Text: Jaakko Kinnunen
Photo: Jenni Toivonen
Psychiatry was not always Professor Olli Kampman’s obvious career choice. He found his calling during the first years of studying medicine.
“I ended up becoming a doctor by chance. My father was an electro-technician and brother an IT engineer, and I also first planned to become an engineer. I already had a place to study at an engineering college, but in my last year of school, a classmate told me he was applying to medical school; I also decided to apply and got in. It was not an obvious choice,” Kampman says.
In the summer following his first year of studying medicine, Kampman worked at a care institution for people with intellectual disabilities. In his job, he came into contact with mental health problems and became gradually interested in psychiatry.
In the early 1990s, Kampman worked in clinical psychiatry. He started his academic career in the early 2000s and was appointed professor of psychiatry in February 2018.
Four main areas of research
At the University of Tampere, psychiatric research focuses on four main areas. The first is related to pharmacogenetics, which concentrates on the hereditary effects and side effects of biological treatments. Researchers at the University of Tampere have already studied this topic for twenty years.
“The research focuses, among other things, on the genetic research of pharmacotherapy for schizophrenia and depression. We also study other biological treatments, such as electroconvulsive therapy,” Kampman says.
Another focus area concentrates on the body’s inflammation processes in depression and substance abuse. Low-level inflammation is frequently associated with, for example, heavy drinking or depression, and there are indications that inflammation markers might even cause or maintain psychiatric problems.
“Population-level studies have shown that depressed people appear to have a higher degree of low inflammation, which is not explained by lipid metabolism,” Kampman says.
In addition to these research areas, the University of Tampere is involved in two broad co-operation projects. The first is an international research project led by Aarno Palotie, which examines the genetic basis of psychosis.
The study collects blood samples from patients with psychotic disorders all over the world. By the end of this year, 10,000 samples will be collected from Finns, of which nearly 9,000 have already been collected. “This is an internationally significant project,” Kampman says.
In addition, stem cell samples are also collected, which can be used to further investigate the mechanisms of psychosis and its genetic regulation in the central nervous system.
“It has been established that the hereditary predisposition factors for schizophrenia and bipolar disorder are very similar; the same genetic factors make patients more likely to be susceptible to these diseases. Certain environmental factors can then trigger the illness,” Kampman explains.
The fourth research area is related to the topic of Kampman’s own doctoral dissertation. The patient’s compliance to the treatment of psychotic disorders has been investigated by looking at co-operation in clinical practice. In the treatment of psychosis, it is especially important that the patient is ready and willing to be treated. From the point of view of treatment, it is also important to recognise the different phases of psychosis: patients with acute psychosis need different treatments than patient with more prolonged illnesses.
“Illness brings its own specific requirements to the therapeutic situation. Problems in the doctor-patient relationship are a major cause of lack of commitment. Doctors must be able to identify both the stage of the disease and the individual situation of the patient,” Kampman says.
Many factors contribute to the shortage of psychiatrists
There is a long-term shortage of psychiatrists in Finnish health care. Annually, approximately 30 – 35 psychiatrist graduate, even though fifty would be needed. In addition, many psychiatrists are currently retiring.
“Psychiatry is very abstract compared to many other fields of medicine, and it is challenging to teach in a short amount of time. The clinical phase of the studies is a prime opportunity: If a medical student is able to encounter one psychotic and one really depressed patient and a couple of other cases during clinical practice, he or she may become a very good doctor for the next thirty years. But if students do not see such cases, they may not have sufficient understanding of how to treat these patients,” Kampman says.
According to Kampman, the causes of the lack of psychiatrists lie in basic medical training. There are a lot of specialist fields in medicine, and competition for the young doctors is fierce.
“We can surely still improve the quality of specialist training, even though we have done a good job of it already,” Kampman says.
The lack of psychiatrists may also cause concern among students. If there is a shortage of practitioners, those in the field will face a harder workload. This may reduce the motivation of young doctors to start studying psychiatry.
“Interest in problems of the mind varies over time, and there have been times when psychiatry has been trendier than it is now. The idea that a psychiatrist must do the job of two or three does not help to attract new people into the field either,” Kampman points out.
The confusing world of outpatient treatment
In Finland, there is large variance in how mental health work has been organised in different places. Kampman acknowledges that even professionals may find it difficult to understand the entire field.
“Outpatient care has been organised in various ways. In some areas it is organised as part of the operations of a hospital district, in which case outpatient care can easily co-operate with inpatient care. In other areas, municipalities are in charge of organising mental health services,” he says.
Kampman gives an example of the fragmentation of mental health services related to his own research: Pirkanmaa Hospital District has nearly fifty different organising agencies. If the University of Tampere wishes to carry out a study across the District, it has to apply for nearly fifty research permits.
“Even professionals find the field challenging. The situation also keeps changing. For patients, it may seem very complicated,” Kampman says.