The Finnish therapy navigator – Digital support system for introducing stepped care in Finland

Introduction: The need to improve quick access to effective psychological treatments is urgent. Success requires effective tools for identifying what kind of therapies an individual is likely to benefit from and managing a comprehensive therapy offering that matches an individual’s needs. First-line therapies initiative (Terapiat etulinjaan–toimintamalli) is a national initiative started 2020 in Finland. It aims to help Finnish regions in building locally sustainable stepped care systems and providing the support services needed. One key service of First-line therapies initiative is the Finnish therapy navigator (FTN). The FTN is a digital tool to help assess individual needs for psychosocial treatments and to build a regionally sustainable stepped care treatment offering, as part of the national reform of social and health services. This paper describes the development, content, implementation and feasibility of the FTN. Materials and Methods: The system was piloted in six regions in Finland between October 2021 and May 2022, with a catchment area of around 600 000. The feasibility data was collected from professionals (n = 48) using the system at 1 and 4 months after implementation, and from the anonymous FTN responses (n = 2630). Results: Professionals estimated the FTN had a positive impact on their work, quality of assessment and notes, and patient experience at 1 month after starting to use the FTN. Satisfaction scores improved further at 4 months, and 93% of users wanted to keep FTN as a permanent tool. The mean time patients used to fill the FTN was 24 minutes; 75% of clinical interviews lasted under 30 minutes. The FTN provides important data on treatment seekers. In our sample 57% of respondents scored between 10-19 points on PHQ-9 and 59% between 5-14 on GAD-7, suggesting mild-to-moderate depressive and anxiety symptoms. 28% reported no previous psychosocial treatments and 33% previous treatments shorter than 6 months. Thus, it seems that a significant proportion of treatment seekers in Finland could benefit from readily available, short-term, evidence-based psychosocial treatments that the First-line therapies initiative supports. Conclusions: FTN is a feasible tool for first assessment of mental health issues in primary care. Implemented and localized using the manualized co-creation process results in very high user satisfaction and acceptability of the system. The FTN provides important real-time data on mental health treatment seekers to support service development and planning. The First-line therapies model that includes introducing FTN in combination with regionally adapted care pathway development, education in short evidence-based psychological interventions and increase in use of digital support systems appears a feasible way to build regionally sustainable stepped systems.publishedVersionPeer reviewe

The Finnish therapy navigator – Digital support system for introducing stepped care in Finland

Introduction: The need to improve quick access to effective psychological treatments is urgent. Success requires effective tools for identifying what kind of therapies an individual is likely to benefit from and managing a comprehensive therapy offering that matches an individual’s needs. First-line therapies initiative (Terapiat etulinjaan–toimintamalli) is a national initiative started 2020 in Finland. It aims to help Finnish regions in building locally sustainable stepped care systems and providing the support services needed. One key service of First-line therapies initiative is the Finnish therapy navigator (FTN). The FTN is a digital tool to help assess individual needs for psychosocial treatments and to build a regionally sustainable stepped care treatment offering, as part of the national reform of social and health services. This paper describes the development, content, implementation and feasibility of the FTN. Materials and Methods: The system was piloted in six regions in Finland between October 2021 and May 2022, with a catchment area of around 600 000. The feasibility data was collected from professionals (n = 48) using the system at 1 and 4 months after implementation, and from the anonymous FTN responses (n = 2630). Results: Professionals estimated the FTN had a positive impact on their work, quality of assessment and notes, and patient experience at 1 month after starting to use the FTN. Satisfaction scores improved further at 4 months, and 93% of users wanted to keep FTN as a permanent tool. The mean time patients used to fill the FTN was 24 minutes; 75% of clinical interviews lasted under 30 minutes. The FTN provides important data on treatment seekers. In our sample 57% of respondents scored between 10-19 points on PHQ-9 and 59% between 5-14 on GAD-7, suggesting mild-to-moderate depressive and anxiety symptoms. 28% reported no previous psychosocial treatments and 33% previous treatments shorter than 6 months. Thus, it seems that a significant proportion of treatment seekers in Finland could benefit from readily available, short-term, evidence-based psychosocial treatments that the First-line therapies initiative supports. Conclusions: FTN is a feasible tool for first assessment of mental health issues in primary care. Implemented and localized using the manualized co-creation process results in very high user satisfaction and acceptability of the system. The FTN provides important real-time data on mental health treatment seekers to support service development and planning. The First-line therapies model that includes introducing FTN in combination with regionally adapted care pathway development, education in short evidence-based psychological interventions and increase in use of digital support systems appears a feasible way to build regionally sustainable stepped systems.publishedVersionPeer reviewe

