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

Thoughts on the seminar presentations

The seminar day's subject was very interesting. Performers were chosen well and they were a pleasure to listen to. Seminar was well organized and despite the fact that my own language skills are not that good, I think I managed to understand the lectures just fine. During the two days we also got an excellent opportunity to network with Norwegian students.


Päivi Rissanen's report on her own work and her own experience as a mental health rehabilitee was very admirable presentation, what perseverance and courage she has! Achievement writing a dissertation is stunning. Research data on the patient's experience is particularly important and, fortunately, it is also on this day is to be used in the development of mental health and substance abuse services. Päivi Rissanen brought a fine presentation to the importance of confidential interaction between the patient and the medical staff. In her case one person said relevant words to her over several years of illness and rehabilitation, although she had met with a number of operators during this period. Päivi Rissanen`s network map presented a lot of different health care operators during her rehabilitation process. It was very illustrative and it describes very well the service fragmentation. Hopefully, in the future of social and health services structure changes will help patients to get better services relevant to their needs.


Despite the fact that I live and work in the metropolitan area, I had not heard of the activities Global Clinic to promote undocumented migrants health. It was very eye-opening and thought-provoking presentation on the subject, which I do not see in my own everyday life. On Sunday we continued our discussion with Norwegian students about the health care services for undocumented migrants. In Norway the responsibility of the Church is to organize the services for undocumented migrants and the society participates in the financing of the operation, while in Finland, society is not involved in the organization or financing of services at all. I wish that I could for my part to affect change in attitudes.



Who am I?


Author: Satu Ek
Field of Study: Promotion on health and wellbeing at risk of exclusion
Level of Study: Master`s Degree programme
Place of Study: Diaconia University of Applied Sciences (Diak)
Country: Finland

Reflections

Last weekend was one of the most interesting times during my studies. Intensive course "Mental Health and Wellbeing - focus on homeless and underprivileged populations" has varied and interesting reviews from exclusion.
I think that most of  Finnish people are well-being. Sakari Kainulainen told last Saturday, that 20 % of people live out of the normal system in Finland. Finnish people can live a normal and a good life and then something happens and all of the things change. It can happen to anyone. Päivi Rissanen told how she got ill and got mental health problems. She told that she met dozens of nurses and doctors. Nobody could help her. Then one day she met a nurse who wanted to help and asked the right questions. Kainulainen thought that professionals who work at social service or health service have to wake up people and help them change their course in life. "Likewise" thought Rissanen, then she told how important the relationship between a service user and a worker is.
I think about myself and my work. The way how I meet my clients is very important; how I build up the trust and the connection between me and the client. We all need other people. Sometimes we all need help from other people and to help them in return.
Who am I:
Tiina Kutvonen
33 years old
Student on The Master's Degree Programme
Diaconia University of Applied Sciences

Reflections from the intensive course


This weekend I got the chance to participate in Diaconia University's course on "Mental health and wellbeing - focus on homeless and underprivileged populations». I think this course made me more aware of some things, and especially the fact that we often tend to forget about this group of people. I think in our day-to-day life we often only see our own needs and forget to think about others.
During our study tour to Office of the church council, the second day of the course, we learned about the Finnish term "talko" which is an apt word for describing people in a community getting together to work for a common cause. In Norway a group of people organized themselves under the name "Refugees welcome to Norway". This is a group of volunteers that got together to help the refugees arriving from Syria.  This could be a good way to help refugees coming to Finland in the future.
I think these values, and community spirit, will become more and more important in the future, and that we need "talko" to make people feel included and as a start of integration.

Who am I? 
 
I am Andrea Tangen, a 22 year old Norwegian student, taking a bachelor's degree in nursing at VID Specialized University in Oslo, Norway.

Reflections after the conference days

It has been really great to participate to this conference, both listening to the speakers and sharing experiences with teachers and fellow students around the tables. 

One main experience is that the picture and challenges are pretty much the same in Finland as in Norway.

