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National strategy for psychiatry

Country: 
Denmark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(14) 2009
Author(s): 
Jytte Seested Nielsen
Health Policy Issues: 
Quality Improvement
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Abstract

A strategy from the National Board of Health intends to provide a professional background for the development of psychiatry taking place over the coming years both in the regions and at the state level. The National Board of Health introduces six themes aiming to contribute to the quality development in psychiatry.

Purpose of health policy or idea

Approximately 10-20% of the Danish population will at some point during their life-time suffer from a mental illness of some kind. The national strategy for psychiatry from the National Board of Health (NBoH) (Sundhedsstyrelsen, 2009) will form the basis for bringing together good visions and intentions for a collected effort in psychiatry.

In the strategy, the NBoH introduces the following six themes aiming to contribute to the quality development in psychiatry:   

  1. It should be easier to be mentally ill. The psychiatric field should be perceived as an integrated part of the healthcare sector akin to the somatic areas. Stigmatization of mental illness should be fought by increasing knowledge and ensuring open-mindedness. Suggested initiatives to fight the stigmatization are eg. open-house at the psychiatric departments and non-traditional information campaigns.   
  2. It should be easier to get early help. Improving mental health status and prevention of mental illnesses should be an area of prioritization for the healthcare sector as a whole (both in the municipalities, the primary and secondary healthcare sector). General practice has an important role regarding early discovery hence general practice should be strengthened and supported. Special attention should be given to children in families with mentally or somatically ill parents. Also, adults with long-term or serious physical illnesses, adults expelled from the labour market and adults with an abuse problem should be given special attention. Moreover, isolated elderly who are alone and have experienced loss and crises should be devoted special attention.   
  3. It should be easier to receive the proper offers. There should be an increased specialization in the treatments offered to patients with mental illnesses, however there should also be an awareness to assure that no patients are 'caught between two stools'. It should be easy for patients to be admitted to hospitals if necessary and there should be good links to the somatic area.  
  4. It should be easier to be a psychiatric patient. It should be prioritized that patients experience continuity of care including the process of recovery and rehabilitation. This emphasizes the need for a good coordination between the different healthcare sectors. The daily work with the patient should be based on respect, professional expertise and responsibility.  
  5. It should be easier to work in the psychiatric sector. Recruitment will be improved by ensuring good working conditions, a good working environment, education and that the members of staff get the experience of doing a meaningful and respectful effort. In addition to improving the recruitment this should make it easier to maintain the labour force as well.  
  6. It should be easier to acquire and use new knowledge. In order to evaluate quality there is a need for documentation in the psychiatric sector. The existing work on quality in psychiatry is as well as in the somatic area included in the 'The Danish Health care quality program' should be maintained and further developed. Conditions for research should be improved, for example by introducing more flexible research positions. 

Overall the National strategy for psychiatry focuses on the healthcare sector. However, they acknowledge the importance of the efforts in the social sector, efforts in culture and education as well as on the labor market. Cooperation across sectors is important for giving the patients the best opportunities for a good life. 

Main points

Main objectives

The National Board of Health introduces six themes aiming to contribute to quality development in psychiatry.

Groups affected

Psychiatric patients, and potential psychiatric patients and their network, health care sector

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Characteristics of this policy

Degree of Innovation traditional traditional innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low very low very high
Transferability strongly system-dependent system-dependent system-neutral

Overall, the aims and goals in the strategy by the NBoH all appear to be very important to pursue. Even though the NBoH introduces six themes, the general impression is that the NBoH is not very specific in describing how the goals should be pursued and how it should be financed      

Political and economic background

As a result of the public sector reform of January 1, 2007 (Pedersen 2006), there was a change in the responsibility for psychiatry. One distinguishes between treatment psychiatry and social psychiatry. Treatment psychiatry takes places in the hospital psychiatry and the community psychiatry whereas social psychiatry is described as the effort taking place after the treatment (Dansk Psykiatrisk Selskab, 2004). After the public sector reform, social psychiatry it is now the full responsibility of the municipalties whereas treatment psychiatry is the responsibility of the regions (co-financed from the municipalities) (Pedersen 2005).

Denmark has endorsed the declaration at the WHO Ministerial conference: " Mental health - Facing the challenges, building solutions", Helsinki 2005 (WHO 2005). Hence recognizing that promotion of mental health and prevention, treatment, care and rehabilitation of mental health problems are a priority for WHO and it' s Member States.

In addition, the political parties behind the agreement on psychiatry 2007-2010 agreed on the common goal that all psychiatric patients should have the same rights as somatic patients (eg. be free  to choose a  hospital) (Sundhedsstyrelsen: National strategy for psykiatri, 2009).

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Origins of health policy idea

During 2007 and 2008, all five regions in Denmark have produced plans for the development of psychiatry with a focus on psychiatry in the future. Patient association and professional associations have also formulated goals and wishes for the future. In addition, the National Board of Health has issued two reports on the topic (Sundhedsstyrelsen 2008, 2009a).

