Why integrate mental health and substance abuse treatment?

10.04.23 Mauri Marttunen 1

PSYCHIATRIC DISORDERS AND SUBSTANCE USE

Psychiatric disorders and substance use problems are

1)Prevalent in the population

2)Cause marked burden, disability, and mortality

3)Secondary costs of mental health and SUD problems remarkable

4)Are commonly comorbid

5)Need to treated both comorbid (mental disorder and SUD) disorders

2

PREVALENCE: Lifetime prevalence of psychiatric disorders among 20-34 year-olds in Finland Suvisaari & al. 2009

Men Women Total

Depressive disorders 11.4% 24.2% 17.67%***

Bipolar disorders 1.3% 2.5% 1.9%

Anxiety disorders 8.4% 16.9% 12.6%**

Substance abuse or dependence 20.9% 7.4% 14.2%***

Eating disorders 0.3% 6.1% 3.35***

Any Axis I disorder 35.3% 45.6% 40.4%*

Personality disorders 8.0% 5.5% 6.8%

Difference between men and women: * = P<0.05, **=P<0.01, ***=P<0.001

PREVALENCE:Overuse of alcohol (AUDIT – C)

10.04.23 Esityksen nimi / Tekijä 4

DISABILITY: New pensions in 2011

• All new pensions: N = 25037

• New pensions due to psychiatric disorders:

N = 8008 (32 % of all)

Three most important disorder categories:- mood disorders: 4844 (60 % of psychiatric disorders)- schizophrenia and schizophrenic psychoses: 1212- mental retardation: 608

10.04.23 Esityksen nimi / Tekijä 5

MORTALITY caused by alcohol and drugs among 15-34-year-olds, by alcohol in 35-64-year-olds

10.04.23 Esityksen nimi / Tekijä 6

0

10

20

30

40

50

60

70

80

9020

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Alkoholi- jahuumekuolleisuus 15-34 -vuotiailla / 100 000vastaavanikäistä

Alkoholikuolleisuus 35- 64-vuotiailla / 100000 vastaavanikäistä

www.sotkanet.fi

In 2011: 1 889 alcohol-related deaths, 1447 males, 442 females

Key objectives of the social welfare and health care reform in Finland

•Promotion of the health, well-being and social safety of the population

•Guaranteeing equal provision of social welfare and health care services in all parts of the country

•Strengthening primary level social and health care services

•Delivering a cost-effective, high-impact service structure

Pekka Järvinen, Ministerial Counsellor 6 27 June 2014

7

Responsibility for arranging services

• Responsibility for arranging the services will rest with five social welfare and health care regions

• The draft act does not specify the boundaries or names of the regions

• Arrangement and provision of services will be two separate entities

• A joint municipal authority in the social welfare and health care region will be responsible for ensuring that the residents of municipalities in the region and others entitled to use the services receive the services they need

Pekka Järvinen, Ministerial Counsellor 6 27 June 2014

8

Mental health and SUD services in the reformChallenges?

• Empahsizing the patients´ needs: Easy access to primary care services

• Administration of social welfare and health care regions Are the leaders and experts aware of patients´needs for mentalhealth and substance use services?

• Need to strengthen the role of universities and research Research, development and assessment of services

• Strategy: The importance of mental health of the poplationas a strategic aim

• Funding and resources: A reasonable proportion of the costs of health care (>10%)

• Balanced development of psychiatric and SUD services: Promotion, prevention, early treatment, acute treatment, development of outpatient care, continuous quality assessment and assurance

10.04.23 9

The national plan for mental health and substance abuse work Includes 18 proposals in 4 groups

I Strengthening the status of service users

II Emphasising the importance of prevention and promotion

III Service redesign – into a functional entity

IV Development of steering tools

The national plan for mental health and substance abuse work

• Coordination of services by municipal authorities

11

Thirdsector

Outpatientcare

Rehabilitationand

housing

substance abuse

services

Privatesector

Hospitalcare

The patient

Primary care and easy access- Psychiatric nurses and social workers, GP, consulting psychiatrist

How to assess the new services?

• Cost – effectiveness – costs are “easy” to measure, how to measure effectiveness?

• Use of services measurable by registers

• Structure – primary vs secondary care, integration – how to know and assess the optimal balance?

• Diversity of services – do services meet the needs of the population?

• Impact for mental health and use of substances?

• Customer satisfaction

=> Several unsolved questions!

12