By listening to the different speakers and not least via group discussions I'm also reflecting that it is so much more into the picture related to mental health and well being among homeless and underprivileged groups than one first could think, much based on what is presented by the media. As I'm working in a psychiatric clinic for acute mental illnesses I see people coming there with a refugee background having a lot of difficult stories in their back pack which they have never been able to treat or talk about at an earlier stage. This because it is not focused when giving health support for instance in the refugee shelters. Of course it is easy to see that this is caused by capasity limits and also that this sort of illnesses is more time consuming (treatment over a long period). And however the result is that they quite often try to solve the problems and run away from them by using drugs and/or alcohol. This entailing that the community will have a lot heavier challenge and cost at a later stage and in the long run. I learned from the speaker with the topic Global Health Clinic that the statistics over their treatments only 3% is related to mental health - and this by the same reasons as mentioned above. By my question she confirmed the figures to be under reporting the real problem and needs. 

Furthermore I reflected during the group discussions yesterday (about the researches) that it is a lot about to motivate the locals around to take response and involve to help the immigrants/migrants to integrate into the community. I think that that the authorities never will be able to solve the challenges and issues as such only with supporting with resources (which are reduced under the challenging economic situation we are facing for the time being). 'Talkoo' is the answer to it - in Norwegian 'dugnad'.

It's a long way to go - and it's also about to remember that early and right treatment is like a Kinder Egg - a benefit to the migrant/refugee, a benefit to the community and a benefit to the budgets (one € in is 4 € saved..).

Resources:
The different speakers
Fellow students
Some from the researches (via the presentations)

Who am I:

Thank you for the days!
Jon Helge Løken
54 years old, but still young enough to be a student at
VID, Diakonhjemmet in Oslo.
Bachelor in nursing, 4th semester (out of 6)

Two weaknesses in our society


I have learned throughout the course that homelessness really is a problem in Finland. Dr. Arja Kosi mentined that 3500 people are in the category «homeless people», just in Helsinki. Even though things are, in the words of one of the workers in a housing unit, «getting worse», things are being done to make homeless people eventually get a place of their own. Dr. Koski said something i really liked, and that was that we need to rethink our thoughts of that you have to earn a place to live. It should be a human right to have a home.
Things to help the homeless are being done by both the municipal and voluntaries. Head of communication for The center for paperless immigrants said that paperless immigrants, specially roma people and people from Bulgaria, do have some rights to access the Finnish healthcare, but not enought. The paperless immigrants have rights to «acute healthcare», but problems appear when the immigrants come to health care centers and get rejected because their condition is not acute. The health workers that are turning them away most likely know that the condition needs treatment, and will in time become acute, but the law is the law so they’re sending them away. 

These two points made an impact on me and shows two weaknesses in our society. We need to continue work, both preventive and treatment to minimize the number of homeless people. And we need to make proper healtcare for everyone a normality worldwide.

Who am I? 
 
My name is Henrik and I’m an 23 years old nursing student from Oslo. I currently work in an psychiatric ward in Oslo, as part of my nursingpraction. I signed up for the course hoping it would bring me new expericenses around the theme mental health, which i’m really interested in.


Occupational therapy and underprivileged groups


Occupational therapists are uniquely qualified to work with people with physical and mental challenges, like homeless people. Occupational therapy interventions focus on training life skills, job skills, interpersonal skills and money management. Although occupational therapy have recognised their role working with marginalised groups, it can be problematic because they often fell unprepared for this role, due to the lack of education on this topic. At the same time many of the other proffesions don´t even know about what occupational therapy is, or what an important role they can have (Grandisson and more, 2009).
CMOP or "the canadian model of occupational performance" is a model that occupational therapists uses. This model can be a good tool for findig out which interventions to provide to those who are homeless (Grandisson and more, 2009).

Occupational therapists role in the work with asylum seekers


The role of occupational therapy is to empower members of the community to recognize their own potential through meaningful occupations and to be included in the society. Occupational therapists work with the promotion of health and wellbeing in all people.

