psychiatric patients (4.2 per 1,000 inhabitants). This was one of the world's highest figures. The number has been cut, and by the end of 1994, there were 6,500 hospitalised mentally ill patients (1.3 per 1,000 inhabitants). The dramatic decrease in inpatient care has been the overall trend in Finnish health care, mainly because of economic pressures but also because of a philosophical shift from institutionalised care to a more integrative approach. The reductions in inpatient care have been greatest in the hospitalised care of psychiatric patients. As a result, the outpatient community-based care system has been improved and extended. In 1991, the staff in community care numbered 5.1 per 10,000 inhabitants. The figure was 2.5 in 1981. The number of outpatient visits has risen from 520,000 in 1980 to 750,000 in 1990 and to 1,290,000 in 1997⁷. However, the development of outpatient care has not been able to compensate in every locality for the drastic decrease in hospital capacity.⁸

In addition to municipalities, various non-governmental organisations play a crucial role in providing mental health services and rehabilitation. In recent years a number of privately-run nursing homes and rehabilitation units have been set up for people with mental health problems. These are considered a form of residential service and are not subject to inspection by the health care authorities.⁹

The occupational health care services

 

The Occupational Health Care Act requires that employers provide occupational health services to their employees. Services can be offered through the employer's own occupational health unit, organised jointly with other employers, or purchased from the municipal health centre, other employers, or licensed health care professionals. Employers are entitled to reimbursement from the Social Insurance Institution (SII) of the necessary and reasonable costs of occupational health services.¹⁰. Entrepreneurs and other self-employed persons are entitled to reimbursement of the necessary and reasonable costs of the services they choose to purchase for themselves.¹¹ In 1992, occupational health services were provided in 1,025 occupational health centres. Of these, 496 were run by individual employers, and 48 were run jointly by several employers; 43 were regional state-run occupational health clinics, 243 were municipal health centres, and 195 were private medical centres.¹² Currently, the occupational health care services employ 200 occupational psychologists (in comparison to 5,000 general practitioners), whose services are available at one occupational health care centre in five.¹³

Since occupational health care services reach up to 90% of the Finnish workforce and are in continuous contact with employees and the workplace, they are an excellent vehicle for preventive mental health care and promotion of mental health. Over the past years, the demand for occupational mental health care services has expanded significantly. However, mental health promotion and prevention of mental health problems are relatively new issues and more knowledge is needed.¹⁴ According to occupational psychologists, occupational health care is too focussed on curative aspects. As a result, mental health issues, and particularly the prevention of mental health problems, have been ignored. This is despite the fact that increasing numbers of people suffering from depression become disability pensioners and that many new drugs and treatment options have become available.¹⁵

A recent reform in the occupational health care scheme emphasised the importance of preventive measures and the maintenance of work capacity and functional ability. The occupational health care service is now obliged by law to offer rehabilitation counselling and to contribute to the maintenance of work ability, which is defined as a function of both the work envi-