10 aims for psychiatry
1. Reducing the stigma
If the current trend towards outpatient care is to succeed, we need to work at and place greater emphasis on reducing the stigma of psychiatric disease.
To reduce the stigma, a national strategy will be needed, which the Finnish Psychiatric Association promotes through the Mielenterveyspooli (mental health pool). The social psychiatric division of the Association is working on appropriate options to achieve this end.
2. Early diagnosis and treatment of disorders
Insufficient emphasis has so far been placed on the prevention of psychiatric disorders. Further development of school health care through cross-professional cooperation is very important. Psychiatric disorders can be diagnosed early, and effective help can be provided.
Treatment of the first psychosis is crucial for the prognosis. Reducing the delay to treatment will improve prognoses and reduce mortality.
3. Increasing awareness
Mental health, methods for promoting it, and psychiatric disorders should be dealt with in health education classes at school. Such education will improve people's ability to 'read' mental health as well as their ability to maintain their own mental health and to seek help. The course of severe disorders can be affected by increasing awareness and thus improving the seeking of help.
4. Improving the availability of treatment
Psychiatric treatment should primarily be provided in outpatient care. This requires qualitatively and quantitatively adequate outpatient care resources. Low-threshold units for acute care, i.e. "psychiatric first aid units", should be established that patients can access without referral. Patients should have the right to stay in the unit for two days without the need to decide whether to admit them to hospital. In such units, each patient should be examined by a physician within 24 hours. Flexible services of this kind that patients can seek out on their own initiative might make it possible to reduce the need for actual hospital treatment.
Hospital treatment should primarily be based on voluntariness. Reducing involuntary treatment requires seamless cooperation between outpatient and hospital care, sufficient personnel resources and increased possibilities for home care. If outpatient and hospital care are far apart, lack of appropriate coordination will make improvement impossible. To reduce the use of compulsory measures, sufficient personnel resources and training of the personnel will be required. We should also keep in mind that involuntary treatment must not be reduced at the expense of the quality of treatment.
It would be justifiable to organise psychiatric hospital treatment within the context of general hospitals. This would improve the possibilities for somatic care of psychiatric patients and, on the other hand, the utilization of psychiatric expertise in somatic care. The particular features of psychiatry could still be preserved if the whole field of psychiatry formed a separate unit.
5. Writing clinical guidelines
Patients with psychiatric disorders receive evidence-based treatment more rarely than patients in other medical specialties. One of the main reasons for this is the significant regional variation in the availability and quality of services due to the small size of psychiatric units.
The Association promotes the writing of clinical guidelines and develops means for assessing how well such guidelines are known and how extensively they are applied.
Clinical guidelines define the principles for high quality in pharmacological treatment, other biological treatments and psychotherapies, as well as the procedures for monitoring treatment.
6. Monitoring of treatment outcomes
Outcomes of treatment should be regularly measured. Monitoring the outcomes of treatment is the only way to find out how well the aims of treatment are achieved. Monitoring outcomes helps to achieve more profound skills which, in turn, leads to improved outcomes and more effective utilization of resources. This increases the value added for the patient. Outcomes should be monitored throughout the therapeutic process. Information technology could be utilized more actively in monitoring.
No savings can be made in the costs of psychiatric treatment without imposing the costs on some other party or burdening the next generation. Good treatment can reduce human and economic losses from psychiatric disorders.
7. Emphasis on working conditions
Improving working conditions is important for the recruitment of psychiatrists and physicians wishing to specialize in psychiatry. At a good workplace, occupational safety is appropriately considered when issuing instructions and establishing practices, and sufficient possibilities are provided for professional improvement, training (2 working weeks/year) and supervision. Coping at work and prevention of burnout should be considered in internal training programmes and included in further development plans.
Work management should be considered when targeting resources already. In outpatient care units with more than 15 000 inhabitants per psychiatrist, work management is difficult and the amount of work excessive. Increasing work loads contribute to the discontinuity of psychiatric resources or to reduced quantity and impaired quality of work input per patient. Each unit should have at least three psychiatrists.
8. Integration of psychotherapeutic treatments in the public sector
Improvement of psychotherapeutic skills is a pivotal means of reducing the burden of disorders. In primary care, the use and mastering of such skills is insufficient. Even in secondary care, there is not always sufficient knowledge regarding the choice and utilization of methods suitable for use in the public sector.
Teaching of the required skills should be organised by secondary care and universities. Hospital districts and municipalities should train their personnel to use at least some time-limited form of psychotherapy. The possibility for providing psychotherapy in the public sector should be assured by appropriate working arrangements.
9. Improvement of various forms of cooperation between public and private sectors
In Finland, the private sector provides services complementing public health care, such as long-term psychotherapy. However, the integration of services is insufficient and patients do not know sufficiently well how to contact psychotherapists, which methods would be suitable for them, and which professionals can provide the required treatment.
The service system should develop practices suitable for local circumstances to better cater for patients' needs for support. Psychotherapeutic outpatient clinics specializing in assessment and guidance could ensure more flexible cooperation between the private and public sectors.
10. Autonomy of service users
Patients are autonomous individuals. Treatment aims at restoring the individual's ability, restricted by the disorder, to make independent and responsible decisions. Respect for the patient's autonomy represents a firm cornerstone for treatment. It should be noted that any restriction of autonomy during treatment primarily applies to the patient's ability to decide on the beginning of treatment. People with psychiatric disorders have the same rights to medical expertise as other citizens. People with psychiatric disorders have the same rights to work as other citizens, and practices facilitating return to work should be developed further.
Suomen Lääkäriliiton strategia (strategy of the Finnish Medical Association)
WPA Madrid Declaration (version of 2005): www.wpanet.org