Læknablaðið : fylgirit - 01.08.2003, Page 52

■ ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS
The mental health service system has experienced great changes
during recent years in Finland. Until the end of the 1970s, the mental
health care system was based on a great number of mental
institutions and an increasing number of mental health centres. It
also had an independent administration. As a result of the reforms
inside and outside psychiatry in the 1980s and 1990s, the number of
beds in menlal hospitals rapidly declined, and the use of psychiatric
outpatient care and complimentary services increased. The psychi-
atric care became fused with the specialised medical care system and
suffered from large financial cuts during the economic depression.
At the same time, parts of the specialised psychiatric care were
transferred to primary care and complimentary services were priva-
tised. At the moment, lack of financial resources, scattered admini-
stration, as well as the burn-out of psychiatric personnel and an alar-
mingly great lack of psychiatrists in the public services constitute the
greatest problems of the mental health care system in Finland. The
centralising of administration, the combining of separate psychiatric
specialities into larger service complexes, the developing of the
personnel’s working conditions, and the content of psychiatrists’
work may help the specialised psychiatric care in its current crisis.
S-XXIII/6 Saturday 16/8, 11:00-12:30
Current situation of the mental health services in Estonia
Andres Lchtmcts, MD, Veiko Vasar MD, PhD
andres.lehlmets@ltkh.ee
Over the last decade the changes in the social sphere of Estonia
have been tremendous. As an accession country to the EU the re-
sources spent on social and health care services are still many-fold
smaller then in the neighbouring Scandinavian countries; however,
the development seems to be more and more oriented to the social
welfare model of the North. The mental health services have to
struggle alongside with all the rest for the limited financial means.
In 2002 the overall budget of the Sickness Fund was nearly 315
million euros, out of which the specialist services received 146. The
mental health services spent 5.8 million euros (this figure does not
cover the reimbursement of drugs nor the social well-fare services
for the long-term mentally ill). Tlre nearly 80 000 outpatient visits
and 10 500 treated inpatients resulted in a mean expenditure of 87
euros per case.
As well as limited resources, Estonia is facing a serious shortage
of specialists in the mental health field. In 2001 the number of
psychiatrists was 170 (1.2 per 10 000 of population), 15 of whom
were working in child and adolescent psychiatry. 59% of the psychi-
atrists were working in outpatient units. Tliere were also 40 clinica!
psychologists, 9 social workers and 100 nurses with specialization on
mental health care. The problem is in the age structure, as many of
the doctors are reaching retirement age. The turning point in
training was in 2003 when the number of trainee posts was doubled
(from 4 to 8); however, there is little progress in increasing the
training of mental health nurses.
Early in 2003 the government adopted the Mental Health Basic
Document, opening a new horizon for the development of a more
elaborated mental health policy. For the time being the main focus
in developing the services is on the outpatient sector. At the same
time the vast decrease in the nurnber of hospital beds has resulted
in the mean stay of 15-18 days (depending on the region) that is
clearly not enough to fulfil the role of inpatient services. Another
problem area is the child and adolescent psychiatry, where the lack
of specialists as well as of clear development strategy is leading to
serious deficiencies in providing the services.
Estonian health care services are run on private (still mostly non-
profit) hospitals and public money (operated by a Sickness-Fund).
This combination makes a great challenge for mental health services
in order to be able to compete for the funding and other resources.
S-XXIV/1 Saturday 16/8,11:00-12:30
The growing needs for child and adolescent psychiatric
care: Ethical and political challenges
Páll Bicring, PhD, RN, Eirfksgötu 34,101 Reykjavík
pb@hi.is
In this paper it is argued that there are two main reasons for the
growing needs for children and adolescents psychiatric care. First,
there is evidence that mental health problems are increasing among
children and adolescents both in developed and developing count-
ries. Second, more and more youth behavior problems and self-
destructive behaviors are being defined as medical conditions. This
development has two critical aspects that caregivers need to exa-
mine before they can respond to it in a way that is clinically holistic,
ethical, and empowering for the children and adolescents. One
aspect faces the ethical and therapeutic considerations surrounding
situations in which the declining mental health of children and
adolescents can, to a greater or lesser degree, be understood as the
outcome of a dysfunctional family or an unjust social order. The
other aspect turns toward questions concerning the disciplinary
power that medicine exercises over psychiatric patients. After
drawing from medical sociology, psychiatric ethics, and the work of
Michel Foucault it is concluded that caregivers need to recognize
the socio-cultural nature of children's and adolescents' mental
suffering if they want to have a role as empowering advocates. To
reach that goal Ihey need to recognize the inevitable power imba-
lance in the caregiver-patient relationship and seek guidance in
postmodern thinking which encourages us to abandon universal
theories about the caregiver-patient relationship.
S - XXIV / 2 Friday 16/8, 11:00-12:30
Seven keys to recovery - clients perspective
Elín Ebba Ásmundsdóttir, MSc, Chief Occupational Therapist, University Hospital,
Psychiatry and Ass. Prof., University Akureyri, Iceland., Laugavegi 53A, 101
Reykjavik, Iceland
ebba@landspitali. is
Research on recovery and resilience in psychiatric disability is in its
infancy. This research aims to explore clients’ perspective on re-
covery in order to improve current polices and practice in mental
health services. The study identifies supports and barriers to re-
covery from clients’ perspective. Qualitative research methods, in-
dept interviews, group-interviews, and participation observation
were used with a diverse cross-section of subjects who consider
themselves “survivors” of mental illness. All interviews were audio-
52 LÆKNABLAÐIÐ / FYLGIRIT 48 2003/89