Ministry of Health and Social Affairs Sweden Government Offices of Sweden The Swedish integrated approach towards children with mental health issues Haag 23/5 2014

Ministry of Health and Social Affairs Sweden Government Offices of Sweden The National Coordination Function The Swedish Association of Local Authorities an Regions (SALAR) – Ing-Marie Wieselgren The Ministry of Health and Social Affairs – Anders Printz

Ministry of Health and Social Affairs Sweden Government Offices of Sweden National action plan for mental illness Strategy for The Government and SALAR cooperate and make agreements for joint work on development Municipalities and regions are financially rewarded by the state if they live up to agreed standards every year (€ 63 million/year, shared by those municipalities and regions that meet the agreed standards)

Ministry of Health and Social Affairs Sweden Government Offices of Sweden Target groups and priorities 1.Children and youth 2. Adults with severe or complicated mental health problems 3. Increased knowledge and support for professionals, competence and quality of services 4. Reception, participation and influence on policy making and services by patient/users/family members organizations

Ministry of Health and Social Affairs Sweden Government Offices of Sweden Children and youth Promote early interventions Increased accessibility to the right level of care Long term planning and social investments

Ministry of Health and Social Affairs Sweden Government Offices of Sweden The situation in Sweden – health among youth Deterioration of mental health among youth since early 1990s 10 % of women and 7 percent of men between years old have contacts with psychiatric care or are on medication 3 % of girls and 4 percent of boys between 0-17 years old

Ministry of Health and Social Affairs Sweden Government Offices of Sweden ADHD Several children have ADHD medication in Sweden in comparison with other European countries 4,5 % of boys and 2 percent of girls are diagnosed with ADHD Differences between different regions

The Swedish Association of Local Authorities and Regions represents the interests of the municipalities and county councils/regions. The Association has four overall tasks: to monitor and safeguard the interests of the members, to act as an employers’ organisation, to offer services and support for operational development, and to provide an arena for a dialogue between members and with the outside world.

Sweden – a unique construction Unitary state with strong autonomy for regions and local authorities (tax + elections) National: Justice, Employment Law Regional: ca to in population 21 autonomous regional authorities  Health

Local: in population 290 autonomous local authorities - Social care, Education - Universally taxation funded Increasingly services are run by NGO´s and For Profits on contract

Developing services on all levels 1.Pioneering best practice: Model areas + PSYNK ( )  2 phases of a partnership between national level (Ministry of Health and Social Affairs) and SALAR aiming at making  autonomous regional and local authorities work together as a ”joined-up locality”

2. Performance-based reimbursements for  improved care coordination  reducing waiting times to specialist and ”first line” mental health care

3-6% needs specialized care % needs special support in school, by first line health care and/or social care Everybody needs good parents, schools and general prevention 2 M children in Sweden Specialist service First line care General level

Who fits in today’s society?

- everybody?

Who fits in today’s society? - who does not?

Agriculture based society

Industrial based society

..and now…

School, scool environment, demands and ecpectations i school and overall society… Big changes:

What happens to our brain in today’s society?

Who owns the problem? If a persons abilities and the demands from society don’t match… DiagnosisSociety

Mental health Family Friends Economy Work Environment General attitudes in society Expectations Somatic health School Sleep

What effects what Results in school Mental health

100% Health: Pre school School School results: Pupil health care Social services Specialized healthcare Maternal/infant helathcare First line response Pre school School Family Friends Sparetime Environment Economy Culture Social services Maternal/infant helathcare First line response Pupil health care Specialized healthcare

School Pupil health care Social services Primary care Infant helth care Child psychiatry Habilitation Communicating vessels

Social services MHV BVC School health Children´s centers CAMHS Juvenile Justice Schools Adult psychiatry Police Youth health services Primary care Youth leisure programs Civil society Placements Dental care The real picture!

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Children and young persons Ultimate aim: Improve mental health among children and young people

Family support Preschool and school Promotion Prevention Health care Work

How do we try to move the sectors forward? Support for innovation to achieve pioneering/best practice (Focused ”localities” across the country) Spreading best practice + Benchmarking (Most ”localities”) ”Raising the bar” - for lowest level of acceptable practice Performance-based reimbursements to whole systems (All ”localities”) Ca 80% of funds

Successful development – a shared responsibility

Development Time Knowledge Services The gap between ambition and reality

Knowledge – Scientists Miracle? Guidelines, laws, documents – Policymakers Miracle? Activity – Service providers Miracle? Reality – Your familiy

CROSS-SECTORAL GOVERNANCE PSYNK – generic governance themes SOCIAL INVESTMENT CROSS-SECTORAL GOVERNANCE

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Don’t wait! A guide to investing in early intervention for children and adolescents

1. Identify the result that needs improving 2. Establish a clear organisational and management structure 3. Identifying potential interventions Five steps: 4. Prioritise the identified interventions 5. Implemenation and follow up

 Describe the target group and the purpose of the Intervention  Describe the content and implementation of the intervention  Calculate costs expected quality gains and financial results for different stakeholders  Present the grounds on which the intervention is expected to achieve the desired results  Describe how to benchmark and follow up the intervention  Describe potential risks with the intervention

Example 4 A municipality has noted that children with confirmed ADHD are significantly overrepresented among pupils with low scores in the national tests in Year 9. By tracing the group’s history they find that a large proportion of the children had difficulties reading and writing in the early years of schooling. Children with confirmed ADHD in the first years of school need specially adapted support in school (e.g. in the form of classroom training, special education, daily feedback and training of working memory). Currently, the municipality and county council have no joint programme for early identification of ADHD, severe reading and writing disabilities or adjacent problems among children and adolescents, which leads to late diagnoses for many children as well as several of them not receiving the support necessary to succeed in school.

Levels of shared governance Effects Indicators Activities

CROSS-SECTORAL GOVERNANCE SOCIAL INVESTMENT PSYNK – issue specific themes Intense coordinated care planning ”First-line” – early access and intervention, mild to moderate Mental health and school performance

 Successful schooling is a strong preventive factor  Guide for early detection and action - school absence

Specialist First - line Universal ?

First-line = Where you first give service to children and adolescens that have a problem.

”First-line” – early access and intervention  Web-based information for children, youth and families  Supporting in building different ”first-lines” in different parts on Sweden  Studies comparing patients and outcomes

Intense coordinated care planning  Improving services (diagnostics, treatment etc)  Focus on children in fostercare  Coordination plan (”Childrens plan”)