centred approaches may include recovery-based thinking, which has its roots in service user–led contexts and has gained momentum also within mental health ser-vices.31 The recovery model redefines how we view mental health difficulties, nurturing empowerment and participation in society.32,33Personal recovery can be thought of as a highly subjective experi-ence around goals, relationships and skills that support a positive life with or without on-going mental health difficulties.34 Although not universally defined, the model acknowledges that mental health treatment may at times be necessary, but views it as one building block in the recovery process, which should also support 'everyday solutions to everyday problems'(Slade 2012).35,36The aim of the current paper was to explore how attention to community-based actions may support person-centred approaches in relation to psychiatric rehospitalization using qualitative data from the Comparative Effectiveness Research on Psychiatric Hospitalisation by Record Linkage of Large Administrative Data Sets (CEPHOS-LINK) project (www.cephos-link.org). Previous pa-pers from the project report on psychiatric rehospitalization using quantitative register-based methodology18 and explore meanings and experiences of the phenomenon qualitatively both in general terms24 and more specifically how it can be avoided.23 The current paper furthers this line of enquiry via a secondary analysis looking at how participants relate community-based actions and day-to-day activities to their mental health. By articulating what actions indi-viduals with experience of psychiatric rehospitalization themselves deem useful for their mental health, we not only illuminate these actions but also may promote the development of person-centred approaches in relation to psychiatric rehospitalization.2 | METHODSThe CEPHOS-LINK project studied psychiatric rehospitalization quantitatively and qualitatively in six different countries: Austria (At), Finland (Fin), Italy (It), Norway (Nor), Romania (Rom) and Slovenia (Sl). Ethical approval was sought from leading ethical committees in all participating countries, and informed consent was given by all participants who participated in the qualitative study. A focus group methodology was employed in order to gain insight into lived ex-perience of psychiatric rehospitalization. The reasoning behind this approach related to its suitability for generating insights into experi-ences, views and meanings through the process of shared discus-sion derived from both the individual and the groups.37 Furthermore, focus groups allow for exploring responses to questions not only in relation to the interview guide, but also in terms of digressions and Patient or public contribution: The current study included participants with ex-perience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study
Method: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell’Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL).
Conclusion: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveydenhuollossa on myös monitekijäistä kohdistuen prosessin eri vaiheisiin.
Itsemurhaa yrittäneet tulee somaattisen akuuttihoidon jälkeen arvioida psykiatrian erikoislääkärin tai psykiatriaan perehtyneen lääkärin johdolla. Itsemurhaa yrittänyt nuori kuuluu aina erikoissairaanhoidon arvioon.
Itsemurhaa yrittäneen kanssa on syytä käydä läpi koko itsemurhayritykseen johtanut tapahtumaketju. Itsemurha-ajatuksista kysyminen ei suurenna itsemurhan riskiä. Itsemurhaa yrittäneet kärsivät yleensä mielenterveyden häiriöistä ja päihdeongelmista.
Itsemurhayrityksen jälkeisen hoidon tulee olla aktiivista ja viiveetöntä. Sen intensiteetti perustuu huolelliseen tilannearvioon niin ajankohtaisesta itsetuhoisuudesta kuin akuuteista psykiatrisista ja psykososiaalisista tarpeista. Itsemurhaa yrittäneen psykiatrinen jatkohoito voidaan useimmiten toteuttaa psykiatrisessa avohoidossa. Psykiatrisen sairaalahoidon tarvetta arvioitaessa huomioidaan psykiatrisen häiriön vaikeusaste, erityisesti mahdollinen psykoottisuus, syvä toivottomuus tai tilan hallitsematon epävakaus, välitön itsemurhavaara ja mielenterveyslain mukaisen tahdosta riippumattoman hoidon tarve.
Itsetuhoisuuteen kohdennetut hoitointerventiot voivat merkittävästi pienentää itsemurhayrityksen uusimisen riskiä. Tutkittuja interventioita ovat kognitiivis-behavioraaliset itsetuhokäyttäytymisen ehkäisyyn suunnatut psykoterapiat, turvasuunnitelmainterventio, Linity/Assip-lyhytinterventiot ja dialektinen käyttäytymisterapia epävakaan persoonallisuuden yhteydessä.
Terveydenhuollossa on syytä kehittää itsemurhaa yrittäneiden arviointia ja lisätä tutkittujen interventioiden saatavuutta. Mielenterveyden häiriöt, sisältäen päihdehäiriöt, tulee hoitaa hyvin itsemurhayritysten ja itsemurhien ehkäisemiseksi.
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This guideline focuses on the assessment and treatment of suicidal patients and describes current knowledge on the prevention of suicides by health care interventions and in health care settings among youths, adults and the elderly. Comprehensive assessment and evidence -based interventions such as safety plan and CBT focused on suicidality are recommended. Easy accessible diverse evidence -based treatment of psychiatric disorders is essential, a majority of suicidal patients suffer from psychiatric disorders. Recommendations of pharmacological treatments with e.g. lithium, clozapine or ketamine relate to concurrent psychiatric disorders.
• Itsetuhoinen käyttäytyminen liittyy useimmiten psykiatriseen sairauteen tai päihdeongelmiin.
• Itsemurhayrityksen jälkeen keskeisiä ovat strukturoitu psykiatrinen arvio, turvasuunnitelman tekeminen ja aktiivinen perussairauksien hoito.
• Lääkärin lakisääteiset velvoitteet ja läheisten tilanne tulee huomioida.
• Psykososiaalisia, muuhun hoitoon liitettäviä lyhyitä erillisinterventioita tutkitaan aktiivisesti
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This review focuses on the assessment and treatment of suicide attempters in line with the national evidence-based draft Current Care guideline on the assessment and treatment of suicidal patients. Internationally, Finland has been a country of high suicide rates, though during the last two decades the number of suicide deaths has greatly diminished. Among women the Finnish suicide rates are currently close to those of other Nordic countries and among men slightly higher. Suicide risk is elevated in some psychiatric disorders, especially major depression, bipolar disorder and schizophrenia. Thus, easily accessible evidence-based mental health services are part of effective suicide prevention in health care.
For suicide attempters, a psychiatric assessment is advised as soon as physical and cognitive recovery is sufficient to allow a comprehensive psychiatric examination. This includes careful assessment of psychiatric and substance-use disorders and their current treatment, risk and protective factors for a new suicide attempt, and current major life-events. In addition to other psychiatric treatment, use of a safety plan is recommended, and especially for adolescents it is important to include parents or close ones in preparation of the safety plan. Non-suicidal self-injury should be noted. Among the elderly, increasing limitations related to illnesses and ability to function, and loneliness need to be taken into account. Psychosocial interventions such as cognitive-behavioural therapy (CBT) focused on the suicide attempt are advised in addition to good clinical care of psychiatric disorders. Bereaved close ones and all those involved may need support after a suicide death. Psychosocial care and support is available through several providers including non-governmental organizations, and for some CBT-based psychosocial group interventions may be beneficial.
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisillä esiintyviä mielenterveyden häiriöitä, jotka tulee tunnistaa kaikkialla terveydenhuollossa.
– Laajamittaisen järkyttävän tilanteen jälkeen niitä voi esiintyä runsaasti. Psykososiaalisen tuen ja palvelujen järjestämisellä ja aktiivisella seurannalla on merkitystä heti poikkeuksellisen järkyttävän tapahtuman jälkeen.
----------------------
The updated Current Care Guidelines for PTSD includes assessment and treatment of acute stress reaction (ASR), acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in all age groups. Psychosocial support and active monitoring are recommended after a potentially traumatic event. If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is effective, but evidence on other pharmacological options and on treatment combinations is limited. Specific groups, such as first responders, military and peacekeeping personnel may require tailored interventions.
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta ja hoitojärjestelmästä. Selvitimme sairaalaan palaamisen esiintyvyyttä ja yhteyttä paluuta edeltävään avohoitoon sairaanhoitopiireittäin.
Menetelmät
Rekisteritutkimusaineisto kattaa 16 814 potilasta (18–97 v), jotka olivat psykiatrisista syistä osastohoidossa v. 2012. Heidän perusterveydenhuollon ja erikoissairaanhoidon käyttöään seurattiin 12 kk:n ajan uloskirjauksesta.
Tulokset
Potilaista 40 % palasi psykiatriseen sairaalahoitoon. Sairaanhoitopiirien erot olivat suuret (28–53 %). Terveydenhuollon avohoitokäynti viikon kuluessa uloskirjauksesta oli 51 %:lla potilaista (34–69 %). 8 %:lla ei ollut avohoitokäyntejä sairaalajakson jälkeen, ja heillä riski palata sairaalahoitoon oli suurin.
Päätelmät
Alueellinen vaihtelu paluussa sairaalaan voi selittyä osin hoidon järjestämisestä ja toteutumisesta uloskirjauksen jälkeen. Jo yksi avohoitokäynti liittyi merkitsevästi pienempään paluuriskiin. Sairaalaan palaavien osuus ja avohoito uloskirjauksen jälkeen kuvaavat palvelujärjestelmän laatua.
ENGLISH ABSTRACT
Background. Psychiatric re-hospitalisation is dependent on patient level factors as well as health system level factors. Low re-hospitalisation rates are often considered a positive quality indicator in terms of mental health services. This study sets out to investigate psychiatric re-hospitalisation and its predictors on hospital district level in Finland.
