BOX 13-1

Health System–Based Approaches to Prevention in the Netherlands and Finland

The Netherlands and Finland have both developed system-wide approaches that initially focused on children of depressed parents and now include prevention work with children of parents with mental illness.


The Netherlands


The Netherlands began in the 1970s to develop a network of prevention and health promotion teams. These teams were placed in multiple health sectors (e.g., public health, mental health, addiction clinics) and supported by prevention-oriented national institutes and national research centers. The work is part of a national health policy that allots about 5-10 percent of the budgets of community mental health centers for prevention of mental disorders.

The experience has been that having preventionists certified to do preventive care has made a difference. It also facilitates the adoption and dissemination of evidence-based programs when they become available and application of continuous quality improvement processes. Preventionists have a network in which they collaborate with research institutes. This structure enables a constant interplay between research and practice. It also has provided a vital infrastructure through which to deliver preventive services. Preventive care for children of the mentally ill is an integral part of the mental health and primary health care system.

Care of children of parents with mental illness is one of five mental health priority areas. To make care of children of mentally ill parents a regular part of the systems of care (not an isolated activity), adults with mental illness are routinely asked if they have children. If children are present, the family automatically qualifies for services. Parents and children receive informal home visits and are offered an array of services, including play and talk groups, information support groups, online websites, brochures, videos, school-based education, a buddy system for children and for parents, home-based mother–baby interventions, and parent training. Delivery of services is accompanied by extensive postgraduate training for providers. Many of the practitioners have been educated in Dutch academic and training programs that first focus on prevention, health education, and health promotion.


Finland


In Finland, under the leadership of Tytti Solantaus, a nationwide program has been developed effectively in a stepwise fashion starting in 2001. The Finnish Child Welfare Act states that if a parent is identified as receiving treatment, the needs of children should be addressed. Before 2001, there had not been a systematic program to do so. The initiative began with the Efficient Family Program, the aim of which is building care of patients’ children into routine practice, with every parent receiving support. This was deliberately conceived as a change from an



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