Welcome to Mental Health Metrics 28 – 29th May, 2018 IIMHL at Sopra Steria, Stockholm

Mental Health Metrics This is Sweden 2018-05-28 Martin Rödholm Senior advisor, MD, PhD Mission Mental Health, Swedish Association of Local Authorities and Regions

Sweden, not Switzerland

This is Sweden

This was Sweden

This is Sweden

The best selling car in Sweden is…

Ahlgrens cars

SALAR The Swedish Association of Local Authorities and Regions

Municipalities, county councils, and regions 20 county councils/regions Regions are county councils with increased responsibility for regional development and infrastructure. Politicians are elected directly by citizens There are municipal and county council elections every four years in conjunction with the parliamentary election. Some county councils have formed regions: Gotland, Halland, Skåne, and Västra Götaland. Municipalities are responsible for most of the social services available where we live. The most extensive services include schools, social services, and care for the elderly. Municipalities are legally obliged to provide some services, while others are optional and decided by local politicians. Regions are county councils with an extended responsibility for regional development. County councils and regions are responsible for services shared over large geographical areas and which often demand considerable financial resources. These include healthcare, dental care, and public transport. Voluntary activities include culture, tourism, and regional development. Quick facts Municipality with the largest population: Stockholm - 847,073 inhabitants (31/12/2010) Municipality with the smallest population: Bjurholm (Västerbotten) - 2,460 inhabitants (31/12/2010) County council with the largest population: Stockholm County Council - 2,054,343 inhabitants (31/12/2010) County council with the smallest population: Jämtland County Council - 126,691 inhabitants (31/12/2010) “There are 44 000 elected representatives in municipalities, county councils and regions. Of those, approximately 97 % are politicians in their spare time.”

Municipal, county council and regional responsibilities Municipalities are responsible for most of the social services available where we live, such as schools, childcare, care of the elderly and disabled, as well as water and waste. County councils and regions are responsible for shared regional activities with an emphasis on healthcare and regional development. Mandatory activities: healthcare, dental care, public transport (together with municipalities) Voluntary activities: culture, education, tourism, regional development

Populations of municipalities The three largest municipalities 2015 Stockholm 923,516 people Gothenburg 548,190 people Malmö 322,574 people The three smallest municipalities 2015 Bjurholm in Västerbotten 2,453 people Sorsele in Västerbotten 2,516 people Dorotea in Västerbotten 2,740 people En attraktiv arbetsgivare måste ha goda anställningsvillkor och kunna motivera och ta tillvara medarbetarnas kompetens. SKL:s uppdrag är att teckna centrala kollektivavtal, att stärka kommuner och landsting i arbetsgivarrollen och att skapa förutsättningar för lokala lösningar. Varje kommun och landsting måste ha stort inflytande över såväl löneökningarnas storlek som fördelning. Den lokala lönebildningen har grundläggande betydelse för vår arbetsgivarpolitik. Vi arbetar för ökad jämställdhet och minskad diskriminering. Vi erbjuder våra medlemmar rådgivning och service. De löpande medlemskontakterna ger viktiga lärdomar så att vi bättre kan tillvarata våra medlemmars intressen. Korta fakta År 2010 var 760 000 anställda i kommuner och 261 000 i landsting. Det motsvarar var fjärde förvärvsarbetande i Sverige. Cirka 80 % kvinnor.

This is psychiatry in Sweden Majority of mental health care performed in primary care, mainly stress, anxiety and depression 40 % of sick-leave due to psychiatric diagnoses and increasing Addiction care as well as old age mental health care included in psychiatric services Since 1995, social services responsible for daily activities and housing support Delayed transfers of inpatient psychiatric care >6 weeks is paid by social services Approx 5 % of mental health care privately provided, all is tax financed. 30 % in Stockholm.

”Mission mental health” Mission Mental Health (Uppdrag Psykisk Hälsa) is the result of an agreement between the Government and the SALAR It coordinates and develops work promoting mental health since 2008 and is funded by the Ministry of Social Affairs 20-40 co-workers Project manager: Dr Ing-Marie Wieselgren A kind of National Mental Health Innovation Lab

Mission Mental Health 2008 – 2015, examples ”First line” mental health for children and youth (Tier 2 CAMHS) School and student health Primary care Child and adolescent psychiatry ”Better care – less restraint” Focus on reducing need for involuntary treatment For all personel Education in how to improve (PDSA) Psychiatric wards from all regions has participated Forms for collaboration

Mission Mental Health priorities 2016-2018 Benchmark Psychiatry Mental health in primary care: Triage and psychosocial teams Collaboration between primary care and psychiatry Prevention and collaboration to reduce sick-leave Newly arrived and asylum seekers Organizing national specialized self-injury care units Independence of ”Rent-a-doctor” in psychiatry and healthcare in general.

Psychiatry in figures Benchmark Psychiatry 2017

Coverage - high Coverage 94 percent Coverage 88 percent 29 av 31 possible caregivers has reported Public and private CYP Coverage 88 percent 81 av 91 possible caregivers has reported Adult Coverage 100 percent 23 av 23 possible caregivers has reported Public Forensic

Beds

Psychiatric beds Källa: Sveriges Kommuner och Landsting Här kommer den längsta tidsserien jag hittade, från 1996. Så på 20 år ser vi att antal vårdplatser minskat – från över 7000 till över 4000 platser. Källa: Sveriges Kommuner och Landsting *Fastställda vårdplatser **Källa: Psykiatrin i siffror

Beds adult psychiatry Källa: Sveriges Kommuner och Landsting Inom vuxenpsykiatrin ser vi också en nergång nästan varje år sedan 07. Till idag strax under 3000 vårdplatser. Källa: Sveriges Kommuner och Landsting

Beds child and youth psychiatry BUP har minskat sina vårdplatser och har idag omkring 140 st. Källa: Sveriges Kommuner och Landsting

Beds forensic psychiatry Inom rättspsykiatrin har man gått i motsatt riktning. Där har man ökat antalet vårdplatser från under 1000 till nästan 1200 st. Så kollar man bara på antalet vårdplatser inom psykiatrin totalt sett, ser nedgången inte så stor ut. Men ser man BUP och VUP för sig är minskningen tydligare. Källa: Sveriges Kommuner och Landsting

Outpatient visits Increasing 2016-2017 CYP +18 % Adult + 6 %

Proportion of population treated Increasing 2016-2017 CYP + 2 %, +31 % since 2012 Adult + 18 %

CYP – patients 10 000 inhabitants 10 landsting +31 % Mellan 2012 och 2017 har antal patienter ökat med 31 procent. Mellan 2016 och 2017 har antal patienter ökat med 2,5 procent (Västerbotten exkl) Avser: Blekinge, Dalarna, Halland, Kalmar, Kronoberg, Skåne, Uppsala, Västernorrland, Västmanland och Örebro. (Övriga exkluderade pga att data saknas 2012, 2014 och/eller 2017)

Children seen by community CAMHS

Involuntary admissions

Seclusion Seclusion per 100 admissions Lower Seclusions, incidence per patient Higher