Finland

Country

• Population 5.5 milj, tensity 15 inh/square kilometer. Health care expenditure 7.7 % on 2008 (has declined from 9 % 1991)
• 15 % of the costs of treatment of mental health problems to treatment of depressions. Out of early retirements because of mental health problems 49 % due to depression.

Psychotherapy in the health care system

• Psychotherapy provided by two ways: (1) main part introduced by the public open access free psychiatric outpatient and inpatient system. The whole country organized into 22 Health Care Districts for special health care. In addition some part of the acute services organized by municipalities since midd of 90’. In addition (2) the National Insurance is obliged for organizing psychotherapy for every client by the referral of Psychiatrist since 1/2011. Previously this was based on judgment after the referral of psychiatrist. The second option is meant to support private praxis psychotherapy for children, adolescents and adult clients. National Insurance covers the psychotherapy for two years and after that evaluation is made once a year. First only long term psychotherapy was financed, but since 2007 also time limited psychotherapies financed.
• In the public system the indication for psychotherapy can vary, but in the private sector financed by National Insurance it has to be based on diagnosis. The psychotherapy form is based on the specific needs of the clients. It includes individual psychotherapy (mainly psychodynamic, cognitive or cognitive behavioural, and solution focused), family and couple therapy and group psychotherapy. In private praxis family and couple therapies are the new comers in financing.
• In public sector every health care district has its own authorization that is based on Guidelines for Treatment of Excellence in most severe mental health problems as schizophrenia, depression, personality disorders or alcohol abuse. In National Insurance financed psychotherapies the psychotherapist needs to have the License for professional title Psychotherapists and in addition to be registered by the National Insurance.
• Quality management requirements are on the way to be developed. In this respect the modern psychotherapy research has become more popular while focusing on therapy monitoring in session to session basis, even if it is not yet official.

Psychotherapeutic Professionals

• The license for using the professional title “Psychotherapist” is law regulated since 1994. This presupposes at minimum 3 to 4 years Psychotherapist training part time. To be qualified as psychotherapy trainer at minimum two years extra training is needed.
• Psychotherapist training programs are mainly multi professional so that nurses, social workers, theologizes, special pedagogies or teachers in addition to medical doctors and psychologists can be qualified as psychotherapist. A new decree starting 31.12.2011 defines that all psychotherapy training should be organized in universities either in psychological or psychiatric institutions. In 2008 4500 psychotherapists existed in official registers. Not all qualified take the professional title Psychotherapist.
• In public sector services many other professionals and students do psychotherapeutic practices under the supervision of qualified psychotherapists.
• National Supervisory Committee for Welfare and Health (Valvira) is the authority that examines and verifies new psychotherapy forms as legitimized form of psychotherapy.

Psychotherapy for Depression

• Guidelines for treatment of depression are followed to define the role of psychotherapy both in public sector services and in National Insurance financed psychotherapies.
• In case of at least moderate depression combination of anti depressive medication and psychotherapy is most often used. Main part of psychotherapy for depression is psychodynamic, cognitive or cognitive behavioural or solution focused individual psychotherapies but couple therapy is on the way to become an option because of the new effectiveness research that support the importan¬ce of having the spouse involved in the psychotherapy for depressed clients.
• Shortcomings are the still all too heavy focus on medication both in early phase and in the longer term treatment. In some Health Care Districts this practice means that clients only after a long term of medical treatment have ac¬cess to psychotherapy and this increase the poor prognosis.

Desirable Changes to Health Policy

• For me the preference is developing public sector psychotherapy. This seems, however, not to be the politics of the government, but private praxis psychotherapy is prefer¬red. This always means poorer access to adequate treat¬ment for poor people, because private praxis always presuppose partly own financing of the psychotherapy. Psychotherapy training covers the entire country and this is a big improvement that has happened during the last 10 years. But still private praxis is more available in big cities, which again increase the unbalance of receiving best practice therapies.

Author
Jaakko Seikkula. Ph.D., Professor in psychotherapy, Department of Psychology University of Jyväskylä. Finland.

The text above is an excerpt from the paper "Psychotherapy in Europe – Disease Management Strategies for Depression. National Concepts of Psychotherapeutic Care".

You can download the paper here.