New measures to improve mental health care accessibility in Estonia

CONTEXT

The mental health support systems in Estonia and in many other countries are currently heavily relying on specialized medical care and highly-trained specialists. The simultaneous lack of respective specialists is reflected in long waiting times, and in services concentrating to major cities. To counter these problems, Estonia has systematically been developing a more comprehensive system. These efforts have manifested into four main activites: 1) changing the Health Services Organisation Act in regards to psychological treatment and introducing new services and providers, to include psycho-social services and low intensity interventions; 2) implementing the Stepped Care Action Plan, that is focused on introducing low-intensity interventions for symptoms of depression and anxiety; 3) changing the Social Welfare Act, to relocate the funding for providing psychosocial and psychological support to local municipalities; 4) analyzing the qualifications and respective educational pathways of different mental health specialists, to get data for developing new ways to counter the lack of mentaal health specialists.

AN EXAMPLE OF IMPROVING THE ACCESSIBILITY OF LOCAL MENTAL HEALTH SERVICES IN ESTONIA

Mapping the problems

In April 2021, the mental health staff of the Ministry of Social Affairs interviewed local governments through regional crisis committees to gather information about their situation and needs regarding the mental health of their residents. Answers were submitted by 75 out of 79 local governments. The results indicated that local governments saw an increase in the mental health related needs of their people, especially among families, parents, and children. The most common problems were conflicts within the families, alcohol consumption, and problems related to distance learning. The local governments described their response (offering services, e.g., prevention, treatment) mainly as a case-by-case problem-solving. Additionally, local governments expected their role in regards to the mental health services pyramid to be clarified and access to counselling services to improve. From the discussions of survey results formed an idea of introducing a subsidy scheme for hiring and offering salary support for a local psychologist-counsellor.

The first pilot

In September 2021, two subsidy schemes were launched to foster non-clinical mental health support on a local level for a pilot period of four months. The first scheme was a salary and supervision subsidy for hiring a non-clinical psychologist (“community psychologist”) to work for the local community. The community psychologists are psychological counsellors, whose job is to prevent mental health problems from developing and promote mental well-being. The second scheme, the mental health service subsidy, was for purchasing a wide range of non-clinical mental health services from the service market, e.g., family therapy, peer support groups, art therapies, etc. After the pilot period, it was clear that the subsidy measures had been successfully received by the local governments.

Upscaling the measures

In 2022, the two subsidy schemes were offered with a budget of 1,3 million Euros. 42 out of 79 local governments (53%) used these measures, with the mental health service subsidy being more popular than the salary subsidy for a community psychologist. However, as of 2022, the budget was still partially underused, despite the continuous positive feedback from the local governments and despite many efforts put into introducing these measures and collecting continuous feedback. One of the reasons for not applying for the subsidy given by the local governments was that there was no specialist with appropriate competencies and allocated working time for doing this job. By 2023, the subsidy measures received wider interest, and within two months, 48 local governments applied for the schemes and booked the entire budget for the year.

Overall, it has taken about 1,5 years for the local governments to adapt to the change and offer various non-clinical mental health services in the community.