Secular trends in psychiatric service utilization in Finland from 2001 to 2023

Abstract Background Prevention and early intervention are key public mental health strategies to address rising mental health needs. Tracking trends in secondary psychiatric care utilization helps assess the success of these strategies and highlight areas for improvement in service delivery. Methods A register-based cohort study followed the entire Finnish population from 2001 to 2023. Annual utilization was defined as the proportion with at least one secondary psychiatric care contact in the Finnish healthcare registers. Outpatient care intensity was measured by median annual visits. Estimates were stratified by diagnosis, age, and gender. ICD-10 diagnostic classification was used. Results In 2023, 264,008 individuals (4.7% of the whole Finnish population; 2.6% women, 2.2% men) used psychiatric secondary care services, a 97.9% rise since 2001 (111.7% women, 83.8% men). Mood (F30-F39), anxiety (F40-F48), and behavioural and emotional disorders (F90-F98) were most common diagnoses in 2023. The sharpest increase from 2001 to 2023 occurred in the disorders of psychological development (F80-F89), up to 2965% in women, 1278% in men. Inpatient care decreased by 33.3% overall since 2001 but rose by 57.8% among women under 30. Median outpatient visits were 2 during 2001-2012 and 3 from 2013 onward, with further growth limited to those under 18. The increase in inpatient care among young women was only partly matched by an increase in outpatient care intensity. COVID-19 temporarily reduced inpatient but not outpatient utilization. Discussion Psychiatric service utilization continues to rise, with concerning inpatient trends among younger women. Despite a policy focus on outpatient care, increase in the intensity of care remain limited. Ensuring adequacy, access, and quality of specialized services needs constant focus in public mental health efforts. Key messages • Psychiatric service use nearly doubled in Finland between 2001 and 2023, with the sharpest rise in young women and children - raising concerns about care needs and system capacity. • Despite policy shifts favoring outpatient care, its intensity rose only slightly, mainly in those under 18. In contrast, inpatient care increased in young women from 2001 to 2023.