April 29, 2016

Did you know?

Did you know that here in Helsinki was held Norddiakoni Intensive course – “Mental health and Wellbeing – focus on homeless and underprivileged populations” on 21.-26.4.2016? Well in case you did not, I will tell you about it.

There were participants from Finland, Norway and Sweden, students and teachers. What all the participants had in common was that they all took care of other people and their wellbeing.  I took part on it 23.–24.4.2016. It was rather interesting. Topics of the seminar were social inclusion, loneliness, mental health and undocumented immigrants and overall what we should, could and would do to those issues?

Students and teachers were discussing after the presentations of the various measures that should be done. How to activate people who feels loneliness or hopelessness in their life and those who suffer from poverty and unemployment. How to help those who live with the help of social benefits from year to year. How to help people who have stopped trying. Not to forget the people who have been forced to leave their country against their will, leaving everything behind just to find themselves in a country, with their high expectations of life and yet their new home country might only have a little to offer. In the worst case, they might not even have a legal permission to be in the country. They would have to live their lives without rights in welfare state.

What kind of activities do we need? What do we do? Because all the people have the right to be a member of our society.

All of the intensive course presentations were global, thought worthy and demanding subject’s activity. For example think about loneliness, homelessness, undocumented immigrants, poverty and hopelessness. Even though the topics covered the underprivileged of the society, not a single subject seemed hopeless. I personally followed the presentations with great interest. I got the feeling that we should come up with something right now, so that we can minimize people´s worries and make the world better place to live.  We must and we can do something to help each other. I suggest that we start the change from ourselves; our attitudes and how we face the people. We should take care of people and to be interested in other people’s wellbeing like we are with our children and loved ones.

Päivi Rissanen, who has been mental health patient for 27 years gave a presentation that brought hope and reassurance that nothing is impossible. Päivi´s survival is quite incredible. Her presentation condensed the whole aim and understanding of the intensive course. Having been a mental health patient for 27 years and now being Ph.D. Päivi told us that we need discussions and debates as well as interaction between people, respect for others, trust, caring and understanding. Rissanen´s survival story is quite touching and sweet. She took the help of a nurse, who saw her as herself as an individual rather than a mental patient. I love that Päivi shared her story with the rest of us. Hope is what we should all remember, isn’t it?

Change the attitude – Join me 

Who am I?

Marja Walldén-Hirvonen, student
Degree Program in promoting the social exclusion of health and well-being. Masters degree (YAMK), Diaconia University of Applied Sciences, Helsinki, Finland

April 27, 2016

My learning experiences during the course

This weekend course was named "Mental health and wellbeing - focus on homeless and underprivileged populations". It was part of my Master Degree -studies.

I think this course was very interesting and important. The preventive work is very important when we want to promote people's wellbeing in the society. I think the big problem is that the service system is very diffuse and bureaucratic. For people with mental health problems or people with a bad ability to function it can cause more stress and more problems. Päivi Rissanen told about her own experiences of suffering mental health problems and how she finally was rehabilitated. That lecture was very touching. It made me think about the role of the society and individuals in rehabilitation process.

The lectures were spoken in English, so I had a good opportunity to improve my vocabulary. Some articles in English were quite difficult but group work gave a possibility to learn from other students and get help from them.

I think one of the most interesting parts of the course was visiting Lehmustupa housing unit. We could meet the residents and workers there. They told us about their experiences and answered our questions, it was very interesting.

Who am I?

Saara Harju, 28
Master Degree -student
Promotion of the health and wellbeing of people in danger of marginalization (90 ECTS)
Diaconia University of Applied Sciences, Helsinki Finland

To have the privilege of helping the underprivileged

In this intensive course we have learned more about the importins of helping the less fortuned and vulnerable groups in society. We have learned the value of teamwork, collaborative relationships between key worker and patient, listening and seeing the opportunities and resources the different people can contribute with. We have been given information, which demonstrate the work done for homeless and underprivileged peoples in different countries and in different schools.

