The care for psychiatric conditions and substance abuse problems in Finland has undergone fundamental changes during the last decades both in terms of the type of services provided and the attitude of society and legislators. Since the 1991 Act on Mental Health (1116/1990) the system no longer relies on institutional care but mostly on outpatient services.
Further restructuring of mental and substance abuse services got into full swing in 2009 with the national plan for mental health and substance abuse work (Partanen et al., 2010), which defined the core principles and priorities in this area. The plan and the subsequent Health Care Act (2010) emphasized the client’s status, acknowledged the role of alcohol and drug abuse problems as part of mental health issues, and strived to strengthen integration of outpatient services and social care. Outpatient care includes the principle of low-threshold access to care with a single point of entry (for mental and substance abuse problems) and the expansion of preventive services. Legislation concerning involuntary treatment was also revised.
Outpatient psychiatric services are provided by mental health offices and outpatient departments of psychiatric hospitals, as well as by health centres, when there is the expertise. Social services, parishes, and NGO s also play an important part in the provision of care, as well as private and occupational care services for employees. An NGO , A-Clinic Foundation, provides a substantial share of outpatient and rehabilitative substance abuse services.
The role of psychiatric nurses has increased in outpatient care, particularly in the detection of depressive disorders. The latest development in outpatient care is the introduction of remote care, including Internet-based psychotherapy by the Helsinki University Central Hospital. This service has a part tailored specifically for adolescents. The improvement of child and youth psychiatry has been the focus of many policies of late ( MSAH , 2016a). In mental health, the age limit of adulthood is considered to be 23 years.
Due to the expansion and strengthening of outpatient care and other care settings, the percentage of patients needing in-hospital care has decreased substantially since the early 2000s. The reorganization of psychiatric emergency care services initiated by the 2014 Decree on emergency care services has led to the closure of several psychiatric institutions and the establishment of new inpatient wards in general hospitals with somatic emergency services.