§71, Alm.del - 2006-07 - Endeligt svar på spørgsmål 1: Spm. om at sammenholde psykiatriske patienters tilbud i psykiatriske hospitaler i Vest Lapland med øvrige tilbud for patienter på andre sygehuse i Finland, til indenrigs- og sundhedsministeren

Mental health services in West-Bothnia health district in the light of statistics and registers

Introduction

National registers and statistics in the use of mental health services and treatment practices are comprehensive and informative only regarding hospital treatment and use of medication. Regarding outpatient community based services they are not very reliable neither regarding the effectiveness of the treatment.

So itâ€™s not at all easy to try to analyse regional treatment practices looking and comparing the health districts in national registers.

I will review here shortly two recent publications:

Atlas of Mental Health (2005) website: http://groups.stakes.fi/MTR/EN/publications/publications.htm
The treatment of minors under age 18 in psychiatric hospitals (2006) (in Finnish), website: http://www.stakes.fi/verkkojulkaisut/raportit/R13-2006-VERKKO.pdf

Indicators of West Bothnia health district in Mental Health Atlas

The number of outpatient visits because of mental health problemsÂ in 2002

The figures (including both primary and specialised care) visits:

the whole countryÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â 385 per 1000 inhabitants

West Bothnia 430 per 1000 inhabitants

As a summary some what more outpatient visits than average

Use of psychiatric hospital in 2003

Index whole country Â Â Â Â Â Â Â Â Â Â Â 100

West Bothnia

Inpatient days 90

Treatment periodsÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â 107

PatientsÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 95

As a summary no difference compared to the whole country in the use of psychiatric hospital

Involuntary psychiatric hospital care in 2000-2003

the whole countryÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 25 % - 27 % of all patients

West Bothnia 11 % - 23 % of all patients

As a summary in West Bothnia is less involuntary psychiatric hospital treatment than in the whole country

Indicators of West Bothnia In the treatment of minors under age 18 in psychiatric hospitals

The time periods followed were 1995-1998, 1999-2001 and 2002-2004

	1995-1998		1999-2001		2002-2004
	Whole country	West Bothnia	Whole country	West Bothnia	Whole country	West Bothnia
Patients	135	18	212	76	244	98
Treatment days	121	6	157	28	166	36
Length of treatment periods	55	22	46	27	43	27
Involuntary treatment	19	3	42	8	43	11

Patients are per 100000 minors

Treatment days are per 1000 minors

Involuntary treatment is per 100 000 minors

As a summary West Bothnia used during the last 10 years absolutely least of all in Finland psychiatric hospital treatment in the psychiatric care. This was true in the number of patients, in treatment days as well as in involuntary treatment.

Conclusions

The registers does not tell very much about the effectiveness of the Keroputaa model especially regarding the treatment of adult patients. They tell that in the treatment of minors hospital treatment is used minimally, but they donâ€™t tell why. The Keroputaa model is certainly one explanation but there can be also other explanations like using more social institutions than the other parts of Finland.

Personally I see the Keroputaa model very interesting, human, patient- and family-centred. But I have been developing these kind of models from the beginning of 80â€™ies. So perhaps I am not the most objective person in answering the questions about the Keroputaa model

Timo Tuori

Senior medical officer

MD, PhD, Docent in Psychiatry

STAKES