Cultural adaption of mental health services to the Sami. A qualitative study on the incorporation of Sami language and culture into mental health services

The Sami people in Norway have a statutory right to receive equitable health services, adapted in accordance with Sami language and culture. However, limited research is available regarding the impact and of Sami culture and language within mental health services. Aim - The overall aim of the study was to explore, identify and describe the significance of culture and language in mental health services as experienced by clinicians and Sami patients, to enhance the understanding of the cultural and linguistic adaptation of the services to the Sami. Methods - The data was co-constructed in individual interviews with clinicians and Sami patients in mental health clinics in northern Norway. The data were analysed thematically. Results - The study demonstrated that Sami patients’ language choice is influenced by a complexity of social and cultural factors. Bilingual Sami patients have different preferences for what they can talk about, in which language, in what way and with whom. However, the result must not be confused with saying that Sami-speaking patients do not need Sami-speaking therapy. Essentialist descriptions of Sami culture were several, but ways to incorporate cultural and linguistic aspects into mental health services were limited. Organisational support for language appropriate services was limited. Culturally adapted clinical interventions were lacking. Incorporation of culture and language was random, provided by the individual clinician within the structural frames and with the knowledge available. Concluding remarks - The study indicates that the incorporation of language and culture into mental health care is a complex process involving strategies at three levels; institutional systems and structures, health professionals’ cultural assumptions and analytical competence, and cultural assessment of interventions within mental health treatment. Stereotypical portrayals of Sami culture narrow the understanding of Sami identity, delimit the identification of Sami-speakers and simplifies possible impacts of culture within health care. Therefore, the question is not what culture “is”, but how culture unfolds in human encounters

’In gille huma’. De tause rommene i samtalen: samiske fortellinger om kreft

Mastergradsoppgave helsefag. Omhandler samisk kommunikasjon om og forståelse av kreftsykdom.Dette mastergradsarbeidet handler om hvordan man kan forstå det å ha kreftsykdom ut fra hvordan sykdommen snakkes, eller ikke snakkes om i samiske samfunn. Det er i dagens kreftomsorg et sterkt fokus på å hjelpe de som rammes av kreft til å mestre krisen dette kan oppleves som. Samtale; det å snakke om og sette ord på følelser, tanker og reaksjoner anses som den viktigste metoden i krisebearbeidingen. Men det er ikke like selvsagt for alle å skulle snakke om kreft og følelser knyttet til det. Oppgaven omhandler også møtet mellom det norske helsevesen og samiske kreftpasienter. Mastergradsoppgaven er en kvalitativ studie, basert på en filosofisk hermeneutisk tilnærming med fokus på forståelse. Empirien bygger på intervjuer med 4 samiske kvinner i 40-60 årene om deres erfaringer med og tanker om det å ha kreft, og måter å snakke om følelser og reaksjoner knyttet til sykdommen på. En av disse kvinnene har selv opplevd kreft, og hun har gitt ut en diktsamling om det å få kreft og behandling for det. Diktsamlingen inngår i kildematerialet. I tillegg er det en forfatter og to helsearbeidere som intervjues om kreft og det å snakke om kreft i samiske samfunn. De ulike kilder som er benyttet gir ulike perspektiv inn mot temaet. Fortellingsperspektivet er gjennomgående i oppgaven. Det å ha kreft og det å snakke, eller ikke snakke om det knyttes til teori av filosofene Hans-Georg Gadamer og Ludwig Wittgenstein, med fokus på forståelse, historiske tradisjoner, språk og livsverden. I tillegg brukes det teori knyttet til sykdomsforståelse i et samisk historisk perspektiv. Målet med oppgaven er å bidra til økt forståelse av hvordan det kan oppleves å ha kreft, ulike måter å forstå sykdommen på og derav ulike måter å snakke om og forholde seg til kreftsykdom i et samisk perspektiv

Cultural adaption of mental health services to the Sami. A qualitative study on the incorporation of Sami language and culture into mental health services

The Sami people in Norway have a statutory right to receive equitable health services, adapted in accordance with Sami language and culture. However, limited research is available regarding the impact and of Sami culture and language within mental health services. Aim - The overall aim of the study was to explore, identify and describe the significance of culture and language in mental health services as experienced by clinicians and Sami patients, to enhance the understanding of the cultural and linguistic adaptation of the services to the Sami. Methods - The data was co-constructed in individual interviews with clinicians and Sami patients in mental health clinics in northern Norway. The data were analysed thematically. Results - The study demonstrated that Sami patients’ language choice is influenced by a complexity of social and cultural factors. Bilingual Sami patients have different preferences for what they can talk about, in which language, in what way and with whom. However, the result must not be confused with saying that Sami-speaking patients do not need Sami-speaking therapy. Essentialist descriptions of Sami culture were several, but ways to incorporate cultural and linguistic aspects into mental health services were limited. Organisational support for language appropriate services was limited. Culturally adapted clinical interventions were lacking. Incorporation of culture and language was random, provided by the individual clinician within the structural frames and with the knowledge available. Concluding remarks - The study indicates that the incorporation of language and culture into mental health care is a complex process involving strategies at three levels; institutional systems and structures, health professionals’ cultural assumptions and analytical competence, and cultural assessment of interventions within mental health treatment. Stereotypical portrayals of Sami culture narrow the understanding of Sami identity, delimit the identification of Sami-speakers and simplifies possible impacts of culture within health care. Therefore, the question is not what culture “is”, but how culture unfolds in human encounters

