In Denmark, Norway, Finland and Sweden reforms within psychiatry have transformed inpatient care to the point where it has increasingly been replaced by outpatient care. The different countries have applied different solutions when reforming their mental health care systems, yet certain shortcomings such as complex service systems in which patients end up in a state of limbo and where cooperation among staff becomes difficult, can be found in all four countries. It is thus not possible to speak of a common Nordic welfare model within this area.
The first evaluation of the mental health care reforms in the Nordic countries generally shows that inpatient admission rates have greatly decreased and that the use of antipsychotic drugs has increased. It is a complex and slightly ambivalent picture that is being painted; as the Nordic mental health care reforms proceed they face the dilemma of optimizing the selection of treatments and social services, as well as providing users greater influence when it comes to the contents of care.
Professor Rafael Lindqvist and his research colleagues are responsible for a comparative analysis where results of the mental health care reforms in Denmark, Finland, Norway and Sweden are presented. The results show that the transition from a mental health care system where most patients are given treatment at one institution to outpatient care practices results in a number of deficiencies.
In spite of similar intentions, variations in service structure and work modes are significant in the four countries. This is true also when it comes to the patients. The number of inpatient beds has been greatly reduced in all countries but in other aspects, the results differ. For instance, when it comes to antipsychotic drug consumption, Finland is at the top while Norway is at the bottom. In Sweden accessibility to both in- and outpatient care is lacking. Furthermore, the most vulnerable sections of the population vary between the different countries.
The report highlights the common problem of how to make the role of primary care clear and effective in the care- and support system; both in relation to inpatient psychiatric care services and social services. There has been no real development in user influence following the mental health care reforms. It is also obvious that equality in care is difficult to realize, especially in sparsely populated areas. The current challenge is to promote a change in attitudes and counteract stigmatization and discrimination.
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