Methods. The register-based study consisted of nationwide data on 16,814 adult patients (18–97 years of age) hospitalised with a psychiatric diagnosis (ICD-10 categories F2–F6) for a minimum period of 24 hours in the year 2012. Health service use was followed for 12 months, starting from date of discharge. Data were obtained from the Care Register for Health Care (Hilmo) and the Register of Primary Health Care Visits (AvoHilmo). Specialised and primary care outpatient contacts were examined. Statistical analysis was performed as frequency analysis and logistic regression with re-hospitalisation as the dependent variable.
Results. A total of 40% of patients were re-hospitalised into psychiatric inpatient care within a year (re-hospitalisation rate varying between hospital districts from 28–53%). Altogether 51% of patients received an outpatient appointment within one week from hospital discharge, while 8% received no outpatient contact at all during the 12-month follow-up. Typically, those who received outpatient care had 2.3 visits per month. The rate of psychiatric re-hospitalisation was highest for those who received no outpatient contact at all.
Conclusions Regional differences in psychiatric re-hospitalisation rates can to some extent be explained by health service organisation. Health services should direct more attention to the early weeks following hospital discharge. Even one contact with outpatient services resulted in a decreased risk of re-hospitalisation. Low levels of unplanned psychiatric re-hospitalisation rates, together with a seamless transition to outpatient services following discharge are both promising health service quality indicators. These indicators could benefit from regular regional follow-up.
Methods. The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or ‘Main Types of Care’ (MTC) as the standard for international comparison, following the DESDE-LTC system.
Results. In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as ‘other care’, significant variation was found in the typology and characteristics of these services across the eight study areas.
Conclusions. The functional distinction between core health and other care overcomes the traditional division between ‘health’ and ‘social’ sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.
Methods:
Following PRISMA guidelines, we searched six scientifc databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.
Results:
We identifed 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifcations” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.
Conclusion:
Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.
The purpose of this study is to systematically review how positive mental health literacy has been conceptualised and measured over the last 20 years. Positive mental health recognises the benefits of feeling good and functioning effectively. Developing clarity around conceptualisation and knowledge (or literacy) of what constitutes positive mental health is an area of continued development, and an important step in measuring the impact of mental health promotion.
Design/methodology/approach
A systematic review of literature was performed to investigate how positive mental health literacy has been conceptualised and measured over the last 20 years. Databases searched included EDS, Scopus, ERIC, PsycINFO, CINAHL and SocIndex with fulltext. Search terms relating to positive mental health were combined with proximity operators within four words denoting knowledge, competence or literacy.
Findings
A total of 464 records were assessed on title level, with six articles included for final review. The final studies included three measures assessing participants’ knowledge of positive mental health, some of which included more distal themes such as awareness of coping strategies and emotional awareness. One measure, the Mental Health Promoting Knowledge – 10, stood out as the most fitting measure of positive mental health literacy.
Research limitations/implications
Our review approaches an under reported area of study, highlighting an area in need for further development with a few limitations. When building the search strategy, care was taken to line it up with literacy around positive mental health and its synonyms. The word “mental health” without positive specification was omitted in the final search strategy, increasing the risk of it also omitting potential articles of interest.
Practical implications
Our findings therefore highlight a knowledge gap in relation to conceptualisations and measures of positive mental health literacy, unfolding an area for further development. A more harmonised understanding of what is meant by positive mental health is an important step towards clarifying the concept and facilitating future study of the topic. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Social implications
New ways of measuring positive mental health literacy can be a useful way to establish benefits of mental health promotion, taking a salutogenic approach to mental health.
Originality/value
These findings expose an apparent knowledge gap in relation to conceptualisations and measures of positive mental health literacy, highlighting an area in need for further development. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Methods: Eligibility criteria were randomized controlled trials(RCTs), clusterrandomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic SearchComplete, Psy-cInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO (CRD42020183640).
Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables.
Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.
Design, setting and participants: The qualitative study included focus group data from six European countries including 59 participants. Data were thematically ana-lysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health.
Results: Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (comple-menting services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning).
Discussion: Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal re-covery. By articulating the value of these facilitators, we highlight benefits of a per-son-centred and recovery-focused approach also within the context of psychiatric rehospitalization.
Conclusions: This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilita-tors, acknowledging the social determinants of mental health and personal recovery.
| 175CRESSWELL-SMITH ETaL.1 | BACKGROUNDThere is a growing interest in how the social, economic and physical environments may support mental health,1-5 with contemporary approaches placing increased focus on the social determinants and the importance providing opportunities for meaningful activities, reducing social exclusion and enhancing community connected-ness.6-9 A well-cited definition by the World Health Organisation (WHO) defines mental health as 'A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community',10 (p.1) underlining the importance of peoples’ everyday actions on men-tal health.Mental health can therefore be promoted both by health-care services and by community-based initiatives, which foster positive mental health, prevent mental disorders and should be included across all policy sectors.11-13 This approach is also endorsed by the WHO Optimal Mix of Services for Mental Health, which emphasizes the need for easily available and balanced mental health services,14while placing considerable emphasis on the value of community and self-care actions.15 Psychiatric rehospitalization is a complex phe-nomenon that has been reported to hamper the recovery process16and be unfavourable in terms of quality and cost of health care.17Psychiatric rehospitalization is a good example where comprehen-sive approaches may be beneficial.17–2 2 These approaches may also be incorporated prior to hospital discharge, for example ensuring access to meaningful activities, and engaging in signposting and planning for community life during the hospital stay.23-25 Such ap-proaches reflect a person-centred ethos where individuals' unique experiences are attended to in a holistic manner and highlight the need for organizing services, organizations, families and communi-ties accordingly.26,27Although a clear definition of person-centred approaches has not yet been formalized,28 it generally reflects health-care practices where the patients’ perspective and a focus on patient-reported out-comes are prioritized.29, 3 0 Person-centred approaches may include recovery-based thinking, which has its roots in service user–led contexts and has gained momentum also within mental health ser-vices.31 The recovery model redefines how we view mental health difficulties, nurturing empowerment and participation in society.32,33Personal recovery can be thought of as a highly subjective experi-ence around goals, relationships and skills that support a positive life with or without on-going mental health difficulties.34 Although not universally defined, the model acknowledges that mental health treatment may at times be necessary, but views it as one building block in the recovery process, which should also support 'everyday solutions to everyday problems'(Slade 2012).35,36The aim of the current paper was to explore how attention to community-based actions may support person-centred approaches in relation to psychiatric rehospitalization using qualitative data from the Comparative Effectiveness Research on Psychiatric Hospitalisation by Record Linkage of Large Administrative Data Sets (CEPHOS-LINK) project (www.cephos-link.org). Previous pa-pers from the project report on psychiatric rehospitalization using quantitative register-based methodology18 and explore meanings and experiences of the phenomenon qualitatively both in general terms24 and more specifically how it can be avoided.23 The current paper furthers this line of enquiry via a secondary analysis looking at how participants relate community-based actions and day-to-day activities to their mental health. By articulating what actions indi-viduals with experience of psychiatric rehospitalization themselves deem useful for their mental health, we not only illuminate these actions but also may promote the development of person-centred approaches in relation to psychiatric rehospitalization.2 | METHODSThe CEPHOS-LINK project studied psychiatric rehospitalization quantitatively and qualitatively in six different countries: Austria (At), Finland (Fin), Italy (It), Norway (Nor), Romania (Rom) and Slovenia (Sl). Ethical approval was sought from leading ethical committees in all participating countries, and informed consent was given by all participants who participated in the qualitative study. A focus group methodology was employed in order to gain insight into lived ex-perience of psychiatric rehospitalization. The reasoning behind this approach related to its suitability for generating insights into experi-ences, views and meanings through the process of shared discus-sion derived from both the individual and the groups.37 Furthermore, focus groups allow for exploring responses to questions not only in relation to the interview guide, but also in terms of digressions and Patient or public contribution: The current study included participants with ex-perience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study
Method: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell’Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL).
Conclusion: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveydenhuollossa on myös monitekijäistä kohdistuen prosessin eri vaiheisiin.
Itsemurhaa yrittäneet tulee somaattisen akuuttihoidon jälkeen arvioida psykiatrian erikoislääkärin tai psykiatriaan perehtyneen lääkärin johdolla. Itsemurhaa yrittänyt nuori kuuluu aina erikoissairaanhoidon arvioon.
Itsemurhaa yrittäneen kanssa on syytä käydä läpi koko itsemurhayritykseen johtanut tapahtumaketju. Itsemurha-ajatuksista kysyminen ei suurenna itsemurhan riskiä. Itsemurhaa yrittäneet kärsivät yleensä mielenterveyden häiriöistä ja päihdeongelmista.
Itsemurhayrityksen jälkeisen hoidon tulee olla aktiivista ja viiveetöntä. Sen intensiteetti perustuu huolelliseen tilannearvioon niin ajankohtaisesta itsetuhoisuudesta kuin akuuteista psykiatrisista ja psykososiaalisista tarpeista. Itsemurhaa yrittäneen psykiatrinen jatkohoito voidaan useimmiten toteuttaa psykiatrisessa avohoidossa. Psykiatrisen sairaalahoidon tarvetta arvioitaessa huomioidaan psykiatrisen häiriön vaikeusaste, erityisesti mahdollinen psykoottisuus, syvä toivottomuus tai tilan hallitsematon epävakaus, välitön itsemurhavaara ja mielenterveyslain mukaisen tahdosta riippumattoman hoidon tarve.
