A Finnish approach to mental health and recovery

30th March 2017

The Finnish Association for Mental Health (FAMH) recently celebrated its 120th anniversary. Here, Johannes Parkkonen, Project Coordinator at FAMH, provides an insight into the work of one of Europe’s oldest mental health organisations.

When what is now the Finnish Association for Mental Health (FAMH) was founded 120 years ago, times were quite different from today. Finland was still a Grand Duchy of the Russian Empire, and no one could yet dream of things like an e-newsletter. In fact, even electricity was not yet very commonplace. However, a small group of concerned individuals, mainly doctors and professors, came together on 19th January 1897 at the Music Hall of the University of Helsinki for the founding assembly of the new “Security Association for the Insane.”

They were concerned about the difficulties of reintegration into society for patients who left the Lapinlahti mental asylum, their lack of secure homes in the community, as well as tackling the prevailing prejudices that the public had towards the insane. So, apart from different language that was used, the issues that were important to them were not very different from what mental health organisations focus on today. And in those days health care was quite generic and went hand-in-hand with the care for the poor, although there was not yet talk about social determinants of mental health. What really stood out in these early days was the emphasis that the founders of our Association put on the importance of the patients’ opportunity to social participation and having an adequate social status. This was quite revolutionary for the time and could in some ways be seen as the predecessor to the human rights approach to mental health today.

In the following 120 years the Association has seen Finnish independence, 100 years ago, the devastation following a civil war and the Second World War, subsequent rebuilding and creation of the welfare state, and a few name changes. Throughout this time a strong belief that people who experience mental health problems should have the right to live as part of the community, and that recovery is not only possible, but should be seen as a goal, has been guiding the work of FAMH. In the early years another important and enduring principle was also established that is still alive today. FAMH develops and pilots new initiatives and approaches that can become established service practices, but it does not replace public mental healthcare services. Continuous development of our volunteer work, especially in creating guidance mechanisms and debriefing opportunities for the volunteers who provide invaluable support to people in crisis either face-to-face, on the phone, or online, has also been a cornerstone of our ability to persevere through many challenging times.

So how does the world’s oldest mental health NGO look into the future? We need to continue finding the same courage and vision as our predecessors to effectively address the challenges in our contemporary society. We know some of the key challenges that we are facing: demographic change, climate change, and the increasing sense of uncertainty and insecurity amidst the rapid technological change and its impact on our social interaction, economy and jobs. However, it is also important to be prepared to react quickly to unpredictable developments, such as the sharp increase in refugees in 2015, many of whom had experienced severe traumas and needed support beyond what the public health services have been able to offer.

Our vision of Finland is a vibrant civic society in which people are empowered to make use of their own strengths and resources. Mental health skills and literacy play a significant role in achieving this vision. Learning these needs to take a life-course approach, which in Finland has taken steps forward recently. Our new school curriculum that came in effect last autumn now includes mental health literacy and skills, and they are clearly stated instead of being disguised behind a euphemism.

This will help build strong mental health foundations for our future generations, but there is also a need to strengthen mental health skills of today’s adult population. And our calls for action on this have not gone unanswered, as the Finnish Ministry of Social Affairs and Health granted two-year funding (2017-18) for FAMH to vastly expand the coverage of Mental Health First Aid (MHFA) training in Finland. The programme will train 26,000 new people in these essential life skills and incorporates both versions of the MHFA. The original Australian model that is also used in Scotland, which focuses on recognising the symptoms of common mental health problems and supporting the person, as well as the “Mental Health as a Life Skill” model that has been developed in Finland. This puts more emphasis on learning about one’s own mental health – what are the protective and risk factors, how to recognise and talk about  emotions, coping with life’s crisis, and dealing with stress. These courses have helped many people to realise that mental health actually means health, and that it’s ok to talk about it. Both when it’s doing well and also when there are challenges with it.

Ongoing innovation is also needed to ensure we find ways to support older people and enable them to lead an independent and fulfilling life as long as possible. One interesting development in this is a new mobile crisis support service for older people, which takes the support to the home of an older person. It acknowledges both the meaning of one’s home as a personal, intimate place and the effect of difficult life situations on the client. With mobility and other difficulties that older age can bring, it is easy to feel like one is not seen or heard, which deepens the crisis. With in-home services, it is possible to be truly present, listen to the client, and respect their right to self-determination.

Although there is a need to empower people and strengthen their own resources, it is essential to remember that mental health is also greatly shaped by different determinants – the social, economic, and physical environments in which we live. One of the most concerning current trends is the growing social inequality, and its impact on the mental health of the most socially deprived. Influencing policy to reverse this trend is a strategic priority for FAMH. Action in mental health needs to be universal, across the whole of society. But at the same time, it needs to be proportionate to need in order to level the social gradient in mental health outcomes. Tackling these challenges effectively requires action across sectors, so one of the key challenges for the future remains convincing stakeholders beyond the health sector that they indeed have a stake in good mental health for all.