Salla’s therapy ended at 18 despite ongoing need

Turning 18 ended the therapy that had helped Salla build a stable life, leaving her unable to afford continued treatment, Yle reports. The 18-year-old says young people are “dragged” through child welfare institutions until adulthood, after which their situation can collapse.

October 1, 2020, is etched in Salla’s memory. She left home that day with only her phone and charger. She was 12.

Salla says she had been raped in a park in Kouvola several years earlier. She did not know the perpetrator, and shame prevented her from telling anyone. Over time, the experience resurfaced, and she could no longer stay at home because of her deteriorating mental health. She self-harmed and attempted suicide.

Salla was first placed in care on an emergency basis, and she was taken into care a year later. She says she was soon raped a second time.

She was then subjected to stalking and threats. An underage boy was sentenced, with his young age taken into account. The cases did not go to court.

Seven child welfare institutions

Salla went through seven child welfare institutions, some of them more than once, and was treated several times in youth psychiatric wards at three different hospitals. Doctors described her as particularly difficult to treat.

Several medications were tried, but Salla attempted suicide using medicines prescribed to her. There were several attempts. She feels that the problem was repeatedly addressed by moving her to a new place.

An ambulance journey saved her life, but her mental health had been badly damaged.

“I was just passed around and completely lost about who I was and what I should do. There were no goals in my life,” Salla says.

The cycle lasted two and a half years. Salla returned home to Kouvola, but the Social Insurance Institution of Finland rejected her application for intensive medical rehabilitation. She could not see a future.

In summer 2023, she received a message from a psychotherapist who had obtained her phone number from a youth psychiatric outpatient clinic. The wellbeing services county had decided to pay for her therapy.

She met the psychotherapist in Inkeroinen, Kouvola, and began her first lasting treatment relationship.

Salla started practical nursing studies at South Kymenlaakso Vocational College and moved to Kotka. Sunlight entered her small rented studio.

But a few weeks ago, Salla turned 18. The therapy paid for by the wellbeing services county ended.

No money for therapy

The Kymenlaakso wellbeing services county says it has had good experiences with psychotherapy for minors. Few wellbeing services counties provide it themselves.

As an adult, Salla has been offered rehabilitation psychotherapy supported by Kela, Finland’s Social Insurance Institution. According to the wellbeing services county, her share of the costs would be about 100 euros a month. Salla cannot afford it.

“Therapy would be necessary in my situation. I cannot get it because I do not have the money.”

Salla has been referred to an adult psychiatric outpatient clinic for medication monitoring. She takes one medicine every day.

Mental health care for young people can easily falter in the first years after they turn 18. The phenomenon was particularly visible last year in Kymenlaakso and South Karelia.

The therapy guarantee for people under 23 aims to speed up access to treatment for children and young people, but there is not yet comprehensive information about how it works across wellbeing services counties. The counties can decide independently how to implement the guarantee.

In Kymenlaakso, for example, the criteria for receiving treatment are the same for all adults. A person’s background in institutional care or aftercare is not taken into account.

Therapy guarantee

The law on the therapy guarantee came into force on May 1, 2025. It applies to children and young people under 23. Brief psychotherapy or another psychosocial intervention must begin in primary healthcare no later than 28 days after the need for treatment has been identified.

Substance abuse can prevent access to the therapy guarantee. A psychologist may recommend Kela’s rehabilitation psychotherapy, for example, while a doctor may not consider it appropriate because of a substance abuse problem. The basic pillars of life must be put in place first.

Young people placed outside their homes or taken into care receive help from child welfare aftercare to become independent.

However, aftercare has been weakened in ways that are now beginning to affect young people.

Requirement to take out student loans

A new Kela policy will significantly change the finances of students receiving aftercare this autumn. They will have to take out student loans if student financial aid or their earnings are not enough to cover everyday expenses.

Until now, they have been able to receive social assistance. This has encouraged young people to pursue education and prevented financial difficulties because the support does not have to be repaid.