Itsetuhoisuuteen kohdennetut hoitointerventiot voivat merkittävästi pienentää itsemurhayrityksen uusimisen riskiä. Tutkittuja interventioita ovat kognitiivis-behavioraaliset itsetuhokäyttäytymisen ehkäisyyn suunnatut psykoterapiat, turvasuunnitelmainterventio, Linity/Assip-lyhytinterventiot ja dialektinen käyttäytymisterapia epävakaan persoonallisuuden yhteydessä.
Terveydenhuollossa on syytä kehittää itsemurhaa yrittäneiden arviointia ja lisätä tutkittujen interventioiden saatavuutta. Mielenterveyden häiriöt, sisältäen päihdehäiriöt, tulee hoitaa hyvin itsemurhayritysten ja itsemurhien ehkäisemiseksi.
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This guideline focuses on the assessment and treatment of suicidal patients and describes current knowledge on the prevention of suicides by health care interventions and in health care settings among youths, adults and the elderly. Comprehensive assessment and evidence -based interventions such as safety plan and CBT focused on suicidality are recommended. Easy accessible diverse evidence -based treatment of psychiatric disorders is essential, a majority of suicidal patients suffer from psychiatric disorders. Recommendations of pharmacological treatments with e.g. lithium, clozapine or ketamine relate to concurrent psychiatric disorders.
• Itsetuhoinen käyttäytyminen liittyy useimmiten psykiatriseen sairauteen tai päihdeongelmiin.
• Itsemurhayrityksen jälkeen keskeisiä ovat strukturoitu psykiatrinen arvio, turvasuunnitelman tekeminen ja aktiivinen perussairauksien hoito.
• Lääkärin lakisääteiset velvoitteet ja läheisten tilanne tulee huomioida.
• Psykososiaalisia, muuhun hoitoon liitettäviä lyhyitä erillisinterventioita tutkitaan aktiivisesti
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This review focuses on the assessment and treatment of suicide attempters in line with the national evidence-based draft Current Care guideline on the assessment and treatment of suicidal patients. Internationally, Finland has been a country of high suicide rates, though during the last two decades the number of suicide deaths has greatly diminished. Among women the Finnish suicide rates are currently close to those of other Nordic countries and among men slightly higher. Suicide risk is elevated in some psychiatric disorders, especially major depression, bipolar disorder and schizophrenia. Thus, easily accessible evidence-based mental health services are part of effective suicide prevention in health care.
For suicide attempters, a psychiatric assessment is advised as soon as physical and cognitive recovery is sufficient to allow a comprehensive psychiatric examination. This includes careful assessment of psychiatric and substance-use disorders and their current treatment, risk and protective factors for a new suicide attempt, and current major life-events. In addition to other psychiatric treatment, use of a safety plan is recommended, and especially for adolescents it is important to include parents or close ones in preparation of the safety plan. Non-suicidal self-injury should be noted. Among the elderly, increasing limitations related to illnesses and ability to function, and loneliness need to be taken into account. Psychosocial interventions such as cognitive-behavioural therapy (CBT) focused on the suicide attempt are advised in addition to good clinical care of psychiatric disorders. Bereaved close ones and all those involved may need support after a suicide death. Psychosocial care and support is available through several providers including non-governmental organizations, and for some CBT-based psychosocial group interventions may be beneficial.
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisillä esiintyviä mielenterveyden häiriöitä, jotka tulee tunnistaa kaikkialla terveydenhuollossa.
– Laajamittaisen järkyttävän tilanteen jälkeen niitä voi esiintyä runsaasti. Psykososiaalisen tuen ja palvelujen järjestämisellä ja aktiivisella seurannalla on merkitystä heti poikkeuksellisen järkyttävän tapahtuman jälkeen.
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The updated Current Care Guidelines for PTSD includes assessment and treatment of acute stress reaction (ASR), acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in all age groups. Psychosocial support and active monitoring are recommended after a potentially traumatic event. If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is effective, but evidence on other pharmacological options and on treatment combinations is limited. Specific groups, such as first responders, military and peacekeeping personnel may require tailored interventions.
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta ja hoitojärjestelmästä. Selvitimme sairaalaan palaamisen esiintyvyyttä ja yhteyttä paluuta edeltävään avohoitoon sairaanhoitopiireittäin.
Menetelmät
Rekisteritutkimusaineisto kattaa 16 814 potilasta (18–97 v), jotka olivat psykiatrisista syistä osastohoidossa v. 2012. Heidän perusterveydenhuollon ja erikoissairaanhoidon käyttöään seurattiin 12 kk:n ajan uloskirjauksesta.
Tulokset
Potilaista 40 % palasi psykiatriseen sairaalahoitoon. Sairaanhoitopiirien erot olivat suuret (28–53 %). Terveydenhuollon avohoitokäynti viikon kuluessa uloskirjauksesta oli 51 %:lla potilaista (34–69 %). 8 %:lla ei ollut avohoitokäyntejä sairaalajakson jälkeen, ja heillä riski palata sairaalahoitoon oli suurin.
Päätelmät
Alueellinen vaihtelu paluussa sairaalaan voi selittyä osin hoidon järjestämisestä ja toteutumisesta uloskirjauksen jälkeen. Jo yksi avohoitokäynti liittyi merkitsevästi pienempään paluuriskiin. Sairaalaan palaavien osuus ja avohoito uloskirjauksen jälkeen kuvaavat palvelujärjestelmän laatua.
ENGLISH ABSTRACT
Background. Psychiatric re-hospitalisation is dependent on patient level factors as well as health system level factors. Low re-hospitalisation rates are often considered a positive quality indicator in terms of mental health services. This study sets out to investigate psychiatric re-hospitalisation and its predictors on hospital district level in Finland.
Methods. The register-based study consisted of nationwide data on 16,814 adult patients (18–97 years of age) hospitalised with a psychiatric diagnosis (ICD-10 categories F2–F6) for a minimum period of 24 hours in the year 2012. Health service use was followed for 12 months, starting from date of discharge. Data were obtained from the Care Register for Health Care (Hilmo) and the Register of Primary Health Care Visits (AvoHilmo). Specialised and primary care outpatient contacts were examined. Statistical analysis was performed as frequency analysis and logistic regression with re-hospitalisation as the dependent variable.
Results. A total of 40% of patients were re-hospitalised into psychiatric inpatient care within a year (re-hospitalisation rate varying between hospital districts from 28–53%). Altogether 51% of patients received an outpatient appointment within one week from hospital discharge, while 8% received no outpatient contact at all during the 12-month follow-up. Typically, those who received outpatient care had 2.3 visits per month. The rate of psychiatric re-hospitalisation was highest for those who received no outpatient contact at all.
Conclusions Regional differences in psychiatric re-hospitalisation rates can to some extent be explained by health service organisation. Health services should direct more attention to the early weeks following hospital discharge. Even one contact with outpatient services resulted in a decreased risk of re-hospitalisation. Low levels of unplanned psychiatric re-hospitalisation rates, together with a seamless transition to outpatient services following discharge are both promising health service quality indicators. These indicators could benefit from regular regional follow-up.
Methods. The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or ‘Main Types of Care’ (MTC) as the standard for international comparison, following the DESDE-LTC system.
Results. In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as ‘other care’, significant variation was found in the typology and characteristics of these services across the eight study areas.
Conclusions. The functional distinction between core health and other care overcomes the traditional division between ‘health’ and ‘social’ sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
The profound burden and costs of the health, social and economic impacts of mental disorders necessitate public mental health actions, not only to treat, but also to prevent disorders and to promote positive mental well-being. Decisionmakers need robust evidence to support good decisions when designing
strategies, as do professionals when selecting interventions for implementation.
They need to consider not only whether something actually works, but in what circumstances and at what cost. Many interventions may be culturally sensitive, and need to be evaluated separately for each setting, culture or region. To accommodate the complexity of public health interventions, evidence should be considered in its broad terms.
Without evidence of effectiveness it is difficult to make a case for investmentin mental health. Moreover in the absence of good evidence there is a danger that policies and practices may be introduced that are either harmful, wasteful, or both. This is particularly true of complex interventions in public health and health promotion, which can be delivered across many different sectors and are not usually subject to the same mandatory requirements for evaluation as health care treatments.
When assessing the evidence for an intervention, the pooled evidence from different sources and studies should be scrutinised, through a stepwise critical appraisal of studies and the evidence they entail.
First, the study methodology should be assessed for the risk of systematic bias, i.e. the risk that the study’s outcomes are a result of something other than the intervention under evaluation. Hierarchies of study categories have been constructed to support the assessment of risk of bias. The risk of selection bias, i.e. that the intervention group and the control group differ from each other at baseline and thus are not comparable, is minimised in the well performed randomised controlled trial (RCT). To avoid assessment biases, the study outcomes should be measured independently whenever possible, regardless of whether the study is a RCT or not. In MHP and MDP, RCTs are not always feasible, and, ordered according to increasing risk of systematic bias, non-randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and ecological studies also contribute to the evidence.
Second, even in the case of high quality study methodology, every study needs to be assessed for applicability to the real world, i.e. its generalizability.
