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In Denmark, equality in health (care) is considered pivotal to enjoying a standard of living and well-being that is considered normal in society. However, there is no strategy on equality in health. Rather, equality in health (care) is a fundamental underlying principle in all measures in the Danish healthcare system.
In September 2018, the former government launched an action plan for psychiatry up until 2025. As of June 2019, the action plan is no longer in effect, but many initiatives in the action plan are currently being implemented.
The top-level document was a national action plan.
The title of the action plan is We Accomplish Together. An Overall Action Plan for Psychiatry up until 2025. (Vi løfter i fællesskab. En samlet handlingsplan for psykiatrien frem mod 2025)
The number of Danes with mental problems is rising. In the national health profile survey from 2017, one out of five people in the 16–24-year age group experiences poor mental well-being.
In the action plan, the government established 43 initiatives divided in six focus areas:
- More people are reached with early and accessible measures
- The competences of the staff are upgraded
- The quality in social psychiatry is improved
- The most ill patients receive better and intensive treatment
- More coherence in the course of treatment
- More research and innovation
In order to ensure an up-to-date psychiatric system, the government established six targets:
- By 2025 at the latest, the share of young people with poor mental health must be reduced by 25%-
- By 2015 at the latest, the use of force in psychiatric treatments must be reduced by 50% compared to the 2017 level.
- Up to 2025, the number of people with poor mental health trying to commit suicide must be reduced.
- By 2025 at the latest, the number of acute readmissions of psychiatric patients must be reduced by 15%.
- Up to 2025, the number of psychiatric patients that were in employment one month before the hospitalisation and again six months after the hospitalisation must be increased by 10%.
- More people who are subjects of a measure regarding social problems or psychiatric difficulties in the Act on Social Services (Lov om social service, LBK nr 1287 af 28/08/2020) must be in education or employment.
The target group was, amongst others, young people with mental problems.
The Ministry of Health was the top-level responsible authority. The healthcare system is the responsibility of the Danish regions.
The last target in the plan (i.e. that more people who are subjects of a measure regarding social problems or psychiatric difficulties in the Act on Social Services (Lov om social service) must be in education or employment) was included in the strategy 10 Goals for Social Mobility.
There are no revisions of the action plan.
The government will strengthen psychiatric care with a 10-year plan that will set the long-term direction for mental health treatment in Denmark, please see section 7.8 for further information.
In 2018, the minister for health established a youth panel to promote mental health among young people. The panel had 10 members in the 20–27-year age group. The panel has held two meetings and four workshops, which resulted in nine recommendations to the minister for health. See section 5.3
In June 2018, the government set up a cross-disciplinary national stress panel. The panel was a cooperation between five ministries and a minister without portfolio: the Ministry of Health, the Ministry of Employment, The Ministry of Social Affairs and the Interior (now the Ministry of Social Affairs and Senior Citizens), the Ministry of Children and Education, the Minister for equal opportunities and the Ministry of Higher Education and Science. In April 2019, the panel presented 12 actions aimed at preventing stress in the population.
With the rate adjustment pool agreement (satspuljeaftalen) 2019–2022, a majority in parliament has allocated 10 million DKK to the establishment of the Centre for Digital Health. The centre will be in charge of research and counselling initiatives on the effect of digitalisation on Danes’ mental and physical health, such as concentration and sleep.
In the 2019–2022 agreement within the area of health, young people’s mental health is in focus in the following funding allocations:
The counselling offer Headspace targets young people in the 12–25-year age group with emerging mental health problems. Headspace is a free and anonymous offer for young people who need someone to talk too. Young people can phone, send an e-mail, chat, or drop by without an appointment. The idea behind Headspace is to establish one point of entry for counselling, and Headspace can guide and counsel the young person regarding municipal or regional offers. Furthermore, the idea behind Headspace is to help young people with problems before the problems become insurmountable or demand a measure in the social system or the health system. With the 2019–2022 rate adjustment pool, an external evaluation of the Headspace initiative will be funded as well as the establishment of more Headspace centres. The total funding in the 2019–2022 period is 57.5 million DKK.
The Student Counselling Service in higher education receives 10 million DKK in operating aid in the 2019–2022 period. The counselling service offers social, psychological, and psychiatric counselling and treatment, and the counselling service helps young people complete their studies.
Moreover, as of the academic year 2019/2020, the Ministry of Children and Education has included student well-being in their quality supervision of general upper secondary education programmes. The objective of the quality supervision is to identify education institutions with persistent quality challenges and with a need for special measures and follow-up in relation to students’ academic- and social well-being.
The following six indicators are included in the quality supervision:
- General well-being
- Academic well-being
- Social well-being
- Learning environment
- Pressure and worries
A survey among all upper secondary students examines the six indicators. Survey results detect underperforming upper secondary education institutions so that support and monitoring measures are applied in order to enhance student well-being.
The quality supervision is funded by the Ministry of Children and Education.
From 2010 to 2017, the number of children and young people in contact with the psychiatric system increased by 53%. In the municipalities, there is a need for strengthened measures in order to prevent and treat children and young people in the 13–25-year age group with mental problems as well as parents to young people with emerging mental health problems. Therefore, the rate adjustment pool funds a strengthening of the early, preventive measures in the municipalities aimed at young people with mental problems in the 13–25-year age group. The objective of the increased measures is to help young people in the least intrusive way and with a coherent measure that allows the young people to have a connection to their everyday life, school, friends, and leisure activities. The measure must have a central coordinating function regarding other relevant services in the municipalities, psychiatric system, in youth education programmes, and in civil society, etc. The National Board of Social Services and the participating municipalities implement the initiatives. The measure is funded with 60.7 million DKK.
In connection with the funding of a strengthened measure targeting the 13–25-year age group mentioned above, the rate adjustment pool agreement allocates 120.4 million DKK for strengthening the PPR measure (pedagogical-psychological counselling) in the municipalities. The funding covers a mapping of knowledge and practice. Based on the evaluations from the mapping, the funding covers the implementation of new measures.
Children and young people who grow up with parents with mental illness are a vulnerable group who may need extra attention. The group is at risk of a failure to thrive, because they often keep their worries and problems to themselves. The rate adjustment pool (satspulje) funds a national competence centre for measures for aimed at children who have parents with mental illness. The task of the centre is to collect and distribute knowledge in the area in order to strengthen the competences of professionals working with the target group. The centre has been allocation 11 million DKK.
The rate adjustment pool agreement for 2019–2022 supplements a pilot project with free psychological treatment for 18–20-year-olds (see rate adjustment pool agreement 2018–2021 below). The rate adjustment pool covers free psychological treatment for 21-year-olds with light to moderate depression or anxiety up until 2021. The funding is 18.4 million DKK.
All of the above-mentioned initiatives are still in effect and there are no main outcomes or evaluations yet.
The rate adjustment pool 2018–2021 funds a pilot project with free psychological treatment for young people in the 18–20-year age group with light to moderate depression or anxiety. The total funding is 15.1 million DKK.
The pool funds an extended regional psychiatric system to help children and young people with mental illness as close to their everyday lives as possible. The objective of the funding is to help children and young people outside the psychiatric system by using evidence-based treatments, such as family therapy and mindfulness, etc. Furthermore, the objective is to establish a more coherent cooperation between municipal and regional authorities, which includes relevant stakeholders, such as the education institutions, PPR cooperation (pedagogical-psychological counselling), the parents, the municipal social services, and the regional psychiatric system for children and young people. The total funding is 214.6 million DKK.
The pool funds the mindfulness-based stress reduction education of professionals working with children and young people in the 11–18-year age group. The objective of the funding is to ensure well-being and an everyday life free from stress, as well as to help children and young people gain a better balance and more presence in their lives. The funding amounts to 12.5 million DKK.
The pool funds an increased measure aimed at people with eating disorders and who self-harm. The strengthened measure includes increased treatment capacity and the testing of screening tools. The total funding is 53 million DKK.
The pool funds the establishment of a national partnership for the prevention of suicide. The total funding is 4 million DKK. The partnership consists of the regional suicide centres, the regions, municipalities, research units, NGOs, the Danish Health Authority, as well as the National Board of Social Services. The task of the partnership is, among others, to strengthen and coordinate the existing national collection and distribution of knowledge concerning the prevention of suicides, to counsel the Danish Health Authority and the National Board of Social Services, and to support a high-quality coherent prevention and treatment in the municipalities.
The pool funds a pilot project that tests the effect of ambulant treatment of persons with psychiatric illness one week following hospital release. Research indicates that the risk of suicide among people with mental illness is the greatest right after release from the psychiatric hospital. The pilot project is funded with 21.8 million DKK.
The pool also funds an expansion of the regional centres for the prevention of suicide in order to make the centres able to initiate immediate follow-up measures aimed at people at risk of committing suicide. The target group is people who are considering committing suicide or have attempted suicide, including children and young people. Every year, participating centres must conduct a professional status report and apply for the continuation of the project. The report and application must be approved before funding can be disbursed for the next year’s activity. The expansion is funded with 7.8 million DKK.
Lastly, the pool funds a cross-disciplinary measure for children and young people with mental problems such as attention deficit, anxiety, eating disorders, and self-harm. The measure must be coherent and implemented as a cooperation between municipalities and regions and across administrations and sectors, for instance general practitioners, social services, schools, PPR (pedagogical-psychological counselling), and hospitals. The pool funds the development of the measure with 3 million DKK and the implementation and distribution of the measure with 33.5 million DKK. Participating municipalities commit themselves to producing annual reports on the activities conducted. The reports are necessary in order to receive the next year’s funding. Furthermore, participating municipalities must hand in a final evaluation in which participants must:
- Document if and how the project target has been achieved.
- Show how and to what extent the project can be continued after the project period.
Furthermore, the National Health Authority and the National Board of Social Services are responsible for an evaluation of the total project.