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56 SCHIZOPHRENIA PROJECT
In 1980, there were 4.2 psychiatric hospital beds per one thousand inhabitants in Finland; only Ireland had a
higher proportion. A couple of years previously, the Finnish Mental Health Act had been reformed with the aim of
strengthening outpatient care, but it had had no significant effect. In 1979, what was then the Association of
Psychiatric Hospitals filed a motion for the creation of a national programme for schizophrenia treatment. More
than half of all psychiatric patients belonged to that diagnosis, and most of them were long-term patients in so-
called b-class psychiatric wards, many of which lacked active treatment or rehabilitation programmes.
Based on this motion, in late 1980 the National Board of Health set up a task force to prepare an action plan
for schizophrenia research, treatment and rehabilitation. The task force recommended the creation of an active
development programme to be implemented in direct interaction with the field. The task force’s report, completed
in the spring of 1981, formed a basis for just such a project, which was initiated by the National Board of Health,
the Hospital Association and the Association of Psychiatric Hospitals. The decision was groundbreaking, as no
similar development programme focused on a single illness had ever been implemented in Finland, or in relation
to schizophrenia anywhere else in the world.
The National Schizophrenia Project was conducted between 1981 and 1987, with monitoring of its outcomes
added in 1992. The quantitative target was to halve the number of new schizophrenia patients and old longterm
institutionalised schizophrenia patients in ten years. The most important measure was the development of new,
proactive treatment and rehabilitation methods, which were largely focused on families and the living
environment. Another objective was the quantitative and qualitative development of outpatient care and its
organisers in order to cope with the additional load created by the earlier target. The fulfilment of these targets
was monitored with a separate district-specific follow-up study based on patient statistics.
All psychiatric hospital districts participated in the project. Representatives of the hospital districts attended
seminars that explained the aims, methods and monitoring of the project. The main approach was to split the
project into two extensive sub-projects, one for developing treatments for new schizophrenia patients (usp
Project), and another for developing treatments and rehabilitation for long-term patients (psp Project). The
development project involved two thirds of Finland’s psychiatric hospital districts (14 out of 21).
Previously implemented, new procedures created good conditions for the progress of the main projects. In
Turku, Professor Yrjö Alanen and his team had been working on an individualand family-focused
psychotherapeutic treatment programme for schizophrenia patients, which suited a public health care system.
Alanen was also in charge of the usp Project, so the necessary treatment model was spread around the country.
Particularly popular were so-called therapy meetings; meetings where the medical team discussed the initiation
of treatment and the patient’s care needs with the patient and his/ her family and close relations. The model
spread to the other Nordic countries and awakened interest elsewhere. Attention has also been received by the
development of long-term patient rehabilitation work by Professor Erik E. Anttinen and his team at the Tampere
Sopimusvuori Association. Anttinen was a member of the national development project team, managing the PSP
Project. A significant number of longterm patients had already been rehabilitated and released from psychiatric
hospitals within the Sopimusvuori Association’s therapeutic communities. The project team also set up separate
task forces to prepare a report entitled Schizophrenia and Primary Health Care and to investigate issues related
to preventing illness.
The actions of the National Schizophrenia Project were reported in a total of 15 publications. The end report
included well-founded recommendations based on the experiences gained from the development programme,
divided into ten areas: prevention, treatment practices, rehabilitation, the care system, qualitative resources,
right to basic services, education, development work, research and legislation. A mid-term report published in
1985 indicated that the rehabilitation of long-term patients in particular progressed quickly, even at the early
stages of the initiative. It became apparent that hospitals had many fairly moderate schizophrenia cases, which
could quickly be rehabilitated into outpatient care. The reduction of new long-term patient cases took more time
and often required significant changes in work practices. The project motivated staff and changed the
atmosphere in hospitals, when a field that had often felt unrecognised received a new kind of attention.
The project’s quantitative targets were well met. According to the follow-up study, the number of new long-
term schizophrenia patients fell by 60% and the number of old longterm patients by 67 % between 1982 and
1992. The number of psychiatric hospital beds was reduced by 51% to 1.9 per 1,000 inhabitants. There was also
progress in the third objective, i.e. the development of outpatient care: while in 1982 there had been 2.7
outpatient care staff per 10,000 inhabitants, in 1992 there were 5.1. New operating models were developed at a
commendable rate, while the number of nonhospital rehabilitation homes, small-scale care homes and assisted
living facilities increased.
The development trend suffered severe setbacks in the recession of the early 1990s. The number of hospital
beds continued to be cut, but outpatient care stopped being increased and was in some cases even reduced. In
the twenty-first century the situation has gradually started to normalise.
The number of hospital beds is only 5,000 and the target is to cut them down to 2,000
– 3,000. Now in 2010´s
the whole service structure is very different from 1970`s. Hospitals have still their important role but the iporance
of outpatient care has increased.
The schizophrenia project’s patient-oriented and humane approach is still present in Finland; in some places
strong and under continuous renewal, and in others, weaker. In some areas it runs the risk of being replaced by
a more externally focused and excessively medicationoriented approach.
Yrjö Alanen
– Professor Emeritus of Psychiatry
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