Kristiina Kuussaari

Objectives: We implemented the first national patient experience survey, with novel patient‐reported experience measures (PREMs), in out‐ and inpatient mental health and substance use services in Finland.Methods: The Outpatient Experience Scale (OPES) and the Inpatient Experience Scale (IPES) were co‐designed with experts by experience and professionals. The survey was carried out in 2021 in 435 treatment facilities. We applied bi‐factor analysis of ordinal indicators to prespecified and exploratory models.Results: We received 8794 outpatient and 1112 inpatient responses. Both the OPES and the IPES were essentially unidimensional, with high internal consistency (omega 0.98 in both) and strong factor loadings. The Net Promoter Score item was a fairly poor indicator of overall satisfaction. The most positive experiences were related to respect and acceptance, while statements related to receiving information and inclusion of significant others in the treatment process received more critical feedback. The best experience was in integrated mental health and substance use services. Involuntarily admitted patients had the most negative patient experiences.Conclusions: The new PREMs proved to work well in measuring patient experience. Service users generally reported positive experiences. The primary service development need is sharing information with patients.

Mental health and substance use disorders are notable contributors to the global total burden of disease. On a population level, co-occurring mental health and substance use problems are estimated to account for 2–4%. In clinical samples, estimate is even higher. The aim of this study was to examine changes in recognized mental health problems (MHPs) and in the substance use profiles among clients with substance use problems in Finland.

Aims: In this article the authors ask how the alcohol use of elderly home care clients affects the daily work of home care professionals and how the professionals act to support the drinking client. Methods: Semi-structured interviews with 10 home care professionals were conducted from December 2014 to February 2015 in the Helsinki metropolitan area of Finland. Everyday situations during home visits related to the clients' alcohol use were analysed according to modalities of agency of the home care professionals. Results: The results focus on three themes raised in the interviews: supporting life management of the client, the lack of qualifications in tackling clients' drinking and the need for multi-professional collaboration. Intoxicated clients complicated the home care nurses' work and obstructed the implementation of recommendations set out to guide the professionals' operations. Care work with alcohol-using clients was particularly demanding, and the professionals were concerned about not having enough training in how to encounter elderly clients' drinking. Multi-professional collaboration with substance abuse services and emergency department personnel was called for to remedy this problem. Conclusions: More extensive and detailed research is needed for a better picture of how clients' drinking influences home care nurses' working conditions and what kind of skills nurses need in different alcohol-related situations. Such research would have the potential to benefit clients and improve the well-being of the employees.

Aim: Many studies have noted that substance abuse and mental health problems often occur simultaneously. The aim of the work reported here was to study the co-occurrence of mental health problems and problems related to substance use in a sample of clients visiting the Finnish social and health care services for issues related to substance use. We collected background information on the clients and considered the parts of the treatment system in which these clients were treated. Data and methods: Survey data on intoxicant-related cases in the Finnish health care and social services were gathered on a single day in 2011. During the 24 hours of data collection, all intoxicant-related cases were reported and data were obtained for 11,738 intoxicant-related cases. In this analysis we took into account the clients’ background variables, mental health variables, information on the treatment type and the main reasons for the client being in treatment. The χ² test, Fisher’s exact test and binary logistic regression analysis were used. Results: Half of the visiting clients had both substance use related and mental health problems. The strongest factors associated with the co-occurrence of substance use related and mental health problems were female sex, younger age and single marital status. Clients with co-occurring problems were more often treated in the health care services, whereas clients with only substance use related problems were primarily treated in specialized services for the treatment of substance abuse. Conclusions: It is important to identify clients with co-occurring substance use related and mental health problems. In this study, half of the clients presenting to the Finnish social and health care treatment system had both these problems.

This article examines the National Plan for Mental Health and Substance Use Work (the MIELI plan), published in Finland in 2009. We place the plan into a wider context of changes in Finnish social and health services and have also studied responses to the plan. The data is provided by national documents, complemented by an online enquiry and some journal articles as feedback material. The MIELI plan is implemented in conjunction with a municipal and service system reform in Finland. While the proposals of the plan clearly carry a potential for change in the treatment system, there are also great challenges. For instance, to what extent can this kind of plan influence reality? Can the proposals really change anything in the treatment system, or does the potential change emerge from elsewhere? Responses to the plan indicate that referral-free access to treatment, the principle of a single entry point and primary-level services in general were considered important proposals in the MIELI plan. At the other end of the scale, the implementation of the plan and its medical orientation were received less positively.