Immediate access to therapy
This legislative motion proposes a new section to the Mental Health Act concerning the so-called Immediate Access to Therapy (“4 a §, Mielenterveyspalvelujen piiriin pääsy” (section 4 a, Access to mental health services)) and a change to paragraph 3 of subsection 2 of section 27 of the Health Care Act.
The Mental Health Act
Chapter 1 General provisions
Section 4 a Access to mental health services
Basic health care includes psychotherapy and other types of psychosocial treatment applicable to mental disorders. A health care professional shall assess the patient’s need for care on the third weekday from the day that the patient first contacted the health centre, at the latest, if the assessment could not be performed during the first contact. The psychotherapy or other psychosocial treatment performed in basic health care and deemed necessary for the mental disorder in question shall be arranged within four weeks of the assessment of the need for care, unless otherwise stipulated by medical, therapeutic or other similar factors.
The Health Care Act
Access to treatment
Section 27 Mental health services
Local authorities shall provide the mental health services required for health and welfare promotion among residents, which shall be aimed at strengthening the factors that help to maintain the mental health of individuals and society and at reducing and eliminating factors that stand to compromise mental health.
In the context of this Act, mental health services include:
1) guidance and advice on factors that help to maintain or stand to compromise mental health, provided in connection with health care, as well as psychosocial support for individuals and families, as necessary;
2) coordination of psychosocial support for individuals and society in unforeseen crisis situations; and
3) mental health services, including tests, treatment, and medical rehabilitation of mental health disorders. Basic health care includes psychotherapy and other types of psychosocial treatment deemed necessary for the treatment of mental disorders.
Mental health services included in health care services must be planned and implemented so that they form a functional entity with the social and health care carried out in the municipality.
Provisions on mental health services are also laid down in the Mental Health Act (1116/1990) and the act on social welfare (sosiaalihuoltolaki (30.12.2014/1303)).
Immediate access to therapy to expedite access to mental health care
Half of all Finns experience mental health issues at some phase of their lives, but only half of those suffering from mental health problems receive the treatment they need.
The proposed law reform on the immediate access to therapy would ensure everyone quick access to mental health care after their first visit to a health centre.
Immediate access to therapy fulfils the recommendation of the Council for Choices in Health Care in Finland (COHERE Finland), dated 23 November 2018, according to which all forms of psychotherapy and other psychosocial treatment and rehabilitation methods which have been found effective in mental health and substance abuse disturbances are part of the publicly funded range of healthcare services.
According to the recommendation, they must be offered as part of the target-oriented and appropriate treatment or rehabilitation of disturbances of various difficulties. After the proposed law reform, suitable early care would be offered already on the basic level of healthcare. The need for care must be assessed immediately when the person seeks help, and symptom-appropriate therapy treatment must begin within one month.
Not enough short-term psychosocial treatment available
Immediate access to therapy would cover the form of treatment appropriate for the patient’s symptoms and need for help, carried out by a professional in mental health work. A diagnosis by a specialist would not be required to start the treatment.
If a patient is considered to require continued treatment after the early therapy sessions, they are referred to specialist healthcare or Kela’s psychotherapy support.
Psychosocial short-term interventions are a research-based and effective means of treatment, but unlike other forms of treatment, they are not sufficiently available in public healthcare services. Psychosocial intervention refers to an appropriate early-stage psychosocial form of treatment, carried out by a professional in mental health work. The treatment may be carried out through individual, family or group therapy, if self-care, peer support, or support discussions are insufficient.
Short-term psychosocial treatment can be offered by trained healthcare professionals who carry out mental health work, whereas psychotherapy can only be carried out by professionals who have completed psychotherapist training as further education.
Immediate access to therapy would improve availability and equality of treatment
The costs of the treatment of mental health disturbances cause inequality among Finns. According to the recent OECD report, the connection between poverty and mental health problems in Finland is evident. Of all European countries, Finland has the biggest differences between the incidence of depression in the different income categories.
Immediate access to therapy would ensure treatment to patients even when they have no financial means to seek private psychotherapy. After the proposed law reform, patients would receive treatment even when they are not eligible for Kela’s psychotherapy support or when Kela’s rehabilitative psychotherapy is not a suitable form of treatment due to the high non-reimbursable cost or extended length of application period (the period from seeking help from a health centre to the start of rehabilitative psychotherapy is approximately 7–12 months).
A possibility for early short-term psychotherapy and other psychosocial short-term interventions on the basic level of public healthcare is necessary alongside Kela’s psychotherapy rehabilitation.
Kela’s rehabilitative psychotherapy is targeted at adults whose ability to study or work is threatened. It leaves out those on disability pension, for example. The regional distribution of rehabilitative psychotherapy is also unequal: the Uusimaa region has almost three times more visits to Kela’s rehabilitative psychotherapy than Lapland, even though the need is greater in Lapland, according to THL’s mental health index.
The proposed law reform would improve availability and equality of treatment. The deepening of mental health problems would decrease if help was available at the right time. The focus would shift from long-term psychotherapy which takes a long time to receive to short-term psychosocial treatment available to more people in need.
Immediate access to therapy would build an efficient basic level of mental health care in Finland and complete the current system by making help available more quickly, easily, and in a more customer-oriented manner.
Annual costs of immediate access to therapy at approximately 35 million euros
According to the OECD estimate (2018), the total annual costs of mental health disturbances in Finland are approximately 11 billion euros. Research shows that investments in mental health repay themselves multifold, as the use of illness benefits decreases and employer costs caused by sick leave and other working life costs decrease.
A low threshold mental health service system is more cost-efficient than a system based on specialist healthcare: early therapy is known to prevent the deepening of problems and decrease the use of other healthcare services. Organising early therapy services as part of public healthcare and increasing their availability would create significant economic health benefits.
Depending on the manner of organisation, the annual costs of the immediate access to therapy are approximately 35 million euros. Immediate access to therapy could partially be carried out utilising the current personnel resources, but additional resources would also be required. The cost of 35 million euros is formed of the work input and further education of the professional personnel carrying out the psychosocial treatment. The form of treatment and number of treatment sessions carried out affect the amount of required personnel resources. Carrying out 125,000 treatment sessions annually corresponds to approximately 800 person-years.
If those not participating in education or working life received early treatment through basic services, an estimated 7,500 people would be rehabilitated to working life every year. This would save approximately 340 million euros annually, due to the decreased use of benefits and increased amount of income taxes. Therefore, every euro invested in the immediate access to therapy would save almost ten euros overall. The reform would decrease social costs and increase wellbeing.