A national evaluation of community-based mental health strategies in Finland

Objective: High-quality mental health care requires written strategies to set a vision for the future, yet, there is limited systematic information available on the monitoring and evaluation of such strategies. The aim of this nationwide study is to evaluate local mental health strategies in community-based mental health services provided by municipalities. Design and setting: Mental health strategy documents were gathered through an online search and an e-mail survey of the local authorities of all Finnish mainland municipalities (n = 320). Participants: Out of 320 municipalities, documents for 129 municipalities (63 documents) were included in the study. Intervention: The documents obtained (n = 63) were evaluated against the World Health Organization checklist for mental health strategies and policies. Main outcome measures: Evaluation of the process, operations and content of the documents, against 31 indicators in the checklist. Results: Out of 320 Finnish municipalities, 40% (n = 129) had a mental health strategy document available and 33% (n = 104) had a document that was either in preparation or being updated. In these documents, priorities, targets and activities were clearly described. Nearly all (99%) of the documents suggested a commitment to preventative work, and 89% mentioned a dedication to developing community-based care. The key shortfalls identified were the lack of consideration of human rights (0%), the limited consideration of research (5%) and the lack of financial planning (28%) to successfully execute the plans. Of the documents obtained, 60% covered both mental health and substance abuse issues. Conclusions: This study contributes to the limited evidence base on health care strategy evaluations. Further research is needed to understand the potential impact of policy analysis.