Complaints regarding residential mental health rehabilitation services have increased significantly this year, with regional administrative authorities grappling with more than 40 allegations of negligence in October alone.
Reports of irregularities touched on inadequate staffing, lapses in medical care, problems with work routines and leadership and even endangerment of patient safety.
Currently about 8,000 clients in Finland use in-house mental health rehabilitation services. Customers generally have serious mental health problems such as depression and schizophrenia.
The residential services are supervised by regional administrative authorities (AVI) and the National Supervisory Authority for Welfare and Health, Valvira.
Yle’s investigative programme MOT reviewed the current situation with regard to residential mental health rehabilitation services and found that addressing reported irregularities often takes a long time, while the investigating problems could take up to two years.
"Respect for the decisions of the oversight authorities is not like it was before. Improvements are not implemented as quickly as in the past. We officials have been told outright lies about these things," Valvira senior inspector Lilli Autti commented.
Inadequate personnel, lapses in care
Psychiatrists working with the regional administrative authority have also had to deal with falsehoods.
"A service provider might claim that they do not use personnel who are insufficiently trained. Then the next thing you know, a person who has no training whatsoever to work in a medical care facility is participating in medical care on the orders of the company or person in charge," regional administrative authority chief medical officer Marja Kuronen noted.
Among the 40-odd reports lodged with regional administrative authorities, complaints focused on inadequate staffing as well as an "institutional" environment. In addition, complaints mentioned shortcomings in customers’ right to self-determination as well as problems with working routines and leadership. The worst cases even posed a danger to patient safety.
"For example, people were not sent for follow-up examinations after serious illnesses, but were instead given inappropriate medication. Only when a situation had already gone on for a long time did other health care staff realise that an evaluation by a specialist physician at a university hospital was required," Kuronen recounted.
Market controlled by health care giants
Finland’s residential services market currently has about 250 service providers, with about 500 residential units. During recent years major providers Attendo, Esperi and Mehiläinen have snapped up smaller firms to cement their hold on the market. Among them, they control some 40 percent of residential units and more than half of customer places.
Customers pay rent for their residential places, however this does not include meals and other forms of care. Providers are required to draw up a personal rehabilitation plan for each resident, the aim of which is to help them to learn to manage day-to-day matters independently.
However due to staff shortages, many institutions become no more than a storage facility for mental health patients, MOT found.
"Financial criteria are IN, mental health rehabilitation OUT"
Social scientist Markku Salo has studied residential services for mental health rehabilitation patients. He said that some of the irregularities in care are the result of the concentration of services in the sector.
"Financial principles determine what happens in residential services. You could say that financial criteria are IN and mental health rehabilitation is OUT," Salo added.
Supervisory authorities also told MOT that they had noticed a change in focus.
"After buyouts there have been efforts to scale back staff, reduce support services and outsource meal services. Over time these changes affect many [other] things," chief medical officer Kuronen observed.
Relatives wary of flagging problems
Supervisory actions by Valvira and regional administrative authorities have long been based on reports of irregularities. In the past only a few such issues have been raised because of the shame that still shrouded mental health problems.
Mental health rehabilitation patients have few advocates. In some cases residents of care facilities are so ill that they cannot speak up for themselves. Meanwhile the fear of retribution may prevent relatives from flagging problems.
However complaints about perceived misdeeds began to flood in last spring, after a number of instances of mismanagement and negligence in elder care began receiving heavy media coverage.
Municipalities indifferent about service
Local governments are responsible for procuring residential mental health rehabilitation services. In such cases, they assume a conflicting dual role as both service provider and supervisor. This sometimes leads to a situation in which oversight does not work effectively.
"A municipality may even know about a problem, but will still place a patient in a unit for financial reasons and because it cannot offer an alternative," Valvira senior inspector Autti noted.
According to regional administrative authority chief medical officer Kuronen municipalities are indifferent about services for mental health rehabilitation patients.
"Municipalities have great difficulty understanding the needs of this group of people because they don’t have the expertise. One director of social services has even said that their tendering process assigns a weighting of two-thirds to price and one-third to quality. But because they don’t know anything about the quality it’s all about the price. This shouldn’t be the case. You must understand what you are buying," Kuronen declared.