Mental health work cannot be postponed

Climate change, pandemics, and societal injustice are pressing questions, so much so that we feel a need to hurry in order to do something about them. A question which we tend to forget, but one that is equally pressing is mental health. The mental well-being of populations is not easy to predict, but generally speaking, the trend has been more or less negative all over the world: mental health problems are increasing, especially among the young. This is partly due to a new openness and novel ways of diagnosing and defining human problems, but what has been long known is that substance abuse, gambling, and eating disorders are entangled and make up a part of the mental health problems paradigm.

It is not easy to accomplish rapid interventions in mental health policies, because they are complex and involve difficult balancing acts between the strived-for amounts of in- and out-patient treatment, medication, prevention, family, and school support. More or less everything that we do affects our mental well-being, which is why all policies are mental health policies just as all policies are – in one way or another – gendered.

At a time of great recalibration pressures on the Nordic welfare states, the Nordic countries, too, are witnessing a rise in mental health problems among young people. In Finland, 75% of early retired persons under 30 have suffered mental ill health before the age of 24 (Auerbach et al., 2018). Notably, from 2010 to 2018 the proportion of the population who were on disability pension for mental disorders increased from 0.8% to 1.1% among 16–24-year-olds and decreased from 3.9% to 3.4% in the 25–64-year age group. In order to deal with these questions, Finland has drawn up a brand-new Mental Health Strategy (2021–2030), which emphasises preventive efforts and easier access for youth.

Because of their similarities in welfare institutional principles and cultures, the Nordic countries have much to learn from each other’s knowledge and experience. In 2017, the Nordic Welfare Centre ran a project, Youth in the Nordic Region, that focused specifically on young people who suffer from or are at risk of suffering from mental illness. The following quotation comes from the publication Mental health among youth in Sweden:

We have never had such well-educated and competent youngsters in the Nordic countries as we do today. At the same time there are all the more young persons who claim to be suffering from mental illness, and young persons who, for various reasons, risk ending up in vulnerable situations. (Nordic Welfare Centre, 2017, p. 3)

In a report about how Nordic knowledge can be built around adolescents’ mental health, the following reasons are cited for the growing problem picture: pressures and challenges, growing academic expectations, changing social relationships with family and peers, and the physical and emotional changes associated with maturation (Eriksson et al., 2019).

But do the increasingly hard to reach and complex problems and the slow progress justify giving up? If we are to believe reports from May this year (WHO, 2020), the Nordic Collaboration on Positive Mental Health has shown favourable results for a surprising reason: it is tracking changes in positive mental health. Rather than just tracking negative trends, in 2018 the researchers incorporated questions in the synchronised Nordic survey that assess positive mental health, including questions on self-efficacy, self-esteem, and social integration. Analysing these measures has, according to the report on the WHO website, provided promising results for positive mental health. While the benefits of zooming in on positive experiences are obvious, we are, on the other hand, reminded of the weaknesses in relying too much on survey research. Mental health is institutionally and culturally steered and defined, and all measuring research must be complemented with systemic interpretations.

A fundamental problem in the current mental health services is the lack of treatment services for mild and moderate mental health problems at the level of primary care service. While the situation differs between Nordic countries, a basic dilemma is that on the primary care level, services include prevention and screening of mental health problems, but school and student health services, for example, do not have the necessary resources to provide treatment and more in-depth support. Also, primary health care centres often lack resources and expertise in providing mental health care for children and adolescents. Sweden has been rather good at building targeted yet open mental health support to families and the young, while Finland is somewhat lagging behind. Consequently, adolescents with even mild mental health problems are referred to specialised services, which leads to delayed onset of treatment and to increasingly bigger problems. In the worst scenario, adolescents are referred back to primary care because the problems are not considered severe enough to merit specialised services. The complex pathway to treatment also leads to drop-outs. Research shows that especially adolescents would benefit from one-stop mental health services. Lack of service integration also means wasted resources.

A sustainable life context approach (health, socioeconomic status, substance use, meaningful activities, and social relationships) combined with systemic recovery capital support has proven to be the most successful in preventing and dealing with young people’s mental ill health (Tew, 2013). While waiting for the broad and in-depth implementation of such approaches, we need to become active and start treating mental health as the pressing acute matter that it is.

In this issue

This issue revolves a great deal around alcohol drinking, studied from many perspectives and by different methodologies. In an overview report, 21st century Finnish alcohol drinking trends are accounted for, showing that the culture changes at a slow pace (Tigerstedt et al., 2020). A survey-based analysis of drinking among older adults in four European countries by Rossow and Træen (2020) also underscores the continuous relevance of notions such as drinking culture and patterns: even if a strong regularity in the distribution of alcohol consumption was observed in the samples, gender was the only common factor associated with drinking behaviour across the four countries. A Botswana-based study by Sebeelo (2020) continues an old alcohol research path of inquiries concerned with how bar visitors see that alcohol control policies relate to themselves and their drinking identity. An interview study from Sweden explores how people with earlier substance use problems narrate their experiences of becoming and being parents (Heimdahl Vepsä, 2020). An experimental study on televised drinking points out some variables for understanding viewers’ expectations towards alcohol (Mayrhofer & Matthes, 2020). Last but not least, the alcohol theme is discontinued with a scoping review regarding problematic internet use (PIU) and internet addiction (IA) by Dahl and Helmersson Bergmark (2020). The study provides insight into how early on we are in understanding the relationships between these phenomena and their relationship to other types of social problems.