Worldwide, 10–20% of children and young people are struck by mental health (MH) disorders (WHO, 2013). MH problems are also a public health issue in Finland (Suvisaari, 2013). Almost one-fifth (18 %) of girls in lower secondary school, grades 8 and 9 (age 13-16), experience self-reported moderate to severe depression (National Institute for Health and Welfare, 2015.) The number of foreign-born young people in Finland has grown (Klemetti et al., 2017) and these young people are experiencing their health weaker more often and have more anxiety disorders than other groups (Halme et al., 2017). Even no increase can be found in Finland in children’s mental health problems over a 24-year period, service use has increased constantly, indicating that contact to service providers is occurring more often than previously (Sourander et al., 2016). Thus, promotion of MH of children plays important role in preventing further MH problems (Cefai and Camilleri, 2015).

MH services refer to social and health care services, which are implemented to promote mental health and to prevent and care mental disorders.  In Finland, municipalities are in charge to organize these services. The aim of MH work is to promote the mental health of children in a co-operation within many sectors of society, including early childhood education and care (ECEC) and basic education (National Institute for Health and Welfare, 2015). The promotion of MH in the environments of everyday life affects the well-being of the individual in a long term; therefore, early intervention is particularly important in children's MH problems. (Cefai and Camilleri, 2015). In a school environment an implementation of a structured and systematic plan for the health and well-being of all pupils and of teaching and non-teaching staff (Health promoting school) strengthens healthy settings for living, learning and working. (SHE Network, 2018).

Several barriers have been identified for access and engagement with MH services for children. Barriers include limited availability of specialist MH services, lack of information about available services, inflexible services, wait times, complex administrative procedures, costs associated with treatment, users' expectations of providers' attitudes and service level barriers endorsed specifically by primary care providers. (Anderson et al., 2017.) Furthermore, primary care practitioners have identified barriers that prevent them to support children with MH problems. These barriers include lack of resources and providers of MH services for children and youth. This, in turn, increases waiting times and reduce access to specialist services (O´Brien et al., 2016).

The objective of this study was to investigate professionals’ views on functioning of mental health services and work of children under 14 in 18 Pohjois Savo region municipalities of Finland. Furthermore, the purpose was to answer the following research questions:

1) How does the ECEC, basic education, and primary healthcare personnel describe the functioning of the mental health services in municipalities?

2) What kind of perceptions do the ECEC, basic education, and primary healthcare personnel have on mental health work in municipalities?

3) Do the organizational groups (ECEC, basic education, and primary healthcare personnel) differ in terms of the current status of functioning of mental health services and work?

This study is a part of international project “e-Health Services for Child and Adolescent Psychiatry (eCAP), 2015-2018”  (http://ehealthresearch.no/en/projects/ecap), which aim is to improve the quality and availability of child psychiatric services in peripheral areas by developing eHealth tools for facilitating better cooperation between professionals working with children having mental health problems. In addition to Finland, project partners include Sweden, Norway and UK (Scotland).

The target groups of this cross-sectional study were 1) early childhood education professionals in municipal daycare (heads of daycare centers, kindergarten teachers, kindergarten special education teachers, daycare nurses), 2) basic education professionals (teachers, special education teachers, student councilors, special needs assistants, principals, school psychologists, school social workers), and 3) primary health care professionals who work with children under the age of 14 (school nurses, child health care nurses, general practitioners, specialist doctors, psychologists, nurses, speech therapists, physiotherapists, social workers, occupational therapists, family therapists). The data were collected between December 2016 and February 2017 using quantitative e-questionnaires. Study respondents were asked to state their agreement concerning to current mental health work of children, mental health services, and organization of the services. The data were analyzed with IBM SPSS statistics (version 21). Descriptive statistics were used to discover patterns in responses from different professional groups. The statistical significances of differences between groups were tested using the chi-square test. These were cross tabulated to reveal individual characteristics for each professional group. Statistical difference was determined at the 95% level. The open-ended answers were analyzed using inductive content analysis.

In all, 482 basic education (52%), primary healthcare (19%), and ECEC (17%) professionals completed the questionnaire. Somewhere else (e.g. in social security, disability services, or mental health services) were working 12% of respondents. About half of respondents were from urban and half from rural municipalities. Nearly one-fourth (24%) of professionals agreed that children's mental health services work well in their municipality. According to 42% of respondents, geographical distances were appropriate for arranging mental health services. There was significant difference between urban (55% agreed) and rural (42% agreed) respondent groups and geographical distances (p= .003). Guidance to special health care was well implemented in municipality according to 20% of respondents. Among primary healthcare personnel, almost half of respondents (48%), but only 24% of ECEC and 17% of basic education personnel were satisfied with guidance to special healthcare (p < .001). Less than half of respondents (42%) reported that children`s mental health symptoms were intervened at sufficiently early stage in their municipality. There was a significant difference between organizational groups (p = .03): Primary healthcare personnel were most satisfied to early intervention, followed by basic education and ECEC personnel. Only 9% of respondents stated that the financial resources of mental health work for children were sufficient in their municipality. A total of 8% of respondents reported that professionals who work with children with psychiatric symptoms have attended work counseling enough. Based on results, ECEC, basic education, and primary healthcare personnel were not satisfied with the functioning of the mental health services. Furthermore, their satisfaction continued low towards mental health work, but differences among professionals emerged: Healthcare personnel assessed it more positively than ECEC and basic education professionals did. Results indicated a real need for develop children’s mental health services and work in municipalities.

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