Invited editorial. challenges for psychiatry in finland – a personal view

From the beginning of the year 2023, twenty-one wellbeing service counties will be responsible for organizing mental health services in Finland. This means a major societal and social change. The change will give new opportunities to foster the development of the whole service system. However, a structural change may also lead to disturbances in processes of the system. There is real need for a whole system approach to skilfully guide the development of mental health services at patientprofessional level, service level, local area level, region level and country level. Service design and development should be rooted in evidence. The quality of scientific evidence on current models of psychiatric care is at best moderate. We have a lack of robust evidence base for many system interventions. In addition, the main approach in the planning and evaluation of service delivery is more provider than user oriented. Person-centred care involves both the acknowledgement of the individual’s right to self-direction with respect to the goals of care, and the protection of this right in ongoing service delivery. This approach promotes the recovery of a meaningful life in the community of the person’s choice rather than solely minimizing symptoms and impairment. It underlines each individual’s own unique life goals and aspirations. Treatment emphasizes the person’s own capacities, strengths and interests, and also the use of community settings and support. Person-centred care may offer several benefits over the usual care. Collaborative care is an effective approach to improving outcomes for common mental disorders, mainly depressive and anxiety disorders in primary care. It aims to promote mutual support between primary care and mental health providers and the delivery of more coordinated, integrated, and evidence-based treatments and prevention. Additional gain of psychotherapy and pharmacotherapy in the treatment of mental disorders in adults is only from small to moderate according to the most recent and largest meta-analysis. Continual critical evaluation of current psychiatric practice and mental health services is needed. New evidence-based and effective modes of action from promotion to prevention and treatment are most welcome. Improving evidence-based and effective prevention and treatment strategies for mental disorders can be regarded as a major challenge for 21st century psychiatry.