One type of intervention that occupational therapist can use while working with homeless and underprivileged groups like asylum seeker is intervention based on a community-centered approach. This intervention is based on developing a humanistisc, transcultural and holistic program, with meaningful occupations as the core of intervention. This intervention applies a client-centered approach where the aim is to promote the sence of independenc and self sufficient for the community. Working transcultural means that occupational therapy introduces cultural meaningful occupations in the intervention. While holistic occupational therapy means understanding the human being as a physical, psychosocial and sociopolitical being, whose essence is spiritual (Algado & Burgman 2005).
One of the underprivileged groups with whom occupational therapist can use the community-centered approach are minor asylum seekers.  To understand children and minors and to help them express themselves we must speak their language. The best way to do this is by using games and play, which is their most essential and meaningful occupation. Play can be used to provide support and to enable the children and youth to communicate their thoughts, emotions, feelings and desires (Algado & Burgman 2005). Different kind of techniques and activities that can be used are: drawing, finger painting, theater, dancing, mime, construction, etc. Engaging in meaningful occupations can help them to look for and find meaning in their experiences that they had suffered and to give new meaning to their daily lives. It appears that occupation has the power to evoke spirit, and spirit has the power to evoke healing (Algado & Burgman 2005).  
Another way to help them get through the trauma is to let the children and youth write their narratives as survivors. Narrative theory suggests that children and youth can benefit from expresssing traumtic experiences as a part of the process of the normalization (Algado & Burgman 2005).
It is also important to listen to these children and youth with respect and try to understand them. Support and be patient with them while they try to recover and return to their natural environment. We as ccupational therapists can help them to be included in the community by promoting community awarness about the problems that these children and youth has faced. These can for example be done by giving infromation to schools, institutions, meetings etc. (Algado & Burgman 2005).

Supported housing unit for minor asylum seekers

We got to visit the supported housing unit for minor asylum seekers in one of our study tours. this was an experience we felt we learned a lot from. This is a house unit with a total of 40 boys in the age of 16-17 years old. The function of this house unit is to offer safe living conditions for asylum seekers during their waiting process to be granted asylum or not.

We learned that some of the boys had been fleeing for 3 whole years before they came to Finland. Because of bad experiences with autorities earlier, it was hard to earn the boy`s trust and we where told that this was a process that took time. The staff experienced a lot of fighting and arguing among the boys in the beginning, they explained this behavior due to all the big changes in the boys life. They are in a new country, in a new house with new people who are strangers to them and they have to follow new rules.

The housing unit focuses on education and school for the boys, were they get to learn the finnish language and about the finnish cultur. They arrange activities like homework clubs, sports clubs, cooking clubs, painting and drawing sessions etc. Football was an activity that the boys were especially fond off. These activities were important for the boys to get their mind on other things and to forget about the waiting proscess and the fact that they dont know about their future. Do they get to stay in Finland? And if they do, were in finland will they be moved to?

Communication and interaction was important so they used a translater alot so that they could understand the boys, their feelings and wishes and in this way better help them.  They used something called cable coaching, a group consisting of the asylum seekers, staff members, volunteers and sometimes students . This coaching method was used to talk about their experiences before, life now, dreams for the future and values.  To do so they often used drawings as a method to let the boys better express them selves.

Literature:
  • Algado, S.S. & Burgman, I. (2005) Occupational therapy intervention with children survivors of war In: Kronenberg. F., Algado, S.S. & Pollard, N. Occupational therapy without borders- Learning from the spirit of survivours. British Library Cataloguing in Publication Data.
  • 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

Who are we?

Authors:

Karoline Gundersen(24), Fjoralba Sadja (age 25),
May Lene Ommundsen (age 25)
Institution
VID vitenskapelig høgskole (Diakonhjemmet)
Field of study
Occupational therapy
Level of study
Bachelor (third year)
Place of study
Sandnes
Country
Norway

Giving those in need their daily bread

Over the last couple of days I have gained a lot of insight into the values and virtues of diaconal work with underprivileged populations. I felt welcomed, through discussions, to share the views, actions, and attitudes of christian diacony, through love and compassion for your next of kin, and utilizing them to perform altruistic actions without having a personal religious belief.