Understanding and learning:

Support of mental health and well-being among the homeless and underprivileged groups are a high priority not only in Finland, but in other Scandinavian countries as well. In this course we have also been given the opportunity to learn about what Finland has done to its homeless and underprivileged groups. Among other things Finland has started housing programs for homeless, addicts and underprivileged groups, such as refugees and immigrants. They give people the opportunity to do everyday rehabilitation which is important and relevant for us, occupational therapists. From the occupational therapists point of view, seeing and hearing stories told about the difference organizations have made, inspire us to take the knowledge back home and try to help the people who are struggling in our own country. The occupational therapists role is to help people, who want, in their everyday lives by finding their meaningful activities. Our job is to giving everyone a chance to be active, and help people be part of the society as much as everyone else (Grandisson, m.fl., 2009). We also experience that mental health and wellbeing are connected and that by learning about what others do to promote mental health we can become better therapists and help more people.

Living in housing units and being apart of a society:
From our study tour to the housing unit we got an broader understanding on how important these offers are for those who are in need. But also how important the relationship and trust between the «key worker» and the homeless was. The feeling that we belong to a society and that the society sees you as a resources is something that everybody should feel. But unfortunately many of the homeless and refugees feel like they are standing on the outside, that they are not a resource, but a burden to the society. Organizations like the housing units show how important it is that the homeless can come there and be a part of a society and meet others who are in the same situation. And not feel excluded, but included, and feel that they are a resources to the society. We visit the «girls dorm», where woman who had previously been working as prostitutes could live in a safe environment, have their own apartment, and live with other women in the same position. They had a really strong unity, and respect for each other. Many of them had known each other from they were kids, and saw them as their own family.

What I liked about this housing unit was that it had grown so big, and become an own little society for those who had a rough time. There they were met with a mutual respect, understanding and wasn't judged based on their past. And most importantly they had a home that was theirs and only theirs.

Meaningful activities:
As occupational students we think we could have contributed to find hobbies and activities which are meaningful for each person. Many who are homeless, refugees or other underprivileged groups missed many of the activities that we take for granted, like washing clothes, go to the bank, make an home cooked meal and the list goes on. Daily activities that most of us take for granted, but the underprivileged misses growing up. Occupational therapists are experts in grading and adapting activities to each individual.

Grandisson, M., Mitchell-Carvalho, M., Tang, V. & Korner-Bitensky, N., (2009) Occupational therapists' perceptions of their role with people who are homeless. British Journal of Occupational Therapy. Canada. DOI: 10.4276/030802209X12577616538672
Who am I:
Victoria Magne (21) and Silje Ness Mæland (22); VID Vitenskapelige Høgskole- Diakonhjemmet Høgskole Sandnes, Norway, Occupational therapy Bachelor. 

Meeting and expanding our understanding of homeless and underprivileged people

We chose to participate in this seminar with a desire to obtain inspiration and knowledge that we could use at our work as future nurses. Homelessness has been a topic that unfortunately has received little attention, both in the nursing program and community. At Lovisenberg, students have been able to theming this topic through a two week project, Oslo by night. This project has given the students a closer relationship with the weakest in society.

Before the trip to Finland, we have had great expectations of an enjoyable seminar where we could discuss the matter and to compare what the conditions were in the Nordic countries. Considering that the seminar would include nursing students and master students from all the Nordic countries, we thought that it would be exciting to exchange ideas, thoughts, experiences, knowledge and competencies.