Evidence from a well-performed RCT may offer no support whatsoever to decision-making if the population of the study differs from the target population,
if the intervention cannot be replicated, or if the outcome measured lacks relevance. In many cases, cohort studies or ecological studies are performed in more “real-life” circumstances than RCTs. Pragmatic RCTs, also known as, naturalistic RCTs, are an effort to combine the advantages of RCTs (low risk of selection bias) with the advantages of observational studies, but may not always be feasible in MHP and MDP.
Third, qualitative studies offer a complementary approach to generating evidence which sometimes has been overlooked. Quantitative and qualitative approaches are not mutually exclusive, and qualitative studies answer many questions which cannot be answered by quantitative studies.
Fourth, evidence needs to be assessed in combination with cost data. It is important not only to look at the evidence on the effectiveness of promotion and prevention strategies but also their resource implications.
The complex process of assessing existing evidence for MHP and MDP can be supported by the use of guidelines for critical appraisal of studies, developed by different groups. This document presents an example of a matrix that matches types of research questions that want to be answered with corresponding types of evaluative studies that will most likely be able to generate that answer accurately.
Lastly, in each case, issues in the transferability of the available evidence needs to be considered when making decisions about going to scale in different settings, cultures or regions. Many interventions in MHP and MDP are culturally sensitive, and need to be evaluated separately in each setting, culture or region.
The primer concludes that there is sufficient evidence for promotion and prevention in mental health; quantitative and qualitative studies are available that can provide answers to the questions we might want to know. Considering and weighing evidence by appraising how it has been generated can help informed decision making. However there is still room to, in general, improve the quality of the research designs applied to evaluate the efficacy and effectiveness of interventions for prevention and promotion in mental health. These interventions should include long-term follow-ups to give sufficient time for interventions to show effect and to provide an accurate estimation of the duration of effects. It is important to note that proven efficacy or effectiveness is no guarantee that programmes or policies will work similarly in different cultural or economic environments. New studies should focus on identifying the mechanisms and processes of adaptation and reinvention without losing initial efficacy.
There are many guides to the generation and use of evidence. Our aims in writing this short primer were to set out as clearly as possible the strengths and limitations of different methods of evaluation, to consider potential bias in study results, to examine how generalisable results may be to real world settings, to describe how quantitative and qualitative approaches should be combined to enhance the use of information, and to suggest how to strengthen the evidence base of mental health promotion and mental disorder prevention at the European level.
The MERTTU project aims to examine the effectiveness of mental health services provided for the working-age population. This report provides an overview of the delivery system of mental health services, describing its state and regional structure in 2004 and analysing differences at the level of hospital districts. Municipal mental health services are described using the standardised European Service Mapping Schedule. Further, the use of mental health services is investigated at the level of hospital districts by analysing the numbers of psychiatric inpatients, care days, admissions, referrals to compulsory care and mental health outpatient visits.
Clear differences were observed between municipalities in both the organisation of mental health services and the diversity of service delivery. Municipalities of course considerably differ in their population structure in many respects, which also affects the service delivery structure. Large cities offer the broadest range of services; in fact, in order for an area to be able to provide diversifi ed services it should have a suffi cient population base. Municipalities use a wide variety of 24-hour service units. However, these units usually consist of traditional hospital wards, a mode of care not necessarily the best possible either from the viewpoint of the client or economically. When 24-hour emergency services are needed, no alternatives for traditional hospital care are usually available. As for 24-hour non-emergency care, the situation is equally unsatisfactory. Only about half of the municipalities use non-emergency 24-hour treatment services other than hospital wards, such as rehabilitation or nursing homes. Organised day activities are in rather short supply although they form an important part of the service choice for a mental health rehabilitation patient. Outpatient services are mostly traditional permanent services by appointment, although there is also a need for more diversified advanced mobile and emergency outpatient services. Only 15 per cent of the municipalities use emergency day services.
The report deals with the administrative changes in mental health work carried out in municipalities since 1991. In general, the municipalities have been moderate in these changes. Some variation can be seen in the propensity to carry out changes between different areas and also between municipalities of different sizes. The most common administrative change in organising the service delivery has been the complete or partial transfer of psychiatric outpatient services from specialised health-care units to municipal health-centres. This change is reported in more than half of the municipalities that responded to the inquiry. As agreed on, the change has led to various forms of co-operation between different service units, whereas it has not created diversity in the provision of services. Another major change over recent years has been the drafting of a strategy or programme for mental health work. Somewhat surprisingly, only a quarter of the municipalities reported that they have begun to implement a strategy or programme.
Despite the long-standing efforts to further develop outpatient care, the diversity of mental health services is still unsatisfactory in many municipalities. The emphasis on inpatient care is still prevalent and outpatient services have not developed in the
desired direction. Finland still has areas where determined efforts should be undertaken to reduce inpatient care and to reallocate resources to psychiatric outpatient care. 24-hour service units outside hospitals should be increased, as well as organised day activities and mobile and emergency outpatient services. The restructuring of mental health services is still under way. The development of mental health work and services will continued to pose a great challenge to municipalities."
maailmas hinnanguliselt 800 000 inimest aastas ning
iga surmajuhtumi kohta tehakse kümme suitsiidikatset. Ene-
setapu või enesetapukatse mõju sooritajale, pereliikmetele,
sõpradele ja kogukonnale on rõhuv ja pikaaegne.
Soomes hakati meeste suurele enesetappude arvule tähele-
panu pöörama 1970. aastatest alates. Üle 14-aastaste meeste
suitsiidisuremus oli üle 60 juhtumi 100 000 elaniku kohta.
Kõrgendatud tähelepanu viis muu hulgas suitsiidikomitee
loomisele 1974. aastal. Algatati maailma esimene riiklik ene-
setappude ennetamise programm, millele koguti alusmater-
jali, uurides iga 1987. aastal toime pandud enesetappu.
1970-luvulta alkaen huomio kiinnittyi miesten korkeisiin itsemurhalukuihin Suomessa.
health is not just the absence of illness, rather it is conceptualized as a
state of well-being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively
and fruitfully, and is able to make a contribution to his or her community
(WHO 2013). Consequently, public mental health is not just about the
occurrence and prevention of mental disorders in the population, but it
also concerns the promotion of mental health and well-being. Thus, public mental health can be defined as actions aimed at developing the mental health of populations and producing healthy societies.
Public mental health research encompasses research that describes
collective experience, occurrence, distribution and trajectories of positive mental health, mental health problems, and their determinants; research on mental health promotion and prevention of mental disorders; research on mental health system policies and governance; service delivery; and the organization of mental health services.
Mental health is more crucial today than it has ever been, due to the
societal transition into the information society era. The population’s
mental capital (i.e. cognitive, emotional, and social-skills resources
required for role functioning) is a prerequisite for the prosperity of
individuals, companies, and societies in this new era. Mental health
becomes more valuable and more vulnerable, due to the many stressors
in information-driven economies. At the same time, in low-income
countries, poverty, discrimination, and poor mental health form a vicious
circle which becomes an obstacle to economic development (Patel and
Thornicroft 2009).
The huge burden and costs of impaired mental health for individuals,
families, society, and the economy call for actions to prevent mental ill
health and promote positive mental health and well-being. This
necessitates public mental health actions, not only to treat, but also to
prevent impaired mental health and promote positive mental well-being
Mielenterveyden häiriöiden luokittelu on haasteellista. Yleensä lääketieteellinen diagnostiikka perustuu taudin etiologiaan tai fysiologisiin löydöksiin, mutta psykiatriset häiriöt eivät ole yksiselitteisiä aivosairauksia, vaan seurausta
biologisista, kehityksellisistä ja sosiaalisista prosesseista. Tämän takia mielenterveyden häiriöiden määrittely perustuu potilaan kuvaamiin ja lääkärin havainnoimiin oireisiin, joista muodostuu yhteisesti sovittuja psykiatrian oireyhtymiä.
On hyvä pitää mielessä, että psykiatrisen
diagnoosin käyttö edellyttää että oireilu on kliinisesti merkittävää ja aiheuttaa ajankohtaista psyykkistä rasittuneisuutta tai toimintakyvyn alenemaa. Oireilun ei tule myöskään olla henkilön kulttuurissa oletettu reaktio tilanteeseen. Poikkeava poliittinen, uskonnollinen tai seksuaalinen käyttäytyminen ei ole mielenterveyden häiriö. Moni psykiatrinen diagnoosi edellyttää myös oireilun vähimmäiskestoa; esimerkiksi masennustila tulee diagnosoida vasta oireilun kestettyä kaksi viikkoa.
Mielenterveyden häiriöiden kohdalla tapahtuu huomattavasti sekä ali- että ylidiagnosointia. Katveeseen jäävät varsinkin häiriöt, joissa oireilu painottuu somaattisiin oireisiin. Esimerkkejä ovat ensisijaisesti väsymyksenä ja
särkyinä ilmenevät masennustilat. Myös päihdeongelmien kohdalla alidiagnosointi on merkittävä ongelma.
Psykiatrisoinnilla tarkoitetaan normaalivaihteluun kuuluvien ilmiöiden siirtymistä diagnosoitavien häiriöiden piiriin. Potilaan hakiessa akuutisti apua elämän- ja kasvukriiseissä, suruunsa tai traumaattisten tilanteiden jälkeen on syytä kriittisesti harkita, täyttyvätkö psykiatrisen häiriön kriteerit. Normaalireaktioiden psykiatrisointi saattaa häiritä henkilön
omaa toipumista ja lisätä hoitotoimenpiteiden kysyntää. Usein rauhoittava kuuntelu on näissä tilanteissa riittävä hoito. Psykofarmakologisia hoitoja tulisi käyttää vain silloin, kun mielenterveyden häiriö on diagnosoitavissa.
