The period of crises also greatly increases the number of mental disorders. The Estonian Mental Health Survey shows that more than a quarter of Estonian residents are at high risk of depression and a fifth are at high risk of anxiety disorders. However, the high prevalence of mental health problems contrasts with the common use of professional services in this area: only 6-8% of adult respondents have used any of the services.
Until now, the development of mental health support has been limited by the problem of the availability of services provided by specialist healthcare professionals. As a result, these services now mainly cover people whose problems are already critical. It is cheaper to prevent mental health problems than to treat them, but there is no prevention system in Estonia. Treatment pathways for people with such problems are fragmented, complicated, and under-resourced.
People's psychological well-being is ensured by a system of quality and cost-effective specialized intervention options, as well as cooperation between support systems. Of course, community-based services and self-help cannot fully replace medical, psychological, or psychiatric care, and a multi-tiered support system must be created.
"By strengthening and developing the system of low-intensity psychological interventions offered in Estonia, we are increasing the availability of high-intensity interventions and treatment. Investing in community-based services will help to reduce health care overload, as people can get the help and support they need before problems get worse," said Triin Naudi, coordinator of services at the Department of Mental Health, Ministry of Social Affairs.
"Based on the experiences of other countries, it is possible to minimize or even prevent potential bottlenecks that may arise when introducing new interventions. In addition, it is useful to collaborate with countries that have already developed, implemented, and improved specific services and where low-intensity psychological interventions are integrated into the health care system. Their experience can help to implement changes in Estonia as effectively as possible," added Naudi.
Last year, the Ministry of Social Affairs commissioned a study on the development of a multi-level mental health support system, the aim of which was to analyze the experience of other countries (currently England, Belgium, and Finland). Based on the experience of these countries, recommendations have been developed on how to build a multi-level support system in Estonia and thereby improve access to psychological support.
In all the countries analyzed the existence of a central regulating body is an important precondition for the sustainable functioning of the multi-level aid system. Thus, in order to coordinate the activities and cooperation of different actors across Estonia, a centralized steering group should be established on the basis of the Ministry of Social Affairs, which should function on a permanent basis and be financed by the state. The first task of the structural unit would be to make an inventory of existing needs and resources, including evidence-based low-intensity psychological interventions, which currently exist in Estonia and could be provided more widely and systematically.
Other findings and suggestions from the analysis as well as a detailed description of the model can be found on the website of the Ministry of Social Affairs.
The study was commissioned by the Ministry of Social Affairs and authored by the Centre for Applied Social Research at the University of Tartu (RAKE).