Initiators of idea/main actors

  • Providers: The Danish Regions are very pleased with the strategy since it represents very well the eight visions that the Regions have set up as points of orientation for the Danish psychiatry in the future (www. regioner.dk).
  • Others: The professional association of Danish Physiotherapists is very positive since physical activity is mentioned in the strategy as a means to a good treatment environment (Dagens Medicin, 4 September 2009)
  • Political Parties: The Red-Green Alliance is of the opinion that it is empty words since no money has been allocated to this in the new Finance Act (Ritzaus Bureau, August 25 2009)

Approach of idea

The approach of the idea is described as:
amended: The agreement on psychiatry 2007-2010

Stakeholder positions

The following political parties stood behind the agreement on psychiatry 2007-2010: the Liberals, the Social Democratic Party, the Danish People's Party, Conservatives, Social-Liberals and the Socialist People's Party. The present National Strategy on psychiatry should not be seen as an action plan but as a description of visions and long and short-term goals for psychiatry.

Actors and positions

Description of actors and their positions
Providers
Danish Regionsvery supportivevery supportive strongly opposed
Association of Municipalitiesvery supportivesupportive strongly opposed
Others
Danish Physiotherapist Associationvery supportivevery supportive strongly opposed
Danish Psychiatric Societyvery supportivevery supportive strongly opposed
Better Psychiatryvery supportivevery supportive strongly opposed
Political Parties
Reed-Green Alliancevery supportiveneutral strongly opposed

Influences in policy making and legislation

The suggested changes can be carried out through amendments to the existing agreements within the framework of the new organizational structure of the public sector implemented during the recent structural reform.

Legislative outcome

success

Actors and influence

Description of actors and their influence

Providers
Danish Regionsvery strongstrong none
Association of Municipalitiesvery strongstrong none
Others
Danish Physiotherapist Associationvery strongweak none
Danish Psychiatric Societyvery strongweak none
Better Psychiatryvery strongvery strong none
Political Parties
Reed-Green Alliancevery strongneutral none
Danish Physiotherapist Association, Danish Psychiatric SocietyDanish RegionsBetter PsychiatryAssociation of MunicipalitiesReed-Green Alliance

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The main actors would be healthcare personnel in municipalities and regions.      

Results of evaluation

A general quality development of the psychiatric effort.

Expected outcome

Impact of this policy

Quality of Health Care Services marginal marginal fundamental
Level of Equity system less equitable system more equitable system more equitable
Cost Efficiency very low neutral very high

References

Sources of Information

  • Dansk Psykiatrisk Selskab. Hvidbog - Psykiatriens kerneopgaver og udfordringer [Psychiatry - main task and challenges] 2004- 2010. Dansk Psykiatrisk Selskab: København, 2004.
  • "Fysisk aktivitet er vigtig i psykiatrisk behandling" [Physical activity is important in psychiatric treatment], Dagens Medicin, September 4, 2009 www.dagensmedicin.dk/debat/2009/09/04/fysisk-aktivitet-er-vigtig/index.xml.
  • "KL's psykiatriudspil" [The proposal on psychiatry from the association of municipalities]. www.kl.dk/ImageVault/Images/id_39360/ImageVaultHandler.aspx , accessed September 22, 2009)
  • "Nyt udspil fra Sundhedsstyrelsen harmonerer med regionernes visioner for psykiatrien" [The new proposal from the National Board of Health is consistent with the visions from the Regions regarding psychiatry], www. regioner.dk, accessed October 7, 2009.
  • Pedersen, KM 2005: Kommunal medfinansiering af sundhedsvæsenet - en ide på sandgrund? [Co-financing from municipalities - an idea on a ground of sand] Syddansk Universitetsforlag.
  • Pedersen, KM 2006: Implementation of healthcare reform. HealthPolicyMonitor, November 2006. www.hpm.org/survey/dk/a8/6.
  • Psykisk syge skal have det lettere"[ Psychiatric patients should be better off] , Dagens Medicin, August 28, 2009.
  • "Regeringen spiller ud med samlet plan for psykiatrien" [The government's is proposing a collective plan for psychiatry], www.bedrepsykiatri.dk accessed October 7, 2009.
  • Sundhedsstyrelsen: FREMME AF MENTAL SUNDHED - baggrund, begreb og determinanter, [Improving mental health - background, notion and determinants] 2008. www.sst.dk/publ/PUBL2008/CFF/MENTAL_SUNDHED/FREMMEAFMENTALSUNDHED.PDF.
  • Sundhedsstyrelsen: Den akutte indsats i psykiatrien - planlægningsgrundlag for det regionale sundhedsvæsen [The acute effort in psychiatry - planning basis for the healthcare sector in the region] 2009a. www.sst.dk/publ/Publ2009/SUPL/Akutindsats_psykiatrien/Akutindsats_psyk_aug09.pdf.
  • Sundhedsstyrelsen: National strategy for psykiatri [National strategy for psychiatry], 2009. www.sst.dk/publ/Publ2009/SUPL/Psykiatri/NatStrat_psykiatri09net.pdf.
  • The Danish healthcare quality program. www.ikas.dk/English.aspx accessed September 22, 2009.
  • "Tomme ord om bedre psykiatri, siger EL"; [Empty words about better psychiatry, says The Red-Green Alliance] Ritzaus Bureau, August 25, 2009.
  •  WHO, Mental health: facing the challenges, building solutions. Report from the WHO European Ministerial Conference, Helsinki, January 2005.

Author/s and/or contributors to this survey

Jytte Seested Nielsen

University of Southern Denmark; www.sdu.dk      

Suggested citation for this online article

Seested Nielsen, Jytte. "National strategy for psychiatry". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/dk/a14/4