In psychiatric hospital care, aggression and agitation are a major concern. A frequent reaction to patient aggression is the implementation of coercive measures, often perceived as being harmful and unfair by patients and also a target for public criticism. On the other hand, patient aggression inflicts harm on providers of mental health care as well. Although major physical injuries are rare, nonphysical effects create much suffering. Nurses’ predominant responses to patient aggression have been found to be anger, fear or anxiety, post-traumatic stress disorder symptoms, guilt, self-blame, and shame. Inpatient aggression can also be directed toward other patients, who are then vulnerable to both physical and psychological trauma. Violent patient behavior also has financial implications as it requires increased staffing.
It is not necessarily easy to keep in mind the low overall risk of violent behavior by psychiatric patients and to be an advocate of reason when confronted with the everyday behavioral problems of patients in mental institutions. In institutional settings, it is a challenge to maintain the safety of the patients and the staff while providing a therapeutic environment.
ammattilaisen toteaman tarpeen jälkeen hoito alkaisi neljän viikon kuluessa. Kelan järjestämä kuntoutuspsykoterapia tulee säilyttää
nykyisellään, mutta varhainen apu todennäköisesti vähentää sen tarvetta.
Special international data collection exercises, such as the World Health Organization (WHO) Atlas Project and the WHO Baseline Project have provided valuable insights in the state of mental health systems in countries, but such single-standing data collections are not sustainable solutions. Improvements in routine data collection are urgently needed. The European Commission has initiated major improvements to ensure harmonized and comprehensive health data collection, by introducing the European Community Health Indicators set and the European Health Interview Survey. However, both of these initiatives lack strength in the field of mental health. The neglect of the need for relevant and valid comparable data on mental health systems is in conflict with the importance of mental health for European countries and the objectives of the ‘Europe 2020’ strategy.
The need for valid and comparable mental health services data is today addressed only by single initiatives, such as the Organisation for Economic Co-operation and Development work to establish quality indicators for mental health care. Real leadership in developing harmonized mental health data across Europe is lacking. A European Mental Health Observatory is urgently needed to lead development and implementation of monitoring of mental health and mental health service provision in Europe."""
increasing numbers of sickness spells
and early retirements due to mental disorders
and problems. However, the importance of good mental
health is still not acknowledged universally. In the
era of the information society, mental stressors are public
health threats of increasing magnitude.
A recently presented green paper by the European
Commission on mental health promotes discussion on
the relation between the European Union’s strategic
policy objectives and the mental health of Europeans.
The paper builds on the Helsinki Action Plan of the
World Health Organization’s European Ministerial
Conference on Mental Health 2005. The potential
adoption of a union-wide mental health strategy later
this year could signal an upgrade in the status of mental
health issues within the union and within each
member state.
The paper acknowledges the need for European
action on mental health. Each year, about 60 000
European Union citizens die from suicide, more than
the total annual deaths from road traffic accidents.
Meanwhile, many countries still have no suicide
prevention policy,5 even though evidence based measures
for suicide prevention are effective and available.
The economic consequences of mental health
problems—mainly in the form of lost productivity—are
estimated to be 3-4% of gross national product. In any
given year a quarter of Europeans are likely to be
affected by mental disorders, while only 25% of these
will have contact with formal health services.
The new mental health strategy proposed by the
green paper should focus on the promotion of mental
health, preventive actions, social inclusion, and the
protection of the rights of people with mental
disorders, as well as on developing a European mental
health information system. The lessons of the successful
control of infectious and cardiovascular diseases
indicate that the road to improved mental health
among populations lies not in investment in mental
health services but in promotion and prevention
activities. Yet these remain challenging, as individual,
familial, and societal determinants of mental health
often lie in non-health domains such as social policy,
education, and urban planning. Promising new
evidence has, however, indicated that effective interventions
exist: interventions in local communities,
home visiting programmes, and school programmes
are some examples of effective interventions
for improving mental health.
Mental health is a marginal issue in existing European
Union health infrastructures, and there is no specific
unit devoted to mental health either in the
European Commission services or at the European
Centre for Disease Control. Though the need for a
mental health information system is acknowledged in
the paper, it does not suggest any sustainable
European infrastructures for monitoring and information
dissemination. There is an obvious need for new
European institutions to complement and support
national activities; such structures could include a
European clearinghouse for evidence on mental
health interventions, an institute providing guidelines
on mental health practice, and an observatory for
mental health. None of these activities exist today on a
sustainable basis in spite of the achievable European
benefits that would be gained.
The European Commission has been given the
chance to take a lead and contribute to the
introduction of progressive national and regional
mental health policies in Europe. Many countries have
neglected the need for a comprehensive mental health
policy for too long. For the most part, mental health is
seen as a matter for health authorities only, and many
existing policies focus on the development of services.
The commission can change this pattern by advocating
the inclusion of mental health not only in European
public health policy but also in social and employment
policy; research policy; and freedom, justice, and security
policies. Such a shift would likewise transform the
alcohol policy of the European Union, in which mental
health considerations have so far been notoriously
overshadowed by trade considerations.
The commission’s green paper is open for
consultation by member states, organisations, and
individual citizens (http://europa.eu.int/comm/
health/ph_determinants/life_style/mental/green_paper/
consultation_en.htm). Input into the consultation will
help shape the future mental health of Europeans. The
European Parliament’s response to the green paper is
scheduled for September and is an opportunity to raise
awareness and political commitment for mental health
issues.
Mental health is a major challenge for European
health policy. Good mental health contributes to prosperity,
solidarity, and social justice, and cannot be
achieved by the health sector alone. All sectors have to
be involved in the promotion of mental health.
Hyvä mielenterveys on keskeistä yksilöiden, yhteisöjen ja yhteiskunnan hyvinvoinnille ja menestykselle. Kunnat ja hyvinvointialueet voivat päätöksillään ja toimillaan tukea monin tavoin asukkaidensa mielenterveyttä. Mielenterveyden edistäminen ja mielenterveyshäiriöiden ehkäisy edellyttävät, että mielenterveyskysymykset huomioidaan paitsi sosiaali- ja terveysalan päätöksissä hyvinvointialueilla, myös esimerkiksi kunnan koulutus-, asunto- ja ympäristöpolitiikkaan, yhteisöllisyyteen ja kestävään kehitykseen liittyvissä päätöksissä. Mielenterveysvaikutusten
ennakkoarviointi tuottaa tietoa päätöksen mahdollisista ja todennäköisistä vaikutuksista asukkaiden mielenterveydelle. Tietoon perustuvilla päätöksillä voidaan lisätä asukkaiden hyvinvointia, vaikuttaa kunnan ja hyvinvointialueen toimivuuteen, vakauteen ja kustannuksiin.
Suomessa on toistaiseksi arvioitu mielenterveysvaikutuksia kuntapäätösten valmistelussa verrattain vähän, eikä yhtenäistä toimintamallia ole olemassa. Arviointeja on tehty esimerkiksi kuraattoripalveluihin, kehitysvammahuollon asuinpalveluihin,
mielenterveyspalveluiden resurssointiin ja kouluihin liittyvien päätösten valmistelussa. Tässä raportissa esitellään konkreettinen toimintamalli, jonka tarkoituksena on yhdenmukaistaa, selkeyttää ja helpottaa kuntien ja hyvinvointialueiden mielenterveysvaikutusten ennakkoarviointia.
________________
Good mental health is essential for the wellbeing of individuals, communities, and for society as a whole. Decision makers on municipality and wellbeing services county level can support the mental health of their residents via the decisions they make. Mental health promotion and the prevention of mental health disorders require attention not only in the social and healthcare sector, but also in decisions made by municipalities on education, housing and environmental policy, communality and sustainable development. Mental health impacts assessment evaluates the possible mental health effects of a decision before it is put into action. Knowledge-based decisions help to increase residents’ wellbeing, as well as contributing to a cost effective, functional and stable municipalities and wellbeing services counties.
To date, relatively little attention has been paid to mental health impact assessments in relation to municipal and wellbeing services county decisions in Finland, and there is no universal model guiding the process. Some examples do exist in relation to social services, residential services for people with intellectual disabilities, mental health services, and schools. This report presents a concrete model aimed at harmonising,
clarifying and facilitating mental health impact assessment for municipalities and wellbeing services counties.
psykiska välbefinnandet. Vi ska därför gå närmare in på den aspekten här och jämföra
den svenskspråkiga ungdomsbarometern med andra nationella och internationella
studier. Vi ska också se på hur den psykiska hälsan bland unga kunde förbättras.
Psykiskt välbefinnande är ett mångfacetterat begrepp, men kan anses innehålla tre dimensioner: känslor av glädje och lycka (emotionellt välbefinnande), upplevelsen av livskvalitet (evaluativt välbefinnande) och känslan av mål och riktning i livet (eudaimoniskt välbefinnande). Barometern visar tydliga försämringar i alla dessa dimensioner av psykiskt välbefinnande.