Autonomic nervous system responses during a relationship enrichment intervention

Vaikka ihmisten fysiologia on ollut tutkijoiden kiinnostuksen kohteena psykologiassa jo pitkään, psykofysiologisia reaktioita pariterapiassa ei ole vielä tutkittu. Tässä tutkimuksessa tutkittiin neljää pariskuntaa terapia-asetelman kaltaisessa, neljän henkilön parisuhteen rikastuttamisistunnoissa tarkoituksena selvittää millaisia psykofysiologia vasteita saadaan aikaan myönteisillä ja haastavilla keskustelunaiheilla tai rentoutushetkillä sekä onko näiden vasteiden välillä merkitseviä eroja. Tuottaaksemme kontrolliaineistoa tutkimusprojektille Relationaalinen mieli monitoimijaisten terapiadialogien muutoshetkissä, oli istunnot suunniteltu muistuttamaan pariterapiaistuntoja. Pareille esitettiin joko myönteisiä tai haastavia kysymyksiä neljästä eri teemasta samalla kun heidän ja istunnon kahden ohjaajan sydämen sykettä ja ihon sähkönjohtavuutta mitattiin. Istuntoihin kuului myös mindfulness-harjoituksia, joiden tarkoitus oli saada parit rentoutumaan. Tutkimuksemme tulokset osoittivat, että parien sydämen syketaajuus sekä ihon sähkönjohtavuuden taso laskivat, kun taas absoluuttisen rentoutumisvektorin arvot nousivat istuntojen kuluessa. Tämä viittaa siihen, että parit rentoutuivat istuntojen aikana ja parasympaattinen aktivaatio kasvoi. Ihon sähkönjohtavuuden tason lasku oli parhaiten nähtävissä rentoutushetkien aikana, kuten oli myös respiratorisen sinusarytmian tason nousu. Tämä tarkoittaa sitä, että mindfulness-harjoitukset, etenkin kehokeskeinen harjoitus, olivat tehokkaita rentoutuksessa sekä sympaattisen aktivaation vähentämisessä. Kehokeskeisen harjoituksen jälkeen sympaattisen aktivaation taso ei myöskään palannut heti harjoitusta edeltävälle tasolle. Tulevaisuudessa näitä tuloksia voidaan hyödyntää pariterapian vuorovaikutuksen ja muutoksen mekanismien paremmin ymmärtämisessä.Even though the human physiology has been a subject of scientific interest in psychology for a long time, the psychophysiological reactions in couple therapy have not yet been studied. In this study, four couples in a four-person relationship enrichment intervention, simulating a therapeutic setting, were studied to determine what kinds of psychophysiological responses can be induced with positive and challenging topics or periods of relaxation and if there are significant differences between those responses. The sessions were designed to imitate couple therapy sessions in order to provide control data for the research project The Relational Mind in Events of Change in Multi-actor Therapeutic Dialogs. The couples were asked either positive or challenging questions from four different themes while their and their two instructors’ heartbeat and skin conductance were measured. The sessions also included mindfulness exercises to induce relaxation. Our results showed that the couples’ heart rate and skin conductance level decreased and absolute relaxation vector values increased throughout the sessions. This indicates that the couples relaxed during the sessions and parasympathetic activation increased. The decrease in skin conductance level was visible especially during the relaxation periods, as was an increase in respiratory sinus arrhythmia. This means the mindfulness exercises were efficient in inducing relaxation and decreasing sympathetic activation, especially a body-oriented exercise, after which sympathetic activation did not return immediately to the level preceding the exercise. In the future, these results can help in gaining better understanding of the mechanisms of interaction and change in couple therapy

Individual causes behind teachers' burnout – Using the "Decimal System" to identify primary problems for work burnout and targeting psychological intervention in occupational health care

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Socioeconomic factors in disability retirement due to mental disorders in Finland

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Socioeconomic status, psychotherapy duration, and return to work from disability due to common mental disorders

Objective: Low socioecosomic status (SES) is a risk factor for work disability due to common mental disorders (CMDs), one possible reason being inequal use of services. Psychotherapy is an evidence-based treatment for CMDs. This study examines socioeconomic and sociodemographic differences in psychotherapy attendance and an association of psychotherapy duration with return to work (RTW). Methods: The study subjects (N = 12,263) were all Finnish citizens granted a disability pension (DP) due to CMDs in 2010–2012. Numbers of psychotherapy sessions (maximum 200) were collected from the nine-year interval around the DP grant. Socioeconomic and sociodemographic differences in psychotherapy duration (dependent variable) among DP recipients were studied using multinomial logistic regression models, likewise, the association between psychotherapy duration and RTW (dependent variable) among temporary DP recipients was examined. Results: Higher SES, female gender, and younger age were positively associated with attending longer psychotherapies and surpassing the early treatment termination level (>10 sessions). Attending 11–60 psychotherapy sessions was positively associated with full RTW and partial RTW, whereas longer psychotherapies were not. Early termination was positively associated with partial RTW only. Conclusion: This study demonstrates varying tendencies among CMD patients from different backgrounds to attend long rehabilitative psychotherapies, which may create inequalities in RTW