Many institutions we toured, learned of, and were lectured about, do not set demands for the clients, lowering the threshold for receiving necessary care. Now I can see how the diaconal institutions do not set demands for my religious beliefs, and lowers the threshold for me to give that necessary care.
Many in underprivileged situations are not far from functioning properly in a societal setting, needing help in a few, but important, key areas. In Norwegian nursing practice, caring for a client or patient only in those key areas, letting them cover their other needs where possible, is essential to maintain autonomy and self-worth. If your care for those in need springs from the "love of thy neighbour", helping them literally to get their "daily bread", is it important from where that love springs?

Who am I?

My name is Aksel Estensen, I'm a 22 year old Norwegian nursing student attending VID Specialized University campus Diakonhjemmet.

FROM PLANS TO ACTION

"Service user involvement is one of the key challenges in Finnish mental health care." This argument by researcher, PhD Päivi Rissanen represents a problem and a call to action that concerns not only the Finnish mental health sector but also the health and social services sector as a whole, together with the diverse clientele that it serves.

By and large, the strengthening and advancement of service user involvement within the health and social services sector is viewed as an important means to prevent marginalization and poverty. For instance, the objective of improving service user involvement is stated in the Finnish government's objectives as well as in the parallel programs of the European Union. (Karjalainen & Raivio 2013, 12). An edited volume titled Osallisuus – oikeutta vai pakkoa (Service User Involvement - A Right or Compulsion) published by JAMK University of Applied Sciences is a collection of articles about service user involvement from a variety of perspectives ranging from an analysis of political programs to the experiences of young men within social service programs. To this end, studies in this collection present conflicting client experiences because some of them felt that they were coerced to participate whereas some of them viewed participation as an opportunity break the cycle of marginalization. In many political programs service user involvement is stated as an objective and an opportunity in fighting marginalization but unfortunately they often lack concrete steps towards its realization. (Era 2013, 141 - 142.)

On the website of National institute for Health and Welfare (THL) one can find definitions for service user involvement, examples for means to increase it and discussions about pertinent laws, policies and research in the field. (Terveyden ja hyvinvoinnin laitos i.a.) Also the Ministry of social affairs and health has a website about service user involvement, which outlines the Ministry's responsibilities in advancing it. (Sosiaali- ja terveysministeriö i.a.). Strengthening service user involvement is included in municipal substance abuse and mental health strategies, and for example, it is the topic of a chapter in a guide provided to municipalities for the preparation of substance abuse and mental health strategies (Laitila, Minna 2013, 5).

As a social and health care field professionals we should become familiar with laws, projects, initiatives and studies that concern service user involvement both at the national and international level. Consequently we can be prepared to bring current information to the grassroots and apply it practical decision making. We should work to support our clients' mental health through all levels (individual, community, structural) and participate in a variety of mental health forums together with our clients.  Through our own examples we can demonstrate the ways in which service user involvement can be improved, how to listen to clients, and engage them in the planning, development and preparation of different projects because involvement improves ownership, which in turn helps achieve better mental health. It's time to act.

REFERENCES


Era, Taina 2013. Osallisuus – oikeutta vai pakkoa? Jyväskylä: Jyväskylän ammattikorkeakoulu. Viitattu 25.4.2016. Saatavissa https://www.theseus.fi/bitstream/handle/10024/64153/JAMKJULKAISUJA1562013_web.pdf?sequence=1

Karjalainen, Jarno & Raivio, Helka 2013. Osallisuus ei ole keino tai väline, palvelut ovat! Osallisuuden rakentuminen 2010-luvun tavoite-ja toimintaohjelmissa. Teoksessa Era Taina (toim.) Osallisuus -oikeutta vai pakkoa? Jyväskylä: Jyväskylän ammattikorkeakoulu. Viitattu 25.4.2016. Saatavissa https://www.theseus.fi/bitstream/handle/10024/64153/JAMKJULKAISUJA1562013_web.pdf?sequence=1
Rissanen, Päivi 2016. Finnish Central Association for Mental Health and rehabilitation model. "Mental health and Wellbeing – focus on homeless and underprivileged populations" seminar 23.4.2016. Diakonia-ammattikorkeakoulu.

Sosiaali- ja terveysministeriö i.a. Osallisuuden edistäminen. Viitattu 25.4.2016. Saatavissa http://stm.fi/osallisuuden-edistaminen


Terveyden ja hyvinvoinnin laitos i.a. Mielenterveyden edistäminen. Viitattu 25.4.2016. https://www.thl.fi/fi/web/mielenterveys/mielenterveyden-edistaminen

Terveyden ja hyvinvoinnin laitos i.a. Sosku kehittää sosiaalista kuntoutusta. Viitattu 25.4.2015. https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/sosiaalisen-kuntoutuksen-valtakunnallinen-kehittamishanke-sosku

Terveyden ja hyvinvoinnin laitos i.a. Osallisuus. Viitattu 25.4.2016. https://www.thl.fi/fi/web/hyvinvointi-ja-terveyserot/eriarvoisuus/hyvinvointi/osallisuus

Who am I?
Marika Puurtinen, 42
Helsinki Deaconess Institute.Team leader of Kuninkaankallio housing service unit for homeless (Housing first principle). Nurse for mentally handicapped. Bachelor of social servicesDiaconia University of Applied Sciences. Master degree programme in social services (The promotion of health and wellbeing at risk of exlusion)



Attitudes towards homeless people and the mentally ill

Who am I? 

My name is Anders Nordsveen, I'm 36 years old and a nursing student at VID in Oslo, Norway. What I have been left with after the seminar and meeting people struggling with drug use is the prejudice that usually exists towards this group of people.

In the international code of ethics for nurses presented by International Council of Nurses it is written that everyone shall be met by acceptance and an open attitude, with no prejudice towards the person they are meeting. This is especially important when meeting people who are addicted to drugs and the homeless.This is important because the people in these groups have an expectation to be met by prejudice and bad attitudes towards themselves. This can again lead them to not using the healthcare options that are provided and can then lead to poor health. This is especially true when working in mental health.

Creating good relations between health care provider and the users is very important. The helper needs to have empathy and to be able to see the situation from the users point of view. This means that some times when working with the homeless or people addicted to drugs you have to go the extra mile to create and maintain a good relation. And in this way make it easier for the users to accept the help they need.

The most important thing I have learned from this course is to leave your prejudices at the door when working with the mentally ill, have an open mind, and that creating a good relation is the most important way to recovery.

Housing first


We are nurse students from UC Diakonissestiftelsen in Denmark. Our common interest in people with mental health issues is what brought us to Helsinki to participate in the intensive course Mental Health and Wellbeing - focus on homeless and underprivileged populations.
Among the many interesting subjects throughout the course we found the project about housing first extraordinarily interesting. Life on the street can be hard and some of the people living there is in contact with crime, abuse, and violence.

Housing first - also in Denmark

This is also a problem in Denmark, where a similar strategy is used to reduce homelessness. The idea of the project is that having a home is seen as a human right. When you have a home, you have a safe base, which can increase stability in your daily life. Viewing people holistically is of the essence in the danish housing first model, which we find to be in line with the holistic Diakonia mindset.

Housing units in Helsinki

We visited housing units where we were taught about these particular housing units' visions and approach. Through harm reduction and reducing the amount drug abuse the health care professionals aim to help the rehabilitation process. The basic idea is not to force the residents with substance abuse to become clean but instead to help them manage and overcome challenges in everyday life. The health care professionals of the Vanha Viertotie housing unit was aspiring to prepare the current residents to return to society and potentially the labour marked.
We all found that the professionals at the housing unit did a great job supporting the residents in their everyday life. They treat the people with trust and respect, and see the residents as individuals. As an example the professionals assist