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This study reports the 10-year evaluation of the Finnish National Schizophrenia Project. The aims of the national project were achieved. The number of long-stay schizophrenic patients in psychiatric hospitals decreased by 63% between 1982 and 1992. Both the treatment of schizophrenic patients and the structure of mental health services have changed greatly in Finland. Psychosocial treatment methods in particular have developed. The major innovations of the Project are the acute psychosis teams now serving over 50% of the country, and social skills training programmes. The 10-year evaluation of the Finnish National Schizophrenia Project shows that it is possible to conduct successfully nation-wide projects to develop the treatment of schizophrenic patients and psychiatric practices across an entire country.

Finland was the first European country to give a high priority to the development of specialized psychiatric services for adolescents. The aim of this paper is to 1) describe the development of these services, 2) study the status and the functioning of psychiatric services for adolescents in 2000 and 3) present some future challenges. The data have been collected from the social welfare register, from a questionnaire sent to Health Districts and via telephone interviews. In addition, the functioning of the treatment system has been studied in detail in one Health District by means of interviews and questionnaires. The general targets set in 1987 giving national priority to focused psychiatric services for adolescents were mostly reached in 2000, and resources for adolescents have increased markedly. In spite of this, minors still have to be treated in adult psychiatric wards. Many problems were detected in the functioning of the chains of treatment for adolescents. The differentiation between primary and secondary care was unclear. Primary care had a limited capacity in the early detection of mental disorders in adolescents. The services for adolescents were broken down into small units. Furthermore, there were no comprehensive future plans. The need for specialized psychiatric services for adolescents is evident. In addition to developing adequate resources, the quality of care should also be guaranteed by training and by competent long-term planning of psychiatric service systems.

The history of Finnish psychiatry has been characterized by polarizations: priority in hospitals vs. outpatient care, centralized vs. decentralized organization, independent vs. integrated administration, biological vs. psychological treatments, private vs. public production, special psychiatric policies vs. general health policies. The independent psychiatric organizations on District level lasted from the 1920s until 1990. Since then, the formerly independent psychiatry was subordinated to General Hospital administration and the centralized system of state planning and financing of healthcare was gradually decentralized and run down. During the heavy Finnish economic recession of the early 1990 s, the cuts of the public sector were unfortunately focused most heavily on psychiatric services. The main focus of research and teaching has shifted from earlier emphasis on psychoanalytical approach to biological psychiatry since the late 1980s. The administrative position of psychiatry has been repeatedly changing and unstable during the last 20 years. At the level of the contents of the services, however, there have been many very positive and promising developments. Psychiatry has come closer to other specialties from its formerly isolated position, when the separate administrations have been integrated. Provision of outpatient services has increased remarkably, while the number of hospital beds has decreased radically. Interest and resources in research have increased remarkably, and numerous new and good quality psychiatric research reports are being published.

Admission to a close ward was analyzed at the Department of Psychiatry, University of Oulu using 888 patients and their 1861 assessment and treatment episodes. Of all referrals for involuntary assessment (n = 237, 12.7% of all episodes) a total of 44 (2.4%) used "questionable" juridical criteria: the final diagnosis was not psychosis. In the follow-up, the admission of the questionable patients was mainly considered a clinical necessity, and at least one third of them were diagnosed as being psychotic and 2 committed suicide. An elevated probability of belonging to the questionable group was seen among patients in their first treatment episode, with minimal professional education, female sex, short treatment time, or residence in a rural area. The result suggests that some inequality existed between women and men, less and more educated and residents of urban and rural areas. The results also reflect conflict between the ethics and clinical practice of involuntary commitment, and the phrasing of the law, especially its diagnostic limitation to psychotic states only.