Finland is trying to answer a question many health systems across Europe are now confronting: How do you get mental health care to young people earlier, faster, and without overwhelming specialist services?

The need is clear. Finland’s latest School Health Promotion Study found that self-reported symptoms of anxiety and depression among secondary school students rose from 20% in 2017 to more than 30% in 2023. Boys have also reported rising symptoms, though at a slower pace. Meanwhile, the latest European Health Interview Survey found that unmet need for mental health care in Finland reached 30% — more than eight times the European Union average.

In response, Finland has rolled out reforms under its National Mental Health Strategy 2020-2030 aimed at improving early intervention and expanding access to care for children and adolescents with mild-to-moderate mental health conditions.

At the center of the effort is a shift away from a specialist- and diagnosis-led model toward one that delivers brief, evidence-based psychosocial support in primary care and school settings. In practice, that has meant training school nurses and social workers to recognize symptoms early, provide short interventions, and help determine when more intensive care is needed. Supporters say the model is helping Finland reach more young people more quickly and in settings they trust. Critics, however, question whether some parts of the approach have been implemented too quickly and warn that early intervention cannot substitute for adequate specialist capacity.

Moving Care Closer to Young People

“The idea was to increase the skills of every professional who meets young people and give basic skills in mental health and short evidence-based interventions,” Outi Linnaranta, MD, PhD, adjunct professor at the University of Helsinki in Helsinki, and head of psychiatry at Turku University Hospital in Turku, which is a part of the Southwest Finland collaborative area for health care and social welfare, told Medscape News Europe.

“We have a long tradition in Finland of stressing the important role of nurses instead of doctors in primary care. Social workers and nurses are working daily at schools, so we asked: Can they provide low-threshold services at schools across the country?”

Nurses and social workers receive training that includes 2 days on early psychosocial interventions for anxiety and depression focused on interpersonal counseling, 1-day learning about depressive symptoms and treatment options, and 2 more days half a year later. Trainees also have supervisors they can turn to for advice and who monitor their sessions for an initial period.

“We have asked: Is this intervention working? Do professionals have enough resources? The basic response so far is yes; it’s going surprisingly well,” Linnaranta said. “We’ve been able to train thousands of professionals. Now there’s a need for a discussion: What can be left out from their work so they can prioritize this? Or do we need to increase the number of professionals? It’s not sufficient to just train people; they need to be able to use their training.”

“A nurse and social worker can detect depressive symptoms and anxiety and if a more serious intervention is necessary. It’s safe, it’s rapid, and it happens within a few weeks — we can’t do that with a doctor given the limited availability of them,” she said.

“Interpersonal psychotherapy — speaking about and strengthening relationships — is empowering…and with it most cases improve. It’s skills people can use later in life as opposed to medication, which doesn’t help them in the future.”

Use of psychosocial treatment in primary health care has grown rapidly. The number of children and young people aged 7-22 years receiving primary health care-based short-term psychosocial interventions rose from about 90,000 annually in 2020 to more than 140,000 in 2023.

A Stepped-Care Model Takes Shape

Finland has also tried to reduce fragmentation in the system itself. In 2023, the country shifted responsibility for organizing health and social care services from more than 300 municipalities to 21 newly created well-being services counties, each linked to one of five university hospitals. That reform brought school health care and student welfare services, including psychologist and social work support, into the same county-run health and social care system as other services, with the aim of improving information sharing and collaboration.

For Henna Haravuori, MD, PhD, adolescent psychiatrist and chief physician of child and adolescent psychiatry in Lapland, the reform was an important step toward a less bureaucratic system.

“We’re trying to make it easy. When families or kids call for help, they’re often not in the right place and get moved around and end up not getting the help they need. This has been one of our biggest problems in our system, and we’re trying to tackle this with the stepped care model,” Haravuori told Medscape News Europe.

That stepped-care model, also known as the first-line therapies initiative, is still in its early phases of implementation. It has four steps and uses a symptoms and needs assessment tool to help determine the appropriate intervention.

The first two steps of the model were designed to allow rapid treatment initiation without the delay of a mandatory physician-assessed diagnosis and are delivered by school nurses and social workers. Step one, the lowest-intensity level, uses digital self-help programs. Step two involves brief interventions, including interpersonal counseling for those with mild or moderate depressive symptoms.

Step three is more intensive and broader in scope, including brief cognitive psychotherapy for depression, anxiety, behavioral problems, and substance use. In Lapland, school mental health nurses and school psychologists are now receiving more advanced psychotherapy training through a modular program involving self-study, group supervision, and mentoring over the course of a year. Physicians may need to be involved when medication is required. Step four is specialist-level care from psychologists or psychiatrists.

“When it comes to children and adolescents, we have several studies where they’ve been asked where they want services, and most answer in school, close by, and by someone I know. This is the preferred model, so we’re trying to bring those services where they want them; where they feel safe and comfortable,” Haravuori said.

“In public services, we have a scarcity of psychologists and psychiatrists, and we must reserve those resources for the most severe cases. But I also think there’s this element that mental health symptoms are so common that you don’t have to make a diagnosis; we can move away from diagnosis-oriented, medicalized mental health care and get help early on and easily. We can help a lot more people this way.”

Efforts to bring mental health care into schools are also being reinforced by a new waiting time guarantee. Introduced in May 2025, it requires people younger than 23 years to be offered short-term structured psychotherapy or other psychosocial interventions within 4 weeks of the need being identified, for a maximum of 25 sessions.

Promise, Pressure, and Open Questions

Even among those who support this direction of travel, there are concerns about how the reforms are being implemented.

Linnaranta raised concerns about the emphasis on digital tools and newer interventions that she said had not been adequately tested in children and adolescents before national rollout.

She also warned that in a cost-constrained system, a rigid stepped-care approach could make it harder for some young people to access more intensive treatment when they need it, a key reason the reforms have divided stakeholders in Finland.

Experts have also said training nurses and social workers is not, by itself, a solution to Finland’s broader workforce problem. Although existing staff have received additional training, that does not increase the number of professionals working in primary care or specialist psychological and psychiatric services. Finland continues to face a shortage of specialists.

Silja Kosola, MD, PhD, associate professor in adolescent medicine at the University of Helsinki and former school physician, told Medscape News Europe that school doctors could also be used more effectively, particularly in more serious cases.

“Doctors conduct health checks in years 1, 5, 8, and once in high school. They don’t see as many children and young people in need as they could be used for. It’s a waste of resources to use a doctor to check all these students who the nurse already checked. They can help with more serious mental health cases before we turn to a referral,” she said.

Still, some experts said Finland’s approach offers a useful example for other countries trying to strengthen prevention and early intervention while avoiding unnecessary medicalization.

Anu Raevuori, MD, PhD, professor in adolescent psychiatry at the University of Helsinki, told Medscape News Europe that the reforms support a more preventive framework, as long as they do not come at the expense of specialized care when it is clinically needed.

“I am supportive of this shift, provided it does not replace access to specialized treatment when clinically indicated,” she said.

“In school settings, many adolescents experience distress or emerging symptoms that do not yet meet diagnostic thresholds for psychiatric disorders but still warrant support. Providing low-level mental health interventions without requiring a formal diagnosis may improve access, reduce delays in care, and help address problems before they become more severe.”

Linnaranta, Haravuori, Kosola, and Raevuori reported having no relevant financial relationships.

Sophie Cousins, MIPH, is a global health journalist who has reported from more than 20 countries.