The COVID-19 pandemic significantly impacted mental health in Estonia. For example, the first Estonian National Mental Health Study in 2022 revealed that one in four adults faced a risk of depression following the pandemic. It also highlighted a stark contrast in depression risks between income groups: 45.5% in the lowest income quartile versus 19.6% in the highest.
Anticipating these issues, policymakers started prioritizing mental health in their political agendas already during the late stages of the COVID-19 pandemic. Thus, the Ministry of Social Affairs (MoSA) initiated the Mental Health Task Force in 2021, collaborating with stakeholders from various sectors, including health, education, social affairs, criminal justice, scientists, NGOs, and startups. This led to the creation of the Green Paper on mental health, Estonia's first comprehensive policy document on the subject. Consequently, in early 2022, MoSA established a Mental Health Department within its Health Sector and by the end of the year, drafted the Mental Health Action Plan for 2023–2026. The development of the action plan had a form of collaborative process, which involved numerous working sessions with stakeholders.
The Mental Health Action Plan outlines expected changes in the field of mental health, focusing on the MoSA’s role in achieving these changes. It aligns with the WHO’s fundamental principles, emphasizing universal health coverage, human rights, evidence-based practice, a life course approach, a multisectoral approach, and empowerment for those persons with mental disorders and psychosocial disabilities. The plan is structured along the mental health services pyramid with promotion, prevention and self-care at its base, followed by the community-based support services and PHC services, ambulatory psychiatric aid and counselling, and psychiatric services in hospitals.
The plan’s five main action lines are:
- Development and innovation in mental health, focusing on evaluation tools and a monitoring system.
- Promotion, prevention, and self-help, including suicide prevention and reducing stigma.
- Community support, integrating mental health activities in various policies, focusing on workplace mental health, and engaging older adults.
- Improvement of mental health services, ensuring equitable access, clarifying care paths, and maintaining adequate professional staffing.
- Organizing mental health and psychosocial support in emergencies, emphasizing access to support, central coordination, and training for first responders.
The action plan, a dynamic document reviewed annually, is designed to establish priority directions for MoSA’s mental health policy through 2026. It acknowledges that resolving problems in the mental health field requires more actions than currently outlined and feasible within the plan’s timeframe, considering political priorities and resource allocation. However, the plan’s adaptability can allow for adjustment in response to evolving needs and priorities in mental health care.
Actions needed to implement the Mental Health Action Plan include linking the MoSA’s annual work plan and proposals for funding actions in the national budget process; annual evaluation of progress made under the plan; and strengthening the link with the National Development Plan.