Psychiatry and Primary Care in Northern Europe


University of Turku, Department of Psychiatry, Turku, Finland


There are considerable similarities, but also differences, in health services in general in Northern Europe. Services are funded in Nordic countries by taxes, but the responsible organization may vary between countries from state, county and municipality. Treatment systems differ greatly between Nordic and Baltic countries, where the responsibility may either be public or insurance-based. Finland has the most decentralized health care and psychiatric services, whereas in Norway the state bears the economic and organizational responsibility. Common psychiatric illnesses are treated mostly in primary health care. Physicians have been educated to diagnose and treat depression more effectively than previously. This may partly be responsible in decrease in the rate of suicides. Treatment guarantees guide the policies of referring patients to specialized health care. Compared to other Nordic countries Finland has more difficulties in accessing primary care and therefore delays in starting adequate treatment are fairly common, but access to occupational health care is considerably better for employees. The ratio of primary care physicians per psychiatrists is much smaller in Finland than in other Nordic countries. Consequently, more patients are being treated within specialized than would actually be necessary. Baltic countries suffer from brain drain, which effects negatively the provision of care. Psychotropic medications for common mental disorders Primary and occupational health care physicians. In Finland, some specialized nurses have been transferred to primary care or nurses in primary care have been trained to take care of psychotherapeutic treatments within primary health care.