’In gille huma’. De tause rommene i samtalen : samiske fortellinger om kreft

Dette mastergradsarbeidet handler om hvordan man kan forstå det å ha kreftsykdom ut fra hvordan sykdommen snakkes, eller ikke snakkes om i samiske samfunn. Det er i dagens kreftomsorg et sterkt fokus på å hjelpe de som rammes av kreft til å mestre krisen dette kan oppleves som. Samtale; det å snakke om og sette ord på følelser, tanker og reaksjoner anses som den viktigste metoden i krisebearbeidingen. Men det er ikke like selvsagt for alle å skulle snakke om kreft og følelser knyttet til det. Oppgaven omhandler også møtet mellom det norske helsevesen og samiske kreftpasienter1. Mastergradsoppgaven er en kvalitativ studie, basert på et filosofisk hermeneutisk tilnærming med fokus på forståelse. Empirien bygger på intervjuer med 4 samiske kvinner i 40-60 årene om deres erfaringer med og tanker om det å ha kreft, og måter å snakke om følelser og reaksjoner knyttet til sykdommen på. En av disse kvinnene har selv opplevd kreft, og hun har gitt ut en diktsamling om det å få kreft og behandling for det. Diktsamlingen inngår i kildematerialet. I tillegg er det en forfatter og to helsearbeidere som intervjues om kreft og det å snakke om kreft i samiske samfunn. De ulike kilder som er benyttet gir ulike perspektiv inn mot temaet. Fortellingsperspektivet er gjennomgående i oppgaven. Det å ha kreft og det å snakke, eller ikke snakke om det knyttes til teori av filosofene Hans-Georg Gadamer og Ludwig Wittgenstein, med fokus på forståelse, historiske tradisjoner, språk og livsverden. I tillegg brukes det teori knyttet til sykdomsforståelse i et samisk historisk perspektiv. Målet med oppgaven er å bidra til økt forståelse av hvordan det kan oppleves å ha kreft, ulike måter å forstå sykdommen på og derav ulike måter å snakke om og forholde seg til kreftsykdom i et samisk perspektiv

"You never know who are Sami or speak Sami": Clinicians' experiences with language-appropriate care to Sami-speaking patients in outpatient mental health clinics in Northern Norway

Background: The Indigenous population in Norway, the Sami, have a statutory right to speak and be spoken to in the Sami language when receiving health services. There is, however, limited knowledge about how clinicians deal with this in clinical practice. This study explores how clinicians deal with language-appropriate care with Sami-speaking patients in specialist mental health services. Objectives: This study aims to explore how clinicians identify and respond to Sami patients’ language data, as well as how they experience provision of therapy to Sami-speaking patients in outpatient mental health clinics in Sami language administrative districts. Method: Data were collected using qualitative method, through individual interviews with 20 therapists working in outpatient mental health clinics serving Sami populations in northern Norway. A thematic analysis inspired by systematic text reduction was employed. Findings: Two themes were identified: (a) identification of Sami patients’ language data and (b) experiences with provision of therapy to Sami-speaking patients. Conclusion: Findings indicate that clinicians are not aware of patients’ language needs prior to admission and that they deal with identification of language data and offer of language-appropriate care ad hoc when patients arrive. Sami-speaking participants reported always offering language choice and found more profound understanding of patients’ experiences when Sami language was used. Whatever language Sami-speaking patients may choose, they are found to switch between languages during therapy. Most non-Sami-speaking participants reported offering Sami-speaking services, but the patients chose to speak Norwegian. However, a few of the participants maintained language awareness and could identify language needs despite a patient's refusal to speak Sami in therapy. Finally, some non-Sami-speaking participants were satisfied if they understood what the patients were saying. They left it to patients to address language problems, only to discover patients’ complaints in retrospect. Consequently, language-appropriate care depends on individual clinicians’ language assessment and offering of language choice

Clinicians’ assumptions about Sami culture and experience providing mental health services to Indigenous patients in Norway

