Disability Pensions Due to Mental Disorders in Finland: The role of social factors and mental health services

Mental disorders are one of the most common and disabling health conditions worldwide, causing considerable human suffering and significant economic costs. In Finland, mental and behavioural disorders are the most extensive diagnostic group for which people receive disability allowance. Previous research has identified important social and regional differences regarding mental disorder disability pension (DP) rates, but more systematic research is required to understand these disparities. In addition, the role and possibilities of mental health services (MHS) in preventing DPs due to mental disorders are still for the most part unexplored, with no consensus among experts and stakeholders on the best practice of MHS provision in different contexts to prevent DPs.

The aim of this dissertation was to study in depth the different risk factors and dynamics affecting the mental disorder-based DP process, from macro-level sociodemographic and socioeconomic factors to contextual regional settings. By considering these factors and the populational context, the definitive objective of this thesis was to identify and describe the connections between MHS and mental disorder DP by applying the Mental Health Ecosystems research approach. This dissertation is part of the RETIRE – research project, which aims to study the risk factors and sequences of mental health-based disability pensioning and to analyse the effectiveness of service systems in different hospital districts in Finland.

We utilised national register data to study all Finnish citizens granted a temporary, permanent, full or partial DP due to a mental disorder for the first time between 2010 and 2015 with added controls. This enabled us to study the DP risk associated with different socioeconomic backgrounds and hospital districts. To study the connections between MHS and mental disorder DP, we used regional outpatient and inpatient data provided by the national registers and detailed data on the MHS provision in seven hospital districts analysed using the DESDE-LTC-tool. We also applied the Gini-Simpson Diversity Index (GSDI) as a novel way to measure service diversity. The association of social and regional determinants, and of MHS utilisation factors, with mental disorder DP risk was studied with regression analyses. This study also performed a broad standard assessment and comparison between the MHS patterns of Finland’s three most populous hospital districts in order to further study the possible underlying factors concerning discovered mood disorder DP risk differences.

The present dissertation discovered significant differences in mental disorder DP risk regarding the social and regional determinants of mental health. The high risk of people with low educational and income levels, as well as of white-collar workers and students, for mental and mood disorder DP was highlighted. The revealed regional variation in DP risk was not explained solely by the districts’ sociodemographic and -economic differences, pointing towards the role of service system characteristics in explaining these differences.

The analysis of the DESDE-LTC data on MHS provision implied that greater richness and diversity of MHS, especially in outpatient and community-based settings, is associated with lower DP risk and may thus be an indicator of a well-developed and balanced, high-quality service system that is more effective in preventing mood disorder DP and meeting the different needs of the population. Our findings also point to the role of sufficient resourcing in all MHS and outpatient services, so that the essential services can provide adequate psychosocial treatment responding to individual and populational needs.

The findings reported in this dissertation contribute to our understanding of the factors and mechanisms at different levels of mental health ecosystems affecting meso- and macro-level early retirement due to mental disorders. In the ongoing health and social service structure reform and the work to implement the Finnish Mental Health Strategy 2020–2030, both the need to consider the local context and local needs, as well as national cooperation and joint service development, must be seen as vital in order to avoid past mistakes of creating fragmented services and to ensure equal, broad, high-quality services that meet the needs of the population.