Contextual and mental health service factors in mental disorder-based disability pensioning in Finland : a regional comparison

Background We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. We also studied the contribution of several district-level contextual and mental health service factors to mental disorder DP. Methods Subjects were all those granted mental disorder DP for the first time between 2010 and 2015 in Finland (N = 36,879). Associations between the district-level contextual and mental health service factors and regional DP risks collected from the year 2015 were studied with negative binomial regression analysis in the Finnish hospital districts. The population number on the age (18 to 65 years), gender, occupational status and residential hospital district of the Finnish population from 2015 was used as exposure in the model. Results Significant differences in the regional mental disorder DP risks between and within hospital districts did not appear to follow the traditional Finnish health differences. A lower risk of DP was associated with contextual indicators of higher regional socioeconomic level. Furthermore, population density as a proxy for access to mental health services indicated a higher regional DP risk for lower density in all mental (IRR 1.10; 95% CI 1.06–1.14) and mood disorder (IRR 1.12; 95% CI 1.08–1.16) DP. Both the highest and the lowest regional numbers of all mental health outpatient visits were associated with a higher DP risk in all mental and mood disorder DP, whereas particularly low regional numbers of inpatient treatment periods and of patients were associated with a lower risk of DP. Conclusions In this comprehensive population-level study, we found evidence of significant regional variation in mental disorder DP and related district-level factors. This variation may at least partly relate to differences in regional mental health service systems and treatment practices. Adapting to the needs of the local population appears to be indicated for both regional mental health service systems and treatment practices to achieve optimal performance.publishedVersionPeer reviewe

Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension

Background: Research in high-income countries has identified low socioeconomic status as a risk factor for disability pension (DP) due to common mental disorders (CMDs). Psychotherapy is an evidence-based treatment for the majority of CMDs along with medication and it is often targeted to prevent work disability. This study examines socioeconomic differences in the use of rehabilitative psychotherapy in Finland, where citizens have universal health coverage, but psychotherapy is partly dependent on personal finance. Methods: The study subjects (N = 22,501) were all the Finnish citizens granted a DP due to CMD between 2010 and 2015 and a comparison group (N = 57,732) matched based on age, gender, and hospital district. Socioeconomic differences in psychotherapy use were studied using logistic regression models. Socioeconomic status was defined by education, income, and occupation. Age, gender, and family status were also examined. Results: A lower level of education, lower occupational status (blue-collar worker), male gender, and older age, were associated with less frequent psychotherapy use, in both groups. Education was the strongest component of socioeconomic status associated with psychotherapy use, but the role of income was not straightforward. Unemployment when approaching DP, but not otherwise, was a risk factor for not receiving rehabilitative psychotherapy. Socioeconomic disparities were not any smaller among CMD patients approaching DP than in the comparison group. Conclusion: This study demonstrates the disparity in the provision of psychotherapy for CMD patients, even on the verge of DP with an acute need for services. This disparity is partly related to a complex interplay of socioeconomic factors and the service system characteristics. Factors predisposing to unequal access to mental health services are presumably diverse and should be studied further.publishedVersionPeer reviewe

Mental health service diversity and work disability : associations of mental health service system characteristics and mood disorder disability pensioning in Finland

Purpose: Public mental health services (MHS) are crucial in preventing psychiatric disability pensions (DP). We studied the associations between mood disorder DP risk and the characteristics of Finnish municipalities’ MHS provision using the ESMS-R mapping tool and Finnish population registers, based on first-time granted mood disorder DPs between 2010 and 2015. Methods: The final data set included 13,783 first-time mood disorder DP recipients and 1088 mental health service units in 104 municipalities. We focused on five different MHS types: all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. Three factors for each MHS type were studied: service resources, richness, and diversity index. Negative binomial regression models were used in the analysis. Results: In all the municipalities, higher service richness and diversity regarding all MHS, outpatient care and local services with gatekeeping were associated with a lower DP risk. In urban municipalities, service richness was mainly associated with lower DP risk, and in semi-urban municipalities service diversity and resources were primarily associated with lower DP risk in outpatient care and local services with gatekeeping. In rural municipalities, DP risk indicated no association with MHS factors. Conclusion: The organization and structure of MHS play a role in psychiatric disability pensioning. MHS richness and diversity are associated with lower mood disorder DP in specific societal contexts indicating their role as quality indicators for regional MHS. The diversity of service provision should be accounted for in MHS planning to offer services matching population needs.Peer reviewe