This qualitative study explores Sami and non-Sami clinicians’ assumptions about Sami culture and their experiences in providing mental health services to Sami patients. The aim is to better understand and improve the ways in which culture is incorporated into mental health services in practice. Semi-structured interviews were conducted with 20 clinicians in mental health outpatient clinics in the northern Sami area in Troms and Finnmark County in Norway. The findings show that clinicians’ conceptualizations of culture influence how they take cultural considerations about their Sami patients into account. To better integrate culture into clinical practice, the cultures of both patient and clinician, as well as of mental health care itself, need to be assessed. Finally, the findings indicate a lack of professional team discussions about the role of Sami culture in clinical practice

What can we talk about, in which language, in what way and with whom? Sami patients’ experiences of language choice and cultural norms in mental health treatment

Background - The Sami in Norway have a legal right to receive health services adapted to Sami language and culture. This calls for a study of the significance of language choice and cultural norms in Sami patients’ encounters with mental health services. Objectives - To explore the significance of language and cultural norms in communication about mental health topics experienced by Sami patients receiving mental health treatment to enhance our understanding of linguistic and cultural adaptation of health services. Method - Data were collected through individual interviews with 4 Sami patients receiving mental health treatment in Northern Norway. A systematic text reduction and a thematic analysis were employed. Findings - Two themes were identified: (I) Language choice is influenced by language competence, with whom one talks and what one talks about. Bilingualism was a resource and natural part of the participants’ lives, but there were limited possibilities to speak Sami in encounters with health services. A professional working relationship was placed on an equal footing with the possibility to speak Sami. (II) Cultural norms influence what one talks about, in what way and to whom. However, norms could be bypassed, by talking about norm-regulated topics in Norwegian with health providers. Conclusion - Sami patients’ language choice in different communication situations is influenced by a complexity of social and cultural factors. Sami patients have varying opinions about and preferences for what they can talk about, in which language, in what way and with whom. Bilingualism and knowledge about both Sami and Norwegian culture provide latitude and enhanced possibilities for both patients and the health services. The challenge for the health services is to allow for and safeguard such individual variations within the cultural framework of the patients

“You never know who are Sami or speak Sami”. Clinicians’ experiences with language-appropriate care to Sami-speaking patients in outpatient mental health clinics in Northern Norway.

Background - The Indigenous population in Norway, the Sami, have a statutory right to speak and be spoken to in the Sami language when receiving health services. There is, however, limited knowledge about how clinicians deal with this in clinical practice. This study explores how clinicians deal with language-appropriate care with Sami-speaking patients in specialist mental health services. Objectives - This study aims to explore how clinicians identify and respond to Sami patients’ language data, as well as how they experience provision of therapy to Sami-speaking patients in outpatient mental health clinics in Sami language administrative districts. Method - Data were collected using qualitative method, through individual interviews with 20 therapists working in outpatient mental health clinics serving Sami populations in northern Norway. A thematic analysis inspired by systematic text reduction was employed. Findings - Two themes were identified: (a) identification of Sami patients’ language data and (b) experiences with provision of therapy to Sami-speaking patients. Conclusion - Findings indicate that clinicians are not aware of patients’ language needs prior to admission and that they deal with identification of language data and offer of language-appropriate care ad hoc when patients arrive. Sami-speaking participants reported always offering language choice and found more profound understanding of patients’ experiences when Sami language was used. Whatever language Sami-speaking patients may choose, they are found to switch between languages during therapy. Most non-Sami-speaking participants reported offering Sami-speaking services, but the patients chose to speak Norwegian. However, a few of the participants maintained language awareness and could identify language needs despite a patient’s refusal to speak Sami in therapy. Finally, some non-Sami-speaking participants were satisfied if they understood what the patients were saying. They left it to patients to address language problems, only to discover patients’ complaints in retrospect. Consequently, language-appropriate care depends on individual clinicians’ language assessment and offering of language choice

Diverse methodological approaches to a Circumpolar multi-site case study which upholds and responds to local and Indigenous community research processes in the Arctic

This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions

Public health restrictions, directives, and measures in Arctic countries in the first year of the COVID-19 pandemic

Beginning January of 2020, COVID-19 cases detected in Arctic countries triggered government policy responses to stop transmission and limit caseloads beneath levels that would overwhelm existing healthcare systems. This review details the various restrictions, health mandates, and transmission mitigation strategies imposed by governments in eight Arctic countries (the United States, Canada, Greenland, Norway, Finland, Sweden, Iceland, and Russia) during the first year of the COVID-19 pandemic, through 31 January 2021s31 January 2021. We highlight formal protocols and informal initiatives adopted by local communities in each country, beyond what was mandated by regional or national governments. This review documents travel restrictions, communications, testing strategies, and use of health technology to track and monitor COVID-19 cases. We provide geographical and sociocultural background and draw on local media and communications to contextualise the impact of COVID-19 emergence and prevention measures in Indigenous communities in the Arctic. Countries saw varied case rates associated with local protocols, governance, and population. Still, almost all regions maintained low COVID-19 case rates until November of 2020. This review was produced as part of an international collaboration to identify community-driven, evidence-based promising practices and recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies