18th of November 2020

In June, new laws were approved in the parliament relating to the subsidising of mental health services. The draft proposal read that from 1st January 2021, the services provided by psychologists and other qualified therapists would be subsidised by the government. However, in the government’s financial agenda for 2021 to 2025, no clear indication is given of how this subsidisation will be funded.

Research on the mental health of Icelanders, suggests there’s a lack of access to mental health services.

In a European comparative study from 2015, Iceland ranked 4th for people reporting symptoms of depression and 2nd for people reporting severe symptoms. The same study declared that depression symptoms were more common amongst young Icelandic women than their counterparts in Europe. Young Icelandic men appear to be suffering too. According to the directorate of Health, one third of deaths for males aged 15-29 comes as a result of suicide. This follows the narrative of a 2016 study which underlined that self-harm and suicidal behaviour amongst young people were more prevalent than expected – more than 10% of girls reported having engaged in self-harm behaviour and just under a quarter of boys claimed to have contemplated suicide.

Until now, medication has often been the first or only treatment feasible for those who seek help due to mental health issues. This has largely been due to shortage of psychologists and other therapists in the public health sector. The use of antidepressants amongst Icelanders seems to confirm this reality. During the period from 2012 to 2017, the proportion of people receiving antidepressants increased by 20%, with prescriptions for young people increasing by 60%. By the end of that period, approximately 20% of women and 10% of men, had received prescriptions for antidepressants. In 2015, the consumption of these medications in Iceland was double compared to the OECD average. 

[the picture above is available in print here at Uppskera artmarket]

Mental health practitioners outside the public sector are expensive. In 2017, one third of Icelanders said they would not be able to afford their services.

In the current financial climate, these is no reason to believe that this has changed. For example, an appointment with a psychologist can cost up to 20.000 ISK, and if a person receives 5-15 of these (standard practice to ensure that therapy is successful) the total cost can verge on 300.000 ISK.

Hugrún and other parties of interest have pointed to the importance of subsidisation of mental health service. As of now, treatment is not available to many of those who most need it. Students, low income individuals, unemployed individuals and marginalized groups cannot afford services running on hundreds of thousands. With subsidisation, this can change. People who otherwise would not be able, can then access clinically proven treatments of official therapists – psychologists, social workers and others. Cognitive behaviour therapy (CBT and variants thereof) has proven to be one of the most effective treatments for common mental disorders such as anxiety and depression. These should therefore be the first choice for people seeking help with those problems. 

As stated initially, the new financial agenda of the government does not specify how the subsidisation of mental health services will be funded. Recently in the parliament, the details of this were said to be in process.  If the law will be enforced according to plan, subsidisation will work in the same way as it does for the services of specialised doctors, physiotherapists and speech therapists, just to name a few. For these services, the following applies: When cost for the service reaches a monthly limit – just over 26.000 ISK – the cost in the subsequent months will be no greater than about 4.400 ISK per month.

The law in question indicates that the same system will cover necessary therapy from a licensed psychologist or equivalent practitioner, with the public health department (PHD) requiring only an attestation from a GP or a health practitioner. The process might therefore look like this: You talk to a GP and explain your problem. If he / she thinks that you would benefit from a treatment, an attestation can be made stating that. That will then be received by the PHD. When you then go to see a therapist, you will pay a maximum of approximately 26.000 ISK monthly. If you reach that amount in one month (which shouldn’t be difficult if an appointment costs 20.000 ISK), the following months you will only pay up to 4.400 ISK. The subsidisation continues as long as you use the services each month. The process is automatic, which means that you do not have to keep track of whether/when you have reached the monthly limit – the system keeps track of your expenses and the subsidisation is automatically activated.

Until it’s clear to what extent the law will be enforced, we want to point out the following: Those who have been paying monthly fees of their income into a union for long enough usually have rights to subsidisation of therapy.

We encourage everyone who thinks that might apply to them to contact their union. Simply call or email, ask into your accumulated rights and send in a receipt for the services you use. If the receipt is received early enough in the month, refund is usually given the following month.

[the picture above is available in print here at Uppskera artmarket]

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Alþingi. (2020). 5.löggjafarfundur 151.löggjafarþings. Taken 29. October 2020 from https://www.althingi.is/altext/upptokur/thingfundur/?lthing=151&fundnr=5

Embætti Landlæknis. (2020). Sjálfsvíg – tölur. Taken 25. October 2020 from https://www.landlaeknir.is/tolfraedi-og-rannsoknir/tolfraedi/danarorsakir/sjalfsvig/

Embætti Landlæknis. (2018). Sjálfsvígshugsanir og sjálfsvígstilraunir meðal íslenskra ungmenna: Niðurstöður kannana í framhaldsskólum frá 2000-2016. Taken 23. October 2020 from https://www.landlaeknir.is/

Embætti Landlæknis. (2017). Mikil aukning í ávísunum þunglyndislyfja á undanförnum árum. Taken 19. October 2020 from https://www.landlaeknir.is/um-embaettid/frettir/frett/item31934/Mikil-aukning-i-avisunum-thunglyndislyfja-a-undanfornu

Hagstofan. (2017). Þunglyndiseinkenni algeng á Íslandi. Taken 20. October 2020 from https://www.hagstofa.is / utgafur / frettasafn / heilbrigdismal / heilsufarsrannsokn-2015-thunglyndiseinkenni / 

Hagstofan. (2017). Tekjur hafa áhrif á það hvort fólk sækir sér heilbrigðisþjónustu. Taken 23. October 2020 from https://hagstofa.is / utgafur / frettasafn / heilbrigdismal / heilsufarsrannsokn-2015-adgangur-ad-heilbrigdisthjonustu/

Lög um aðgengi að sálfræðiþjónustu og annarri gagnreyndri samtalsmeðferð nr.93/2020. Taken 14. October 2020 from https://www.althingi.is/altext/150/s/0008.html 

Sjúkratryggingar Íslands. (e.d.) Greiðsluþátttökukerfi vegna læknisþjónustu, þjálfunar o.fl.. Taken 27. October 2020 from https://www.sjukra.is / heilbrigdisthjonusta / greidsluthatttaka / almennt/ 

Vísir. (2020). Vonbrigði að ekki sé gert ráð fyrir niðurgreiðslu sálfræðiþjónustu. Taken 29. October 2020 from https://www.visir.is/g/20202021896d

[the picture above is available in print here at Uppskera artmarket]

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Why Not Now — New Mental Health Care Subsidy Law