The Danish 10-year plan for psychiatry
Interview with Merete Nordentoft, Chairperson of Danish Psychiatric Association
The 10-year Danish psychiatric plan has been long under way but is now ready to be implemented. The plan that has been developed by a working group consisting of many stakeholders has been supported unanimously by the Danish parliament.
How did the work with the plan start?
The work initiated in 2019 as part of the paper of understanding (forståelsespapir) by the previous social democratic government, and subsequently the National Board of Health was asked to prepare a 10-year psychiatric plan. A long process started resulting in the completion of a plan in January 2022. Consensus was reached in the working group chaired by the National Board of Health and with participation from e.g. Danish Psychiatric Association; the Association of Child & Adolescent Psychiatry, SIND, consumer groups and other professional groups about the plan. The participating organizations further reached a large degree of consensus, thatthe plan contained many good elements, but a sharp criticism was raised by the group that psychiatry is characterized by having insufficient capacity both with respect to treatment and prevention. The Director as well as the Deputy-director of the National Board of Health expressed this criticism very eloquently.
How can the plan be described?
The plan covers all aspects of psychiatry. The limitations are that there are not outlined any dimensions how the plan should be implemented, nor do you find calculations of the costs of the implementation nor any assessment of the prevailing needs for mental health care.
To overcome these weaknesses the Danish Psychiatric Association, the Association of Child & Adolescent Psychiatry in collaboration with professor of health economics Jakob Kjellberg made in November 2021 an estimation of the funding required for the implementation. This was amounting to 4.5 billion kroner for the operational costs and 3 billion kroner for the initial construction costs of the plan. It is indeed interesting that these estimates have been accepted both by the ministries as by the working group.
So what has been the following steps in the implementation of the plan?
We have now a new coalition government. In the negotiations prior to its nomination the governmental foundation included the 3 billion kroner to psychiatry in addition to the 1 billion already given. So, it is fair to say that the two professional organizations have made their solid mark on the plan. The pertinent question is: How long shall we wait till the plan is beginning its implementation? It is our opinion that we should start the process, the sooner the better, as the future is always unpredictable, and new crises may appear that necessitate a change of plan. As an example, hereof the National Board of Health and the Social Welfare Agency presented a plan but due to the war in Ukraine the political agenda and priorities were changed, and the plan was not implemented.
But in September 2022 a psychiatry plan was presented with its point of departure based on the memorandum from the professional organizations. The National Board of Health will oversee that programs for the progress of the plan are developed and the established Council of Psychiatry (psykiatriråd) is given the task to develop landmarks in order to follow the progress of the plan.
An annual sum of 600 million kroner was allocated in 2019 as a permanent lift to psychiatry and in September 2020 a further 500 million were allocated annually. Considering the intentions behind it is fair to say that these sums are not large as they are also intended to cover initiatives directed towards the mental distress of young and adolescent persons – even though the reasons for this to a large extent is beyond psychiatry. If the plan is that interventions to reduce mental distress among the young generation shall be covered by this grant it is a well-founded fear that not much will be left to core psychiatry. Already now we see how a large proportion is already used for initiatives against mental distress in youth.
A sum of 77 million has been allocated to the most severe psychiatric patients but how shall this amount cover the establishment of more psychiatric beds; and increased outpatient activities? I am afraid that divided among the 5 regions of the country the amount for each region will be fairly limited and resulting in little change.
A plan to prevent suicide has received 600.000 kroner and our wish is that this will be implemented in 2024 and not wait till 2025. In the last plan on suicide prevention we gave 121 ideas how to proceed but unfortunately nothing was implemented.
We should also keep in mind that the number of outpatients has increased significantly, we have today approx. 50.000 more patients receiving outpatient treatment with very limited increase in the number of staff. A result hereof is that we cannot provide the same quality of care and we have to watch out to avoid discount models of care. By that I mean an outpatient treatment with very short episodes of care; limited access to cognitive therapy and reduced involvement of families. It is important to invest extra resources in the discharge phase of mental health care.
As psychiatrists we need to explain that psychiatric care is very frequently a long-term care, it is not adequate care just to discharge a patient to continue in the municipal system. Professional mental health care requires that patients are seen by the mental health professionals over longer periods of time with continuous monitoring and a multidisciplinary team involved. All this will result in a lift in the quality of outpatient care, a fact that many politicians unfortunately fail to understand, and the Danish Psychiatric Association has an important task in enlightening them about this.
Of course the Danish Psychiatric Association is very pleased that 3 billion kroner have been reserved for psychiatry and we do hope that the implementation will start in 2024 and not be postponed to 2025. □