Professional mental health care largely comes down to prescribing medication, particularly for older people, according to a survey commissioned by the Estonian-Swedish Mental Health and Suicidology Institute and conducted by Norstat. Experts say this may be because medication is cheaper and more readily available.

As part of the "Depression-Free Tallinn" project, researchers surveyed 1,000 adults in Tallinn's Lasnamäe, Õismäe and Mustamäe districts about their attitudes and experiences. Rainer Mere, who is leading the research project, said one thing that immediately stood out in the results was the continued prevalence of prejudice, stigma and confusion about navigating mental health care.

"When we asked people whether they were willing to receive treatment and what kind of treatment they had received if they had sought help somewhere, it also emerged, particularly among older people, that their treatment tends to focus solely on medication and that they very rarely receive therapy," Mere said. "This is in contrast, for example, to younger people, who receive both medication and therapy."

Mere noted, for example, that people over the age of 60 use medication to treat depression three times as often as they receive psychotherapy.

"What we can infer from the figures is that older people are willing to receive help. In other words, they are not opposed to therapy, for example. When we looked at the figures, they would be willing to receive it, but perhaps it is simply not offered to them, they do not know to ask for it themselves or their doctor does not know to offer it to them," Mere said. "For some reason, they really are not getting into therapy."

Margus Tõnissaar, president of the Estonian Association of Psychologists, said the survey results were to be expected because while medication is inexpensive and more readily available, access to mental health services in Estonia is currently very difficult. The association is also concerned that the quality of services varies considerably.

"We want ordinary people to understand who is actually a psychologist and who is not," Tõnissaar said. "In our view, many of those who call themselves psychologists should not be doing so. From the standpoint of service quality, it is very important that in professions or services where a professional qualification is required, the person providing the service actually has that qualification. If they do not, they should not call themselves a clinical psychologist, counselor or sports psychologist."

He added that the landscape is currently very confusing for clients.

"I very much agree with what the researchers wrote: Mental health issues cannot be addressed through medication and therapy or counseling alone. It is a much more complex issue," Tõnissaar said. "It is also about how the community supports a person, how their family supports them and how we develop or foster the skills, including social skills, that can support people."

Mari Ader-Nobels, a mental health adviser at the Ministry of Social Affairs, said the government's goal is to improve access to psychological care so that people have a wider range of treatment options.

"In recent years, we have expanded opportunities for clinical psychologists to provide services while also working to ensure that there are enough of these specialists," Ader-Nobels said. "At family medicine centers, for example, mental health support can be provided not only by family doctors but also by mental health nurses and clinical psychologists and since last year also by counseling psychologists whose services are funded by the Estonian Health Insurance Fund. To increase the number of specialists, the Ministry of Social Affairs is also continuing to support the professional qualification year for clinical psychologists and counseling psychologists."

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