The Ostrobothnia Project 2005-2014

A development project of mental health and substance misuse work within The Hospital District of Vaasa, the Hospital District of South Ostrobothnia and the Hospital District of Central Ostrobothnia

www.pohjanmaahanke.fi

Mental health and substance misuse services • The municipalities are responsible for organising

the services• They can organise the services by themselves, in

co-operation with other municipalities or purchase services needed from private sector or from different kinds of organisations

Mental health services• Primary social and health care services are the first

source of help and treatment• If the primary services are not effective enough,

psychiatric outpatient treatment and sometimes inpatient treatment is needed

• There are 3 Hospital Districts in the Ostrobothnia area offering both psychiatric outpatient care (17 outpatient departments) and psychiatric inpatient care (app. 300 psychiatric beds)

• Private and 3rd sector organisations offer psychiatric rehabilitation, housing services and day centres

Proportion of people on sick leave due to mental illness

Number of psychiatric beds in Nordic countries

beds/1 000 inhabitants

Iceland Finland Denmark Norway Sweden

Source: Nomesco

Number of long-stay patients per 100 000 inhabitants in Finland

Source: MINDFUL database/indicators

1990 1995 2000 2004

Substance misuse services

• Substance abusers are treated in primary health care and general social services

• When these general services aren’t sufficient enough there are also special services available

• In the Ostrobothnia area there are 4 outpatient clinics

• The municipalities purchase institutional care, rehabilitation and housing and support services from organisations and private enterprises

Total consumption of alcoholic beverages 100 % alcohol per capita, litres

Source: Quick facts 2008 about Alcohol and Drugs. Stakes

Consumption and detrimental effects on alcohol, 1969-2007

Source: Quick facts 2008 about Alcohol and Drugs. Stakes

Sale of alcoholic beverages per capita, as litres of pure alcohol 2006 2007 2008 South Ostrobothnia hospital district

6,6 6,8 6,8

Central Ostrobothnia hospital district

6,4 6,4 6,4

Vaasa hospital district 6,1 6,4 6,3 Whole country 8,4 8,7 8,5

Leading causes of death at ages 15 to 64 by sex, 2007

The Ostrobothnia Project

45 municipalities, part of them are bi-lingual

3 hospital districts

440.000 inhabitants

Background• In 2005, Finland has made commitments to

promote mental health by signing the Declaration of the WHO European Ministerial Conference on Mental Health

• Raising awareness of need for promotion and prevention actions and development of services

• The European Commission’s Green Book on mental health put further pressure on national policies

• The Ministry of Social Affairs and Health initiated an open call for development proposals

National co-operation• In 2005-2009 there have been three national

development projects for mental health and substance misuse:– Ostrobothnia Project –comprehensive project

in mixed urban/rural area with focus on promotion and prevention

– Vantaa Umbrella Project –urban population, with focus on depression

– Lapland Project –rural area with depopulation –focus on maintaining services

• The projects have participated in the formulation of The national plan for mental health and substance abuse work (Mieli 2009)

Progress of the Ostrobothnia Project 2005-2014• 2005-2006: Start-up, forming alliances, building

companionships, raising mental health and substance misuse on the agenda

• 2007-2009: Municipal communal and regional strategies of mental health and substance misuse, implementation of MHP/MDP actions starts. The project seeks active co-operation in European networks.

• 2009-2012: Continuing and deepening the change from regional to provincial and united areal strategy of mental health and substance misuse

• 2013-2014: Mainstreaming the project results and building structures for sustaining of project actions

Ostrobothnia Study –the evaluation of the Ostrobothnia Project

– Process evaluation – Outcome research – Population survey – Evaluation of the key interventions

Development work in the Ostrobothnia project 1. Strategy work 2. Mental health promotion, prevention of

mental health disorders and substance abuse prevention

3. Improving care and services4. Mental health and alcohol and drug

rehabilitation 5. Working life

1. Strategy work within the Ostrobothnia Project • The Ostrobothnia Project supports

municipalities and regions in the drafting of strategies to address issues concerning mental health and alcohol and drugs.

• Besides developing services, these strategies also take into account the promotion of mental health and substance-free lifestyles.

Mental health promotion, prevention of mental health disorders and substance abuse prevention • A three-part process:

1) Increasing public awareness of mental health and substance abuse issues.

2) Developing methods that will transform the co-operation both between social welfare and health care and between other actors.

3) Rooting mental health promotion and prevention activities in everyday mental health and substance abuse work.

Improving care and services• Care and service chains• The quality of and access to mental health

services is improved by promoting the use of the national Current Care guidelines.

• Renewing service structures is the way to improve access to services.

• The Ostrobothnia alliance against depression is a broad-range development project concerned with the prevention, early recognition, high-quality treatment and rehabilitation of depression.

Mental health and alcohol and drug rehabilitation • The attitudes, expertise and structures should

enable participation, residence and work in the context of individual needs-based rehabilitation.

• The primary alternative for rehabilitation is outpatient and home-based rehabilitation.

Working life

• The underlying objective is to provide managers and occupational health care with the appropriate training and tools to better support wellbeing at work.

• Work communities should have better capacity to promote mental health and substance-free lifestyles.

Mental health promotion, preventive mental health care and substance abuse prevention – some tools introduced by the project

• The FRIENDS programme for the prevention of childhood anxiety and depression (For more on the FRIENDS programme, go to www.friendsinfo.net.)

• The BARO instrument (Basis Raads Onderzoek/Basic Council Examination) can be used as a screening instrument to assess the needs of young people, introduce case management in social work at school and evaluate the need for after-care.

• Responsible alcohol sales• The Ostrobothnia project has also contributed to

introducing the model ‘Time Out! Getting Life Back on Track’ in the regions of Ostrobothnia. (More: http://info.stakes.fi/aikalisa/EN/index.htm)

Some tools…2

• Mental Health First Aid (MHFA2)• Maternal prenatal and postpartum depression

(MASU). A key goal of the training is to support grass-roots professionals in the identification and treatment of maternal depression.

• Prevention of suicidal behaviour and domestic and family violence

• Locating, identifying, treating and providing psychosocial support to older people with depression

• Training and implementation of The Effective Family methods to support families and children when a parent has mental health problems or substance abuse.

• Co-operation with various 3rd sector organisations

Changes in the Ostrobothnia project• From the beginning of November 2009 the

project’s regional division and funding system will change, as a result of The national development programme for social welfare and health care (KASTE).

• The three Hospital Districts will continue development work within two new projects: – the Hospital District of Central Ostrobothnia

as a partner in “Tervein mielin Pohjois-Suomessa” project

– the districts of Ostrobothnia and South Ostrobothnia will be part part of the “Välittäjä 2009” project on mental health and alcohol and drugs in Mid-Finland

Changes in the Ostrobothnia project• Despite of these organisational changes,

the Hospital District of South Ostrobothnia is fully committed to continue the Ostrobothnia project 2005-2014 and co-operation with Lanarkshire

• The Hospital Districts of Central Ostrobothnia and Vaasa are interested to know more about the work models of Lanarkshire

Some ideas about the co-operation