Our experience of the seminar has in summary been positive. We have been welcomed by the staff and been provided with good information about the program of the course. We have gained a good impression that the seminar has been structured and well planned. The props, like school building, auditoriums, lighting, library and cafeteria has worked well in relation to the use of resources and feeling of comfort and relaxation during the seminar. Thursday night was the first day of the seminar where we were pleasantly greeted with live band and a warm dinner. Towards the end of the evening, the students participated in a game where they could become familiar with each other. We were to present our names and country we came from. The game created a pleasant and fun atmosphere, but we wish that it was taken into account of other forms of games or more time to set aside for us to get to know each other. We felt that the social parts were happening outside the seminar and through the students' own initiative. Unfortunately we did not get any good tips for sightseeing, adventure or culinary experiences from one of the Diak student during the first day. She told us that Helsinki had limited offers for the tourism. As an experience for the next seminar, we hope that the organizers can take into account that the ability to joint activities the first two days of the seminar is very important for the establishment of openness and close cooperation among students.

When it comes to the lectures, we felt that some of them were unnecessary for the program, for example about Diaconal, which is a very familiar theme in all of the diaconal schools that participated. Some of the lectures were in forms of statistics, which was a bit overwhelming. We also found some of the use of English language challenging as in terms of different dialects and communicative skills. During our sessions with the master students, we found it challenging to discuss the topics related to research articles. The short form of reasons for this included a lack of English knowledge and understanding. Many of the students couldn't provide a summary or opinions regarding their topics, which made the discussions more complicated.

Looking back at this course, we found two of the topics quite interesting. The first one was the visit from Global Clinic. The second one was the visit to Helsinki housing unit for people with mental health issues and drug related problems.

Who´s responsibility? Global Health Clinic.

Before we went to the seminar in Finland, the participants were given the opportunity to choose between different study tours. We decided to join the study tour named "Global Health Clinic", because we thought it would be interesting to learn about the health care provided to paperless residents and immigrants in Finland. Unfortunately, it did not cross our minds that it would be difficult to visit this particular place because of the matters of security for the clients of the clinic. Since the clinic had a secret address, the communication leader of the clinic held a presentation at DIAK instead. Although we were disappointed that we could not visit the clinic, we received a lot of interesting information about the paperless residents' possibilities for getting health treatment and practicalities concerning the clinic.

One of the points that were made during the presenting and that we think is worth highlighting is the fact that the clinic is based on volunteers and private funding. As for today, there is only one employee who gets a salary from working at the clinic, so the rest of the personnel are as mentioned volunteering. Based on the diaconal values that we have been learned and reflected about during the seminar, working as a volunteer and helping other underprivileged people is highly relevant. There were different types of ethical dilemmas regarding this kind of health clinics in Finland and the situation of the paperless residents. One of the dilemmas that made an impression on us and that we though were absurd, was that the government were not engaging in the health situation of paperless immigrants and neither cooperated with the health clinic for paperless immigrants. In practice this could have a negatively impact on the clients in different ways. One example is clients who are in need of more advanced health care than the health clinic can provide to their clients. Since the government is not collaborating or supporting the clinic, it is more difficult to refer patients when in need of more advanced and suitable health care, to more resourceful hospitals like university hospitals. Moreover there are several legislations that define when people, regardless of their background, can receive "emergency care" without being discriminated. In practice this meant that if the patients´ health condition were not "bad" enough to fit the legislations criteria, they would not get the medical treatment that they needed until their condition got bad enough to fit the criteria. The woman presenting this facts, underlined that this system were inhumane and also very little cost-effective. Their clinic was trying to ease the paperless immigrant´s difficult situation, but expressed that this were not a long-term solution as the situation were today. The workers of the clinic think that the government should take responsibility for the health condition of paperless immigrants and change the existing legislations regarding this topic. As the situation is today, the workers of the clinic though that the government are neglecting their responsibilities concerning this vulnerable group. The workers at the clinic is also being challenged concerning the morally and juristically responsibilities they have through their professions, because they are being forced to priorities their services due to financial reasons. The economic resources limit them in a matter that affects their possibilities to sponsor medication and long-term treatment to the clients who needs this. The financial barriers also lead to short opening hours, and as for today the clinic are only open for two hours once a week. We think that this is too little when thinking about the number of paperless immigrants that exist in Helsinki.

In comparison to Oslo where their clinic is led by the Church City Mission and Red Cross, the clinic in Helsinki seemed to be have more difficulties providing the needed health care. The clinic in Oslo seems to inhabit more resources to proceed their health work. One example of this is that the health clinic in Oslo is open for eight hours a week, compared to two hours in the health clinic in Helsinki.

Housing Units for people with mental health issues and drug related problems

On Monday we went to the Housing Units for people with mental health issues and drug related problems. Most of the residents are originally homeless, coming from the street. The average age for people staying there is 45-55 years, but they also have residents under 20 and up to 65. Different professionals work at the unit, such as practical nurses, social workers, occupational therapists and regular nurses. The residents pay rent to stay in the apartments, and the stay is temporary. Some of the residents have stayed for three years, others for a shorter amount of time. An individual plan is made for each person, containing different treatment activities the person is supposed to attend during the stay and unique goals. The main goal is to help the person get back on his/her feet, supporting them and prepare them for the outside world, often with follow-up from the community. For this, different kinds of activities are offered at the unit, both therapeutic and social. The treatment activities includes discussion groups, individual therapy with a personal contact (social worker or nurse) and art therapy, and the social arrangements includes cooking classes, gardening, bingo, movie nights etc. They also have the freedom to go out to work, buy groceries, go to doctor's appointments, attend AA-meetings, collect money from social services and so on. We were told that some of the residents found exercising therapeutical and were therefore encouraged to do this. Also, when guided around the area with one of the employees, two residents welcomed us into their apartments. Me and my fellow students thought this was a very nice gesture, as we were a quite large group (approximately 12) and also from different countries speaking unfamiliar languages. With the employee translating for us, the two residents told us they were very satisfied with their lives at the unit, that they appreciated the freedom given, the activities offered and the facilities and appearance of the apartments. We asked one of them what his plans was for the future, and he replied that he has been living out on the streets for many years, and that his main goal was to keep a roof over his head. He would be satisfied if this could be managed. This was quite touching to hear. He didn't dream of a life filled with an overflow of money and expensive things, he would be grateful if he had a place to stay. It was also interesting to see how they live at the unit, that they have a lot of freedom and mainly decides for themselves what to do - with some restrictions of course. For example, they are free to do drugs in their apartments, as long as they keep behaved and peaceful. We appreciated that we actually went to the unit, instead of them coming to DIAK. It left us with a lot of impressions and thoughts, which we students have reflected on afterwards.

Who are we?

We are Susanne, Vy and Valentina (age: 24, 28 and 21), nursing students from Norway. We are in our final year of the bachelor degree in nursing at Lovisenberg Diaconal University College.

Seminar reflections

Jemima Heinonen from the Global Clinic gave a presentation about the paperless healthcare they provide. Global Clinic is run by volunteers, who provide both health and dental care.

Global Clinic is open to everyone, regardless of person's nationality or theirmigration status. Help is given for free, anonymously and in strict confidence.The audience were interested to know the reasons why patients in generalgravitate to the clinic. Audience also wanted Heinonen to explain to them why only about 3% of the patients were seeking help due to psychiatric reasons. According to Heinonen, there are plenty of reasons why patients seeking for psychiatric help cover such a small percentage of the whole patient base. One of the reasons is the fact that in many countries and cultures mental health disorders are a taboo and such problems are not talked about openly. Also, currently Finland does not have a institution or a hospital for these patients. The Global Clinic is looking for cooperation partner which the Clinic could consult in need. An other problem is the language barrier. The clinic is run by volunteers and so is the interpretation. The majority of the patients at the moment are from Romania and Bulgaria. Heinonen says that even though they do often  recognise the patients with psychiatric needs or problems, the treatment of those patients os difficult and it has limits.

The Global Clinic accepts donations from individuals and corporations, but do not receive grants from the state. The clinic has a patient registry, even though it is very primitive and on a slow computer. The patients are not asked about their ethnic background, only the very essentials; e.g, age, gender, diagnosis. The most touching and interesting lecturer of the weekend was Päivi Rissanen. Rissanen has done her doctoral thesis on how the patient him/herself experiences psychiatric illness and the treatment of it. Rissanen told that she herself was 40 times in a psychiatric hospital for treatment. She herself was first diagnosed with a borderline personality disorder andschizophrenia. Later, this diagnosis was discarded and Rissanen was given a new diagnoses: dissociative disorder. 

Rissanen explained how no one wanted to be her personal nurse, because she was considered so difficult for treatment. Eventually she got a new personal nurse, who had not previously taken care of her. Rissanen shared that her rehabilitation started when this new nurse asked her "Päivi, do you want to spend the rest of your life in a hospital?" Rissanen told that her motivation to get better awakened when she felt that her new nurse appreciated her. Rissanen told that finally she was given a change to tell herself how she wanted to be treated and rehabilitated.

Who am I?

My name is and I am Seija Kautto psychiatric nurse. I work in the closed ward that takes care of diseased psychosis patients. The majority of patients also have a substance abuse problem.

Mental health and wellbeing - focus on homeless and underprivileged populations

The seminar in different ways gathered together the things of underprivileged groups of people and began with a way fitting the theme, with a musical perfomance by the band which consist of people having  substitution treatment. I was especially impressed by Päivi Rissanen, and her doctoral thesis "A Hopeless Case? An Autoethnography of Getting Mentally Ill and Rehabilitation of It" on her own illness, treatment and recovery. The study also uncovered problems with the Finnish healthcare system. She told that she had met 300 nurses and 40 doctors during those seven years and 40 hospital periods, that was the most difficult time of her illness.
Although she was regarded as chronically ill, she recovered and therefore was not a hopeless case. She told that the process of healing had begun with a single question asked at the right time by her nurse: "Päivi, do you really want to live rest of your life in a hospital?".

For me the best part of this seminar was study tour to supported housing unit for minor asylum seekers. Unit is for youngsters aged between 16-17 and there asuu 40 boys at a moment. Basic function in this unit is to offer safe living conditions for asylum for the duration of the process. Only two of these youngsters who came to Finland last autumn have already got residence permits. After that Ely Centre can relocate them also to some other municipality. This raises the question, will all those  relationships made here be cut off with the change of municipality. Luckily, almost all these youngsters have some kind of contact with some relative. In the operation of the unit there are also ca. hundred volunteers that i.e. guide different activies such as homework tutoring or cooking class. The large amount of volunteers suprised me positively. I'm interested in things related to immigration becuse I also act myself as a representative for an unaccompanied minor asylum seeker from Afghanistan.

One of the themes was Undocumented migration and life without rights in welfare state. We in a group with other students from the Nordic countries thought about i.e. what happens to those who receive negative decisions to their asylum application. Do those returned to their home country stay or will they leave again to seek their future elsewhere? All the things highlighted in the seminar where such, that they evoked questions for myself to ponder on afterwards.

Who am I?

Sanna Hakaheimo, Bachelor of social services and now completing Master degree studies in promotion of the health and wellbeing of people in danger of marginalisation.

April 26, 2016

Mental health and Wellbeing- focus on homeless and underprivileged populations

It was an interesting weekend. Most touching and the best lecture was Päivi Rissanen. Finnish central association for mental health and rehabilitation model. She told of she's life as a patient of mental health problems. Päivi was for many years a patient in psychiatric hospitals. In 2015, he left for examination of the dissertation treatment.

Interesting was also a visit to Lehmustupa, Housing Services. We received information about their activities. Lehmustupa has 17 small bed-sitters, some of them being reserved for HIV-positive persons and AIDS-afflicted persons. Admission to Lehmustupa is via City of Helsinki's Social Department's unit dedicated to assisting the homeless.

Who am I? 
My name is Päivi Nikkilä. I am registered nurse and  I study Diaconia University of applied Sciences. Name of the education is: The promotion of health and wellbeing at risk of exclusion