The internet has brought many benefits to people in the past decade including those with mental ill health, such as the use of online cognitive behavioural therapy and online forums helping to facilitate peer support. But in Finland, they have gone further, and it is providing better patient outcomes. Professor Grigori Joffe explains.
As many countries across Europe struggle to deal with rising demand for mental health services, Finland is improving service provision via an online portal, offering a range of services from a single source.
The Mental Health Hub (www.mielenterveystalo.fi) – a comprehensive range of mental health services that can be accessed through a single portal. By streamlining patient access to information and treatment, the Hub is enabling practitioners to address disorders at an early stage, for better patient outcomes. Plus, in an age of growing demand for psychotherapy and health budgets being stretched even further, the Hub aims to prevent mental healthcare costs spiralling out of control.
Offering a symptom-based local service finder, reliable sources of information, guides and self-help programmes, plus training and support for professionals, the portal also gives immediate access to ICT-assisted asynchronous therapies with no waiting list. All these services – for patients and healthcare professionals – are now available in one place, with each patient receiving the same high quality treatment and care.
At the heart of Mental Health Hub is a ‘symptom navigator’, which directs the public to appropriate local services based on the severity of their distress, but at the same time preventing any self-diagnostics. In addition, an automatic ‘psycho-educator’ provides reliable, common sense information on symptoms and disorders. This empowers public and professionals alike. For mental healthcare professionals, the Hub also offers education, training, advice and consultation opportunities plus various tools for measuring mental health.
Behind the scenes of Mental Health Hub is a modular IT platform, designed to support the growth and expansion of the portal, via diverse additional modules which include self-help; monitored peer group discussions; professional-guided, computer-assisted, internet-delivered cognitive behavioural therapy, consultations and professional training, to name a few.
The portal currently offers patients computer-assisted cognitive behavioural online therapies for depression, alcohol misuse, general anxiety, panic and social anxiety disorders, as well as a symptom control programme for bipolar disorder. A range of additional therapies is being developed, including bulimia therapy, scheduled to go live in Autumn 2017. As with previous therapies, these will also be available immediately with no waiting lists.
When the project began almost 10 years ago, there was no national co-ordination of mental health service providers. But when we reached out to the relevant stakeholders from the public, private and third sectors, we were met with an incredibly high level of enthusiasm; they all wanted to become involved.
This open and inclusive dialogue with all stakeholders was the primary, critical success factor of the project. From the government to private sector, it was quickly learned that all parties need to collaborate – don’t be selfish, speak to anyone and encourage cooperation for the benefit of everyone. By maintaining the patient as the central focus at all times, it guarantees the ethical nature of the project, which makes it straightforward for all parties to participate.
Another key learning was to start small and think rationally. It began by bringing together mental health and substance abuse professionals from the local catchment area and involved patients in the early stages. This approach created a basis for the service paths and the first version of Mental Health Hub was born.
Subsequent growth involved widening the geographical scope and collaborating with local professionals. This slowly grew until it had national coverage. Inclusion, discussion and co-creation all played a central role in the success of the programme.
Results to date
Overall, Mental Health Hub is helping to achieve better outcomes at less cost and the demand is finally being met. Now, primary healthcare practitioners are referring patients directly to the online therapies, which is improving the general mental health of the population with a minimal financial input.
In terms of some preliminary results, over the average three-month period that patients undertake their therapy, the mean Beck Depression Inventory score, for example, appears to reduce from 23 to 14 points, with almost half of the patients achieving remission (less than 10 points). And this positive progress seems to continue once the therapy has been completed too. These results are comparable to traditional therapies.
On the back of this success, we are developing the Hub’s platform model by applying it to other fields, such as social services. Live projects, in conjunction with regions across Finland, are already well underway.
Simultaneously, we are collaborating with other university hospital districts to build a government-funded, national Virtual Hospital at HealthVillage.fi.
Thirteen hubs have already opened, including Weight Management Hub, Women’s Hub and Pain Relief Hub. By the end of 2018, around 30 hubs for more than 40 patient groups will have been launched.Again, the objective is to make services more accessible and affordable and create a flexible platform that can be adapted to meet the needs of overseas healthcare providers too. Working closely with governmental organisations Finpro and Tekes, those behind the Hub are seeking out international partnerships that will drive healthcare innovation across Europe and beyond. n