On the one hand, Estonia's mental health system is more diverse than ever. However, it must also be acknowledged, that certain services are still lacking, writes Minister of Social Protection Signe Riisalo (Reform).
The work, which (we) began in 2021, will result in a total of €7 million being invested in mental health policies next year. We have come a long way in a short time, but this long-neglected area is still only just starting to develop.
In our two years in government, we have supported local authorities in expanding mental health services, contributed to covering salary and training costs for psychologists, supported a vocational year for program clinical psychologists for two consecutive years, opened a mental health department at the Ministry of Social Affairs, and much more.
The intensity of our action so far has been due to, among other things, the poor indicators when it comes to the mental health of our children. According to health insurance data, between 2016 and 2021, 12 percent of adults were diagnosed with depression and 10 percent with anxiety disorders. However, for young people aged 15-24, the risk of both depression and anxiety disorders was, according to the results of a self-report questionnaire, up to double the level of the national average.
Overview of what has happened so far
While 'prevention' is the key word for our future work, let's take a look at what has been done so far to mitigate the current situation and trigger further change.
For example, to address the shortage of specialists, for two years running, we have funded a vocational year for clinical psychologists. As a result, hopefully the number of specialists will increase many times over.
This fall, the Riigikogu approved amendments to the Health Services Organization Act, which will make it much easier for people to see a clinical psychologist. The state is also funding a vocational year for psychologist-counsellors and, together with the Ministry of Social Affairs, we are offering local authorities the possibility to apply for additional funding to facilitate the provision of mental health services at the local level.
Among other things, the state funds respite care in nursing homes, victim support and mental health hotlines, the Estonian Coalition for Mental Health and Wellbeing and the NGO Peaasjad (Head Matters in English). Counselling and support systems are also in place in the education system. For example, for children with special needs, the state is developing new interventions to ensure that assistance is needs-based and reaches children as soon as possible.
On the one hand, Estonia's mental health system is more diverse than ever, but we have to acknowledge, that certain services are still lacking.
Alongside the development of support services, prevention and awareness are also critical. In other words, measures and techniques to ensure that people have sufficient opportunities for self-awareness, to seek help at the right time, or to help pull themselves out of a hole. This is how we, as a country, want to invest in people's mental health.
Exacerbating, rather than acting to prevent these kinds of concerns will lead to a range of problems, which will be far more costly to society and individual families. This means, that much-needed extra funds will certainly be spent on mental health services to prevent the need for psychiatric help, to support children and young people, and continue work on developing victim support services.
As for young people, while risky behavior among children has decreased over the last 15-20 years, the number of children experiencing episodes of depression has increased. Our children are doing better, but feeling worse. The Health Behavior among Schoolchildren in Estonia survey (HBSC) has identified children's home environments, as well as relationships with parents and other peers as the reasons behind this.
Research has consistently shown the hugely positive effects of a safe home, healthy diet and supportive parenting when it comes to child development. We therefore believe that more resources need to be invested in interventions, which contribute to the safety and well-being of children, so that future generations grow up mentally healthy and strong.
Specific interventions that target children's mental health through prevention include supporting the development of parenting skills, as well as children's social-emotional skills and self-awareness. This also involves integrating (awareness of) mental health issues into curricula and preventing abuse.
Developing parental skills is also a specific focus of UNICEF, and a number of evidence-based programs to do so have been developed worldwide. In Estonia, for example, the "Imelised Aasted" (Wonderful Years) program is available. There are also many different initiatives in the school environment in Estonia, such as (Finnish anti-bullying program) KiVa and VEPA (a behavioral skills game to help develop self-control socio-emotional skills through play – ed.).
For parenting education, however, we have already laid the foundations. We have implemented the evidence-based parenting program "Imelised Aasted" mentioned above, and we also have a website, "tarkvanem.ee," where parents can find advice about how to support their child's development and prevent risky behavior. However, there is a clear need to add to the parenting education toolbox, and this is something that the Institute for Health Development is working towards.
For example, the continuation of the "Imelised Aasted" program will be brought to Estonia, as will parental education shortcuts, among other things. In the same way, in cooperation with local authorities, we need to think about other services, which can help families to cope socially, economically and emotionally.
Our future journey together is therefore a multifaceted one. On the one hand, we must learn to maintain and support our own mental wellbeing, because good mental health is not just the absence of a disorder or worry. It is a connection between ourselves and our emotional world.
We also need to learn to notice the people around us, and to break the stigma of mental health problems together. No single concern is not too small to seek help. And surely, the state has to continue to try to find ways to provide people with urgent help.
Despite our efforts to alleviate the drought in the mental health profession, we will unfortunately have to live with a shortage of professionals in the field for some time to come. This is why, in order to achieve a system whereby services meets people's needs, we need to focus on providing mental health support in local communities: during primary health care, at a local level, but also outside the health care system, in education, sport, culture and the workplace.
There are no quick and easy solutions to these issues, band-aids do have a tendency to fall off after a while. The answers, which best serve us all need to be complete and holistic. So, let's step up, and move forward together.
Editor: Michael Cole