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14 February 2025 | Country Update
Strengthened acute psychiatric services
5.11. Mental health care
Public services for patients with mental health disorders are provided through cross-sector collaboration between the health and social care sectors. The regions are responsible for psychiatric health care services. The municipalities are responsible for community psychiatric services, except for some community psychiatric institutions, which are still managed by the regions but financed by the municipalities. Consequently, there are partial overlaps within some community psychiatric services provided by the regions and municipalities. This further complicates the effort to run an effective, coherent system linking decision competences and financing responsibility. To counter this, psychiatry is included in the health agreements between regions and municipalities.
As a result of the policy of deinstitutionalization of the psychiatric sector, there has been a decrease in the number of available beds in hospital psychiatric departments. Since the health care reform was implemented in 2007, however, the number has been relatively stable at around 3000 beds, while the number of beds in child and adolescent psychiatry has increased (Sundhedsstyrelsen, 2022c). At the same time, the number of outpatient contacts increased, from 732 950 in 2007 to 1 002 055 in 2020, an increase of around 27% (Sundhedsdatastyrelsen, 2021).
Outpatient psychiatric treatment is often established locally in specific centres and is provided by interdisciplinary community mental health teams. These are made up of doctors, nurses, social workers, occupational therapists, psychologists, physiotherapists and other health professionals. The regions have different outpatient psychiatric services; some strictly provide services for people with long-term and socially disabling conditions. Others also include services for people with short-term mental illness. Referrals are from a GP, the hospital, or, in some cases, the municipal caseworker. Acute care patients can also sometimes self-refer.
Community mental health care has been criticized for providing insufficient treatment, which may be linked to reductions in the number of beds without simultaneously increasing outpatient care resources. All of Denmark is served by community mental health care services and other outpatient facilities, although there are challenges in maintaining staffing levels, particularly in remote rural areas. The current focus is on quality development and revision of guidelines. Only a few specific health services are provided to deal with the mental health problems faced by refugees, asylum seekers or other vulnerable groups.
In 2014, the government and the regions agreed to reduce coercion and halve the use of restraints in psychiatry. Although it has been possible to limit the usage of restraints, the use of coercion has increased, including emergency sedatives, detentions, coercive medication, involuntary hospitalizations and coercive detentions (Sundhedsstyrelsen, 2021). The use of coercion could be seen as a symptom of a psychiatry health care system not working well. Likewise, the National Audit Office has also criticized this, stating that the management of efforts to reduce the use of coercion in psychiatry has been unsatisfactory (Rigsrevisionen, 2021).
In the recent decade, an increasing focus has been targeted on destigmatizing mental illness. The Danish Mental Health Fund, whose primary aims are to disseminate knowledge about mental illness and minimize prejudice in the field, has established a nationwide programme on depression, anxiety disorders and schizophrenia. The programmes are coordinated by the Danish Mental Health Fund and implemented in collaboration with the municipalities and networks in the regions.
A report published in 2022 by the Danish Health Authority has formed the basis for a comprehensive 10-year plan for the development of psychiatry. The report includes nine key themes. Challenges and recommendations for better mental health and a strengthened effort for people with mental health needs across sector boundaries are described with each theme. The recommendations cover both the initiatives that have a particularly high priority (early intervention for children and young people, and strengthened efforts for people with the most severe mental illnesses), and that can be implemented in the short term and the efforts that can be gradually rolled out over a 10-year period (Sundhedsstyrelsen, 2022c). In December 2022, investments in psychiatry were prioritized over the next 10 years so that the plan is now funded with DKK 4 billion (€536.4 million) annually.
As part of the “Better Psychiatry Agreement” from November 2023, the government and agreement parties have decided to improve access to regional acute psychiatric services. Following recommendations from the Danish Health Authority, an acute psychiatric emergency hotline will be integrated into the existing emergency response system, creating a single point of contact through 112 and the out-of-hours medical service. Both services will be enhanced with psychiatric expertise. Additionally, a new regional psychiatric emergency coordinator will be established to ensure better coordination between the 112 telephone triage and regional psychiatric emergency services.
The agreement aligns with the 2024 structural reform (see policy analysis “A comprehensive mosaic reform to strengthen primary and chronic care capacity” from 25 November 2024), which aims to create a better and more cohesive organization and ensure equal treatment across psychiatric and somatic care. The agreement is supported by approximately DKK 113 million (€15 million) in 2025, with annual funding of DKK 150 million (€20 million) thereafter.