Since 1990, significant policy changes have been put in place to address Estonia’s mental health challenges. They aimed to create affordable access to mental health services and decrease the length of time people had to spend in psychiatric hospitals. 

Despite this, the need for mental health services is continuously increasing. In 2024, Estonian psychiatrists recorded a 4% increase in mental health and behavioral disorder diagnosis during outpatient visits than the previous year. The biggest increase was among children under 15, according to the National Institute for Health Development (TAI). This is because Estonians still face some challenges when it comes to seeking mental health support.

Challenges People with Mental Health Issues Face in Estonia

Challenges for people with mental health issues in Estonia include:

• Waiting Lists: People often have to wait several months to be seen by a mental health specialist. In 2007, 13% of people in Estonia felt the need of a psychologist or counsellor but they did not get the help they needed in time due to the long waiting lists.
• High Costs: Private mental health services are financially out of reach for many people in Estonia, as the costs often range between 50-100 euro.
• Availability: There is a lack of availability of mental health professionals, which is the most prominent prevention of the national mental health development. Therefore, institutes can only treat patients when their condition is already critical and not beforehand.
• Shortage in Workforce: The Estonian Qualifications Authority said Estonia is projected to need around 7,700 new health care workers in the next 10 years. However, the current training rate is only expected to produce only around 6,400, which means they will be 1,300 specialists.

Estonia has gradually implemented policy changes which aim to reduce Estonia’s mental health challenges.

How Poverty Affects Mental Health in Estonia

The Estonian government has been placing a large number of orphaned children in state-run institutions that have impoverishing conditions. For example, the children don’t have access to adequate resources or specialized staff. This means the children are at a higher risk of developing mental and behavioral issues because of their economic status. The UN Committee on the Rights of the Child has stated that Estonia needs to implement more open and rehabilitative care strategies to reduce the number of orphaned children with mental health issues.

Reducing Estonia’s Mental Health Challenges

From the early 1990s to 2003, the government closed large psychiatric hospitals and established family medicine as a specialty. It also established the publicly financed benefits package, which expanded mental health care in the region. The purchasing agency (Estonian Health Insurance Fund) provided this.

Furthermore, from 2004 to 2013, the role of mental health in primary health care was established through the development of policy frameworks and clinical guidelines, which allowed more family doctors to prescribe medicine for mental health conditions.

Additionally, since 2014, the government has consolidated and made numerous changes to the mental health services to further tackle Estonia’s mental health challenges. Some changes focused on establishing multidisciplinary primary health care with indirect benefits for mental health care. Others explicitly prioritized mental health care by making changes in how the government finances it.

Addressing Workforce Shortages

The Ministry has worked significantly to improve mental health services in Estonia, said Anne Randväli, the Head of Mental Health Department at the Ministry of Social Affairs in Estonia. They have addressed “workforce shortages” through state funding “residency or induction years for clinical psychologists and psychologist-counsellors since 2021.” The Ministry created “a coherent and sustainable system for training new specialists.” Before, “training largely depended on the personal resources of the professionals.”

Stepped Care Model for Mental Health

In 2024, the Ministry introduced a “stepped care model for mental health.” This model focuses on treating “common conditions such as depression and anxiety” through educating citizens on psychology and mental health and through specialists providing “digital self-help tools” or “low intensity intervention” to those with minor mental issues. This system provides support “at the earliest possible stage and progresses to more intensive services as needed” stated Randväli.

The findings of “the Estonian Human Development Report 2023” were used to create this model. EHDR’s current findings show that the current system resembles an “hourglass shape: relatively strong in terms of self-management and specialist care, but weak at the intermediate levels of community and primary care support.” The stepped care model will use “cost-effective solutions” to improve these intermediate levels, Randväli added.

The Outcomes of These Efforts

The national suicide rate dropped from 15.1% per 100,000 people in 2020 oecd.org to 14% per 100,000 in 2023. This is significantly lower than the suicide rates of countries such as Lithuania, which is at around 17% in 2023, or Korea which is at 24%. However, Estonia’s rate is still higher than many other countries. For example, Chile which is at 11% and Denmark at 9.5%.

Conclusion

The Estonian government has significantly improved their mental health services over the years through their policy changes, which have had a significant effect in extreme cases such as reducing the suicide rate. However, the mental health system is still seen as weak in terms of providing primary care support. The Ministry is working to further improve the mental health services through the stepped care model.

– Bianca Burdulea

Bianca is based in Sunderland, UK and focuses on Good News and Politics for The Borgen Project.

Photo: Flickr