Mental healthcare abroad: the similarities and differences
Nursing student looks at the similarities and differences between Finnish and British mental healthcare
On a second year placement in Finland, nursing student Emma Sheridan discovered that nurses' education was a dedication met by all staff, and a crisis ward initiative was vital in reducing lengthly admissions. So what are the similarities, and differences, between Finnish and British mental healthcare?
During the second year of my mental health nursing degree in Liverpool John Moores University, I was offered the opportunity to undertake a two-week placement in an acute mental health ward in North Karelia Central Hospital and Honkalampi Centre in Joensuu, Finland.
It was evident how dedicated the staff were to the development of student nurses’ education. Mentors dedicated time to translating handovers and meetings – as well as explaining the Finnish mental health system. They organised spending time in their crisis ward, hospital-based community teams and isolation areas.
The crisis ward is an excellent initiative for reducing lengthy admissions. Here, patients would be admitted for three days for intensive support. If patients were not ready to be discharged and required further treatment they could be transferred onto another ward.
Emphasis on community care
There was an emphasis on community care and reducing hospital admissions. The Finnish mental health act states that patients must be reviewed by a psychiatrist within four days of hospital admission; and if a patient's condition improved or the environment was not believed to be therapeutic to their needs they could be discharged to community services.
The community mental health team was accessible, telephone numbers were available online or in leaflets obtained from the hospital. It mean that patients could easily access community services without lengthy waiting times or need for a referral process.
It is believed that by investing more in community services it would prevent hospital admissions and allow people to be treated in the comfort of their own community. This accessibility can be managed due to Joensuu’s small population; therefore it may not be manageable for large towns in the United Kingdom.
Similarities with the UK
Much of the mental health system in Finland seemed similar to the United Kingdom. A striking difference was the use of restraint beds when patients were either at risk of harming themselves, other patients or staff. A doctor’s approval is needed for this process and re-sought every 12 hours and a qualified nurse has to sit with the patient for the duration of the restraint. Admittedly, I felt uneasy observing patients being strapped into a bed by several staff members. Surprisingly, afterwards the patient said that she was grateful that the staff did this as it prevented her harming herself. Staff explained that bed restraining was always a last resort.
'It is interesting to learn that in Finland all student nurses are trained in the general field, before specialising in their chosen field'
These incidents are recorded and initiatives have successfully reduced the number of restraints.
It was also interesting to learn that in Finland all student nurses are trained in the general field, before specialising in their chosen field. This means that when patients in mental health wards become physically unwell, their physical health could be managed onsite.
Initially, the concept of having to train longer, and in a general field, was daunting. However after consideration, I thought about how beneficial this training would be.
When a patient on a mental health ward is physically unwell I have often observed them having to travel in an ambulance to a general hospital. I have also observed mental health nurses’ anxieties over their perceived lack of knowledge of physical health during these situations. In considering these factors, further training in physical health may be beneficial for mental health nurses.
I would recommend every nursing student to seek opportunities for international placements abroad. I thoroughly enjoyed it and it has furthered my knowledge, reflective practice and confidence.
About the author
Emma Sheridan is a mental health nursing student at Liverpool John Moores University