Keskeisenä näkökulmana korostui näyttöön perustuvien tai hyviksi käytännöiksi todettujen hoitomal-lien painottaminen. Päähavaintona nousee myös esille uusien ihmislähtöisten, osallisuutta ja vertaisuutta tukevien toimintamallien luomat mahdollisuudet uudistaa mielenterveys- ja päihdepalveluja. Tutkimusnäyttö puoltaa perustason mielenterveys- ja päihdepalveluiden integraatiota perustervey-denhuoltoon. Monitoimijaiset mielenterveys- ja päihdepalvelut rakentuvat julkisia palveluja täydentävien järjestöjen palveluja hyödyntäen. Selvityksen mukaan mielenterveyspalveluihin ja mielenter-veyden edistämiseen investoimalla on mahdollista vähentää mielenterveysongelmien epäsuoria kustannuksia – kuten tuottavuuskustannuksia – merkittävästi.
English abstract:
The objective of the MindsTogether project has been to provide decision makers with evidence-based information about effective models for mental health and addiction services. The project consisted of a literature review, expert interviews, general public survey, and focus group work with experts by experience. A draft of the effective mental health and substance abuse service models was openly available for comments on the Ota kantaa public participation portal.
Emphasising service models that are evidence-based or established good practices is high-lighted as a key perspective in the report. The opportunities to reform mental health and sub-stance abuse services that new operating models, which are person-centred and support inclu-sion and peer experience, have created also emerges as a main finding. Existing evidence supports integration of basic mental health and substance use services with primary care. A multi-stakeholder approach, which includes complementary services provided by the third sector, is recommended. According to the analysis, investing in mental health services and mental health promotion enables a significant reduction of indirect costs, like production costs, caused by mental health problems.
the accountability of policy-makers for mental health impact. The MHiAP approach can be applied at all administrative levels, ranging from local authorities to the EU level.
The EU Joint Action for Mental Health and Wellbeing set out to map, assess, disseminate and pilot good practices within an MHiAP approach. In this respect, the term mental health incorporates both mental wellbeing and mental disorder. Mental health is perceived as an important resource for the
wellbeing of individuals, families and societies, according to the World Health Organization (WHO) definition of mental health. The Joint Action is underpinned by the notion that mental health is more crucial today than it has ever been. This is due to its broad range of impacts and due to the increase in
mental capacity required by the transition from a society dominated by manual work into an information
society, and by the notion that a range of cost-effective public mental health interventions exists but are not widely implemented.
Mental health has a substantial and broad set of impacts across policy areas. Mental disorders constitute one third of the disease burden in Europe, a figure which is on the increase. Not only do mental disorders cause a significant loss of work days and decrease in European productivity, but also immense
individual and family suffering. Mental disorders also have profound negative effects on academic achievements. A shift in this trend requires coordinated implementation of a range of effective public mental health interventions to promote mental wellbeing and prevent mental disorders.
Many individual, familial and societal determinants of mental health lie in non-health policy domains such as social policy, taxation, education, employment and community design. It is now recognised that the very foundations of mental health are laid down early in life and are later supported by positive
nurturing, high social capital, a good work life and a sense of meaning. Many of these factors can be enhanced through the MHiAP approach in non-health sectors and, therefore, remain important targets for mental health promotion and mental disorder prevention interventions. Examples of effective
interventions to promote population mental health include interventions in local communities, parenting support and home visiting programmes as well as school based programmes.
Lessons learned from the promotion of physical health indicate that the road to improved mental health among populations lies less in the investment in late-coming mental health services, but more in a co-ordinated public mental health programme to implement large-scale promotion and prevention activities.
Globalisation and European integration have strengthened the influence of international actors on health determinants and thus reduced the power and opportunities of national health policies. Increasingly, mental health determinants lie in the areas of EU policy and international agreements. EU legislation and actions in many non-health fields can have a decisive impact on the mental health of EU citizens. This calls for an active civic society to minimise potential negative mental health impacts and to create strong local communities which are conducive to mental health.
families and society. This burden is increasing in Europe, especially when compared to the relative burden of physical health problems. The cost of mental disorders in Europe is estimated as €461 billion per year. Mental health research can
help to resolve these burdens.
Europe is home to some of the world’s best mental healthcare and research centres. Europe’s diverse and comprehensive health systems allow for rich and representative datasets not available elsewhere in the world. European research networks are gaining momentum, and a coordinated strategy for
mental health research will help to realise the EU’s full potential.
Funding for mental health research in Europe is much lower than the population impact of these disorders, with spending being less than half the disability burden. Mental disorders
represent between 11% and 27% of total disease burden, while investment across countries and FP7 is about 6%. For every one euro spent on mental health research there is a 0.37 euro return per year which is similar to the return for cardiovascular
disorder research and other areas of health.
ROAMER (ROAdmap for MEntal health and Wellbeing Research in Europe) has developed a comprehensive and integrated mental health research roadmap, focused on improving the mental health of the population and increasing European competitiveness. ROAMER analysed existing resources in European regions, and involved input from over 1000 individuals and stakeholder organisations. Evidence-based
recommendations were prioritised through iterative feedback, consensus meetings, international advisory boards and surveys of researchers, experts and wider stakeholders in Europe.
Analyses of contemporary European research produced 6 high level priorities: these are targeted, actionable, built on excellent European science and resolvable in the next 5 to 10 years. The answers to these proposed research questions will markedly improve the mental health of European citizens and tackle societal challenges:
1. Research into mental disorder prevention, mental health promotion and interventions in children, adolescents and young adults
2. Focus on the development and causal mechanisms
of mental health symptoms, syndromes and well-being across the lifespan (including older populations)
3. Developing and maintaining international and interdisciplinary research networks and shared databases
4. Developing and implementing better interventions using new scientific and technological advances
5. Reducing stigma, empowering service users and carers in decisions
A large scale development project for the mental health and substance abuse services, the Ostrobothnia Project, has been implemented since 2005 by the hospital districts of the Ostrobothnia, South Ostrobothnia and Central Ostrobothnia regions. In addition, the ‘Pohjalaiset masennustalkoot’ project aimed at promoting identification and management of depression, was implemented by the Vaasa and South Ostrobothnia hospital districts in 2004–2007. Both projects were co-funded by the Finnish Ministry of Social Affairs and
Health. To lay the basis for an evaluation of the outcome and effectiveness of these projects, a baseline population survey was performed in spring 2005. The aim of the survey was to assess the status prior to implementing the project interventions. Sequel surveys were conducted in spring 2008, 2011 and 2014. The random population sample consisted of 5000 persons aged 15 to 80 from the intervention area and another 5000 persons of the same age from the hospital district of Southwest Finland, which was set as a control area.
The number of inhabitants and the demography of the Southwest Finland region can be considered similar to
the intervention area.
The survey objective was to collect information about mental health determinants, respondents’ mental health, their attitudes towards mental disorders and their use and experience of mental health and substance abuse services. Age, gender, municipality, marital status, mother tongue, the most advanced degree of education, current main activity, internet use and activities in associations and societies were set as background questions. Standardized survey instruments were used in the questionnaire to define different indicators related to mental health. Positive aspects of mental health were studied with the Warwick-Edinburgh Mental Well-being scale (WEMWBS) and with the Pearlin's Sense of Mastery scale. The Oslo-3 instrument was used to define social support. Exposure to physical abuse during childhood was measured
with the Brief Physical Punishment Scale (BPPS). Six items from the RAND health survey were used to define role limitations due to emotional problems and physical health. Respondents’ psychological distress was measured with the General Health Questionnaire (GHQ-12) scale and alcohol problems with the AUDIT-C test. The Lie/Bet tool was included as a screening instrument to identify problem gambling behaviours.
Questions based on the Composite International Diagnostic Interview Short Form (CIDI-SF) were used for assessing prevalence of major depressive disorder. Use of social and health care services for mental health or alcohol problems was studied with the same questions used in the Finnish health examination studies Health 2000 and Health 2011. One of the questions included in this survey for measuring aspects of social capital was also used in the Health 2000 study. Respondents’ attitudes towards mental ill health were examined with questions that were partly constructed for this survey.
The survey response rate was 36.7 per cent. The Vaasa Hospital District had the highest response rate (40.6 %) whereas the South Ostrobothnia district had the lowest rate (31.7 %). An obvious gender difference was also noted with regards to response rates; 43.3 per cent of women responded to the questionnaire but only 31.4 per cent of men. A higher proportion of Swedish speaking respondents participated in the survey (47.8 %) compared with Finnish speaking respondents (36.2 %). The age group 71–80 years had the highest response rate (54.2 %) and the 21-30 year age group the lowest (25.1 %). Responses could be submitted by
mail or online on the web. Only 6.2 % of all the survey answers were given online. Younger respondents
utilized the web-response opportunity at a higher rate. The final dataset is adjusted for age, gender, language, and hospital district.
lähtien tiivistä yhteistyötä Alueellisen terveys- ja hyvinvointitutkimuksen (ATH) ympärillä. THL:n
koordinoima ATH-tutkimus käynnistyi vuosina 2010–2011 ja vastasi pilottivaiheessaan tietoperustaisen
päätöksenteon haasteisiin mittavalla 34 000 suomalaisen tutkimuskokonaisuudella. ATH-tutkimus on
laajentunut kansalliseksi vuosina 2012–2014 käsittäen jopa yli 150 000 suomalaista. Lisäksi tietosisällön
peittävyyttä lisätään etnisiin ryhmiin. Tutkimuksessa havaittiin alueellisia ja sosioekonomisen aseman
mukaisia eroja muun muassa kulttuuri- ja terveyspalveluiden, hyvinvoinnin osatekijöiden ja elintapojen
suhteen. Näihin eroihin voidaan vaikuttaa päätöksenteolla ja toiminnalla yhteiskunnan eri lohkoilla.
Vastaavasti ATH-tutkimus luo erittäin hyvän pohjan myös RAY:n avustustoiminnan tarvitseman toimintaympäristötiedon keräämiseen. Erityinen lisäarvo RAY:n kannalta yhteistyössä saavutettiin, kun keskeisten järjestötoimintaa koskevat kysymykset sisällytettiin tähän laajaan tutkimuskokonaisuuteen. RAY:n näkökulmasta on nähtävissä myös monipuolisten eri tietolähteistä koostuvien alueraporttien
kehittäminen avustustoiminnan seurannan kehittämiseksi. THL:n näkökulmasta aineiston monipuolinen hyödyntäminen tulee myös näin taattua. Tuoreita tuloksia on raportoitu nopealla aikataululla kansallisille, kunta- ja aluepäättäjille verkkopalvelussa sekä erilaisissa tilaisuuksissa.
ATH-tutkimuksen tulokset väestön hyvinvoinnista, terveydestä ja toimintakyvystä sekä niihin vaikuttavista tekijöistä raportoidaan välittömästi asiantuntijoiden käyttöön. ATH on merkittävä uusi kansallinen avaus ja suuri apu kunnille ja alueille hyvinvointikertomusten tekemisessä sekä uuden terveydenhuoltolain mukaisen väestöryhmittäisen seurannan toteuttamisessa. Kuntien ja alueiden lisäksi tutkimusaineistoa
hyödynnetään lukuisissa tutkimushankkeissa.
Yksi esimerkki tutkimusaineiston hyödyntämisestä on RAY:n ja THL:n koordinoima järjestöjen ATH-tutkimusverkosto
ja -ohjelma, jossa on toistaiseksi ollut mukana seitsemän järjestöä. Ensimmäiset järjestön ATH-tutkimusverkoston tulokset julkaistiin keväällä 2014 THL:n "Tutkimuksesta tiiviisti" -sarjassa. RAY on kannustanut järjestöjä hyödyntämään tutkimusaineistoa sekä levittämään ja hyödyntämään tuloksia
laajasti järjestökentässä. Tutkittu tieto luo pohjan niin julkisten palveluiden kuin järjestötoiminnankin kehittämiselle ja suuntaamiselle sosiaali- ja terveysalalla. RAY hyödyntää ATH-aineistoa ja tutkimustuloksia kehittäessään avustustoimintaansa sekä kohdentaessaan rahoitusta sosiaali- ja terveysalan järjestöjen yleishyödylliseen toimintaan.
Nyt käsillä olevaan julkaisuun on koottu seitsemän artikkelia, joiden kirjoittamiseen on osallistunut ATH-tutkimusverkoston
28 kirjoittajaa järjestöistä, RAY:stä sekä THL:sta.
introduce the questions and survey instruments included. The survey was a continuation of the population
surveys carried out in 2005 and 2008.
A large scale development project for the mental health and substance abuse services, the Ostrobothnia
Project, has been implemented since 2005 by the hospital districts of the Ostrobothnia, South Ostrobothnia
and Central Ostrobothnia regions. In addition, the regional project ‘Pohjalaiset masennustalkoot’ to promote
identification and management of depression was established by the Vaasa and South Ostrobothnia
hospital districts and implemented in the area in 2004–2007. Both projects were co-funded by the Finnish
Ministry of Social Affairs and Health. To lay the basis for an evaluation of the outcome and effectiveness
of these projects, a baseline population survey was performed in spring 2005. The aim of the survey was to
assess the status prior to implementing the project interventions. Sequel surveys were conducted in spring
2008 and 2011. The random population sample constituted of 5000 persons aged 15 to 80 from the intervention
area and another 5000 persons of the same age from the hospital district of Southwest Finland,
which was set as a control area. The number of inhabitants and the demography of the Southwest Finland
region can be considered similar to the intervention area.
The survey was set to collect information about mental health determinants, respondents’ mental health,
their attitudes towards mental disorders and their use and experience of mental health and substance abuse
services. Age, gender, municipality, marital status, basic education, the most advanced degree of education,
current main activity and activities in associations and societies were set as background questions. Standardized
survey instruments were used in the questionnaire to define different indicators related to mental
health. The Pearlin's Sense of Mastery scale was used as an indicator for positive mental health and coping
abilities. The Oslo-3 instrument was used to define social support. Exposure to physical abuse during
childhood was measured with the Brief Corporal Punishment Scale (BCPS). Three items from the RAND
36-item health survey were used to define role limitations due to emotional problems. Respondents’ psychological
distress was measured with the General Health Questionnaire (GHQ-12) scale and alcohol problems
with the CAGE test. The Lie/Bet tool was included as a screening instrument to rule out possible
pathological gambling behaviours. Questions based on the Composite International Diagnostic Interview
Short Form (CIDI-SF) were used for assessing prevalence of major depressive disorder. The questions/
statements describing schizotypal features were taken from the Schizotypal Personality Questionnaire
(SPQ). Use of social and health care services for mental health or alcohol problems was studied with the
same questions used in the Finnish Health Examination Study Health 2000. One of the questions included
in this survey for measuring aspects of social capital was also used in the Health 2000 study. Respondents’
attitudes towards mental health disorders as well as their knowledge of mental health were examined with
questions that were partly constructed for this survey.
The survey response rate was 46.2 per cent. The Vaasa Hospital District had the highest response rate
(50.4 %) whereas the Central Ostrobothnia district had the lowest rate (40.8 %). An obvious gender difference
was also noted with regards to response rates; 52.7 per cent of women responded to the questionnaire
but only 39.6 per cent of men. A higher proportion of Swedish speaking respondents participated in the
survey (54.6 %) compared to Finnish speaking respondents (46.1 %). The age group 61-70 years had the
highest response rate (63.3 %) and the 21-30 year age group the lowest (33.4 %). The final dataset is adjusted
for age, gender, language, and hospital district.""
Projektet er finansieret af Nordisk Ministerråd under handlingsplanen för psykisk hälsa, med en bevilling som er tildelt ”Nordiska akademin för forskning om psykisk hälsa, Nordiska
högskolan för folkhälsovetenskap”.
Vi har fra de nationale patientregistre udtrukket oplysninger om indlæggelser med psykisk sygdom, samt fundet dødsdag og dødsårsag i dødsårsagsregistrene. Ud fra disse oplysninger
har vi lavet en række undersøgelser omkring dødelighed og forventet livslængde blandt personer med registreret psykisk sygdom.
Vores overordnede mål har været at undersøge overdødeligheden blandt psykisk syge personer i forhold til den generelle befolkning. Herunder at se på udviklingen over tid, forventede levetider, forskelle på undergrupper af psykisk sygdom, samt undersøge
eventuelle forskelle imellem de tre lande. Resultaterne er beskrevet i fem artikler som i øjeblikket er indsendt til peer-review hos internationale tidsskrifter, eller under udarbejdelse
og klargøring til indsendelse. En kort beskrivelse af disse artikler er at finde til sidst i rapporten. Det er på grund af ophavsrettigheder desværre ikke muligt at vedhæfte artiklerne i
denne rapport. Resultaterne vil desuden blive fremlagt på en konference den 22.11.2010 i København. Her vil repræsentanter for alle de nordiske lande være til stede.
Projektgruppen har udover produktion af artikler afholdt nordiske forsknings seminarer om psykiatrisk registerforskning.
Tamperelaisten mielenterveyspalvelut järjestetään tilaaja-tuottajamallin mukaisesti. Vuonna 2009 mielenterveys- ja päihdepalveluja on tilattu noin 49 miljoonan euron edestä, mikä on noin 12 % Tampereen sosiaali- ja terveydenhuollon kokonaisbudjetista. Tästä noin 22 miljoonaa kohdistuu erikoissairaanhoidon psykiatriaan, ja noin 27 miljoonaa Tampereen kaupungin mielenterveys- ja päihdepalvelujen palvelutilaukseen. Tästä oman tuotannon osuus on suunniteltu olevan 10,6 M€. Avomielenterveyspalvelut-tuotantoyksikkö toimii avopalvelujen johtokunnan alaisuudessa ja vastaa psykiatrian avohoidon ja päiväsairaalatoiminnan tuottamisesta 16:ssa palvelupisteessä. Lisäksi Tampereen kaupunki tuottaa perusterveydenhuollon mielenterveyspalveluja ja psykogeriatrian osasto- ja vastaanottopalveluja.
Useat väestötason mittarit viittaavat siihen että mielenterveyspalvelujen tarve saattaa sosiaalisista syistä olla Tampereella koko maata suurempi. 3% tamperelaisista on mielenterveysperusteisella työkyvyttömyyseläkkeellä ja noin 3% on vuosittain sairauspäivärahalla mielenterveyssyistä. 10 % tamperelaisista käyttää vuoden aikana masennuslääkkeitä. Vuonna 2007 0,64 % tamperelaisista oli psykiatrisessa osastohoidossa (koko maa: 0,59 %). Vaikuttavuusmittarina voidaan käyttää itsemurhien määrää, joka Tampereella on alle maan keskitason.
Tampereella mielenterveyspalvelut ovat monimuotoiset ja erikoispalveluissa pääsääntöisesti riittävän hyvin resursoituja. Silti mielenterveys- ja päihdepalvelujen osuus kaupungin sosiaali- ja terveydenhuollon budjetista ei vastaa ongelmien kuntalaisille aiheuttamaa sairaustaakkaa. Toiminnan kehittämistyötä on tehty pitkäjänteisesti mutta palvelut ovat kuitenkin edelleen pirstoutuneet ja vaativat asiakkaalta melkoista navigointikykyä. Asiakkaan näkökulmasta palveluiden saatavuuteen liittyy ongelmia. Kuntouttavan mielenterveystyön toiminnot ovat monipuoliset.
Resurssien painopiste tulisi siirtää erikoissairaanhoidon korjaavista palveluista lähipalveluihin perustasolla ja ehkäisevään työhön. Avohoidon tehostuessa on mahdollista vähentää sekä aikuis- että vanhusväestön psykiatrista sairaalakäyttöä. Päihdepalveluja ja mielenterveysavopalveluja tulisi yhdentää ohjattavuuden parantamiseksi, päällekkäisyyksien välttämiseksi sekä yhteistyön ja päihdepalvelujen saatavuuden parantamiseksi.
Tamperelaisten psykiatrian sairaalakäyttö ei merkittävästi eroa koko maan tasosta, mutta tamperelaista mielenterveyspalvelujärjestelmää ei voi pitää kovin avohoitokeskeisenä. Puutteita on varsinkin perusterveydenhuollossa, joissa tarvitaan matalan kynnyksen vastaanottoja ja panostusta kouluterveydenhuollon mielenterveystyöhön. Perustason mielenterveystyön johtaminen tulee organisoida. Terveysasemien resurssit hoitaa tavallisimpia mielenterveys- ja päihdeongelmia ovat niukat, mikä lisää paineita erikoistason palveluihin. Erityisesti psykiatrian sairaanhoitajia ja ryhmämuotoista toimintaa tarvitaan enemmän terveysasemille. Siirtyminen perustasolta erikoistuneisiin avomielenterveyspalveluihin tulee helpottaa ja nopeuttaa.
Benchmarking vertailukuntiin osoittaa että psykiatrian sairaalakäyttö on mahdollista vähentää kolmanneksella tai neljänneksellä avohoitotoiminnan kehittyessä. Psykiatrian osastohoidon sijoittuminen Pitkäniemen sairaalaan haittaa kehitystä, ja kaupungin tulisi aktiivisesti pyrkiä vaikuttamaan sairaanhoitopiiriin Pitkäniemen toiminnan siirtämiseksi Keskussairaalan alueelle.
Psykiatrisessa päivystystoiminnassa on puutteita. Terveysasemilta puuttuvat matalan kynnyksen päivystykselliset hoitajavetoiset vastaanotot. Ensiapu Acutan erikoissairaanhoidon puolella ei ole psykiatrista päivystystä ja Acutan perusterveydenhuollon puolella ei ole mielenterveys- tai päihdetyöntekijöitä. Sosiaaliasema Paussin sijoittumista Acutan yhteyteen tulisi harkita. Sairaanhoitopiirin rajapintayöryhmä (Rapi) ja kaupungin kriisipsykiatrian poliklinikka sijaitsevat kaukana Acutasta. Rapi, kriisipsykiatrian poliklinikka ja päiväosasto 1 tulisi yhdistää volyymin kasvattamiseksi ja päällekkkäisten toimintojen karsimiseksi. Nämä toiminnot tulisi sijoittaa Keskussairaalaan Acutan yhteyteen sujuvan yhteistyön mahdollistamiseksi.
Ikäihmisten psykiatrian palvelut ovat liian laitospainoitteisia. Yli 65-vuotiaat tamperelaiset käyttävät psykiatrian hoitopäiviä lähes puolitoistakertaisesti koko maahan verrattuna.
Nuorten mielenterveyspalveluissa tulisi lisätä osaamista ja resursseja peruspalveluissa. Lisäresursseja tarvitaan kouluterveydenhuoltoon. Työnjako kaupungin ja sairaanhoitopiirin nuorisopsykiatrian välillä on toimiva.
services from hospital districts to individual municipalities. Development of the mental health care is part of a large scale reform of social- and healthcare services in Finland. The reform reflects ideological rethinking through focus on social
participation and increased influence of market economy thinking in public sector services, as well as through aims to decentralise the service structure. The central aim in the field of mental health care has been to reduce the need of long term care,
to develop and increase the amount of non-institutional care, to focus on development of user oriented services and to encourage independent initiative abilities. Early intervention and preventive work is also prioritised in the development of mental health care services.
Development has taken place based on new legislation and on national recommendations, and has lead to reorganisation of service structures. Strategic governmental development projects have been the Target and Action Plan for Social
and Health Care (TATO), the National Development Plan for Social and Health Care Services (KASTE programme) and the “Mieli 2009” plan for mental health and substance abuse work.
Municipalities are responsible for providing mental health services, mainly through primary health care, social services and the psychiatric specialised health care. Municipalities may also purchase mental health care services from private and
third sector service providers.
The supply of outpatient services has not yet reached a sufficient diversity, despite purposeful development measures. The number of sectioned minors has increased greatly, which reflects the shortcomings of outpatient care for children. The rising number of persons granted early retirement pension due to mental health problems indicate shortcomings in mental health care and a reduced acceptance of mental illness on the job market. The amount and diversity of occupational services
for persons suffering from mental illness is inadequate, and realistic job opportunities are seldom offered. Housing services for persons suffering from mental illness often become permanent living arrangements, rather than temporary, rehabilitating housing arrangements. Neither occupational services nor housing services for persons suffering from mental illness seem to meet with the
rehabilitating aims set for such services.
Currently, the reformation of mental health services in Finland is still in progress, as the transmission to and development of a versatile network of non-institutional care continues. The dismantling of institutional and hospital care of mental illness, which begun in the 1980s, has drastically reduced the number of in-patient psychiatric beds. The reformations can, despite the reduction of resources for psychiatric care during the 1990s, be considered a success. Suicide rates have decreased, also among patients recently discharged from hospital care. The volume of non-institutional care has increased, however further development is needed in order to acquire a well functioning, versatile community service network. Service centres for labour have developed individual, multidisciplinary methods for support which prevent marginalisation. A positive development has also taken place in mental health services provided by third sector actors. The Mental Health Act, mental health related public debates, and the openness and public appearances of well known persons suffering from mental illness, have increased the openness towards mental health issues and the support of non institutional care. The transmission to outpatient services has however not been successful in increasing social participation for persons suffering from mental illness. No realistic methods for reintegration and rehabilitation have been provided for persons suffering from severe mental illness. Extended institutional care has been, in some cases, substituted by extended stays in housing service units that do not support rehabilitation and increased social participation.
The reformations have prepared the way for a diverse network of outpatient services and occupational services. However, prejudice, inflexibility and a lack of will seem to be the key obstacles that hinder a successful inclusion of persons suffering from mental illness into all sectors of society.
the European Pact for Mental Health and Wellbeing, and it highlights the main findings and conclusions from the EU
Thematic Conference on Preventing Depression and Suicide Conference, held in Budapest in December 2009.
• The mental health of the population is an important resource for the EU and needs to be actively developed and protected. Mental health in terms of wellbeing and cognitive, emotional and social skills is
produced not in the health system, but where people live their lives: in the family, among friends, in kindergartens, schools, work places, local community, culture and sports. Therefore, mental health is not
a sole responsibility for the health authorities.
• Failure to promote mental health has had severe consequences to European economy, welfare and wellbeing. Today, no other health condition costs more to Europe than does mental disorder, in terms of
lost productivity, active disability and sickness absence costs, and in terms of suffering. The burden comes primarily from common mental disorders such as anxiety disorders, depression and alcohol abuse,
which – paradoxically - are also the easiest and least costly to prevent.
• Promotion of mental health and prevention of the common mental disorders require that we address the social determinants of mental health and disorders; i.e. living conditions.
• Mental health must be incorporated into all policies where arenas were people live their lives are planned and regulated, i.e. in all policies at national, regional and local level. Routine assessments of the
impact of all policies on the population’s mental health and equity should be introduced.
is based on tax-funded public services and a high level of social protection. Improvements in mental health and mental health services have been
on the agenda in these countries during recent decades. Mental health services have undergone a thorough reform, from an emphasis on
psychiatric institutional care to the current emphasis on out-patient care and social participation. The reduction in numbers of hospital beds for
psychiatric patients, especially for those with long-term disorders, has been met by an increase of psychiatric treatment in primary care and by
growth in housing institutions provided by social care. In spite of the reforms, there is still a considerable life expectancy gap between people with
mental disorders and the rest of the population.
A core element of Nordic mental health policies is a focus on mental health promotion, preventive actions and social inclusion. Acknowledging
that determinants of mental health often lie in non-health domains such as social and family policies, labor policies and education policies, the
Health in All Policies approach has been developed. Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. In Europe, different models and best practices have been developed to secure that public policies across sectors systematically takes into account the mental health implications of decisions and avoids harmful mental health impacts. This includes effective safeguards to protect policies from distortion by commercial and vested interests and influence. Especially in times of economic hardship, nonhealth policies may have a decisive impact on populations’ health including mental health.