The Finnish welfare system resembles those of the other Nordic countries in terms of institutional structure, financing, and goals. The system covers the whole population. Service are mainly provided by the public sector and financed through general taxation. In general, Finns can rely on the country's health and social services, even though, at the beginning of the 1990s, the expansion of the health and social service network was terminated, staff numbers were trimmed, and the delivery of some services curtailed.^{1 2} In terms of mental health, however, there is a wide gap between needs and available services. The long-term unemployed, people with mental health problems, and drug abusers face a clear threat of exclusion from society, since the health and social service sectors cannot adequately respond to their needs.³

There are growing differences between provinces and municipalities across the country in providing for citizens' wellbeing. Since 1995, there has been a significant change in demographics. Population has shifted to the south, depleting the tax base in the north, where support for welfare services, including mental health has been reduced. The southern regions, which are experiencing a population influx, are finding it difficult to respond to the corresponding increase in welfare needs.⁴

Mental health care services

 

Municipalities are responsible for providing mental health care services, which are organised by primary health care, social services, and special medical care systems and financed through taxes and state subsidies. Individual municipalities are responsible for primary health. Joint municipalities (two or more municipalities acting together) are responsible for special medical care, such as psychiatric and mental health care services. Since the beginning of the 1990s, a greater share of responsibilities and resources has been directed to individual municipalities. This has meant an increase in the role of primary health care in providing mental health care services and a decrease in the roles of specialised psychiatric services and social services. In one third of municipalities, mental health care is organised as a part of local primary health.

The shift in responsibilities for mental health care from specialised health care to primary health care has not simply been an administrative change, but has required a new approach to health care management. The benefits of locally provided services are obvious. One in three primary health care appointments concerns mental health, and collaboration is easier to co-ordinate at the local level.⁵ However, many experts have argued that specialised psychiatric care is needed to maintain the quality of mental health services. When decisions are made locally, services can vary from one municipality to another, depending on local priorities and the needs of the population. Problems, such as lack of resources for community care, insufficient recognition of the needs of the severely mentally ill, and difficulties in guaranteeing continuity of services, have arisen as a result of the move from specialised psychiatric services to primary care.⁶

Until the 1980s specialised psychiatric care was based mainly on institutional treatment. In the early 1980s, Finland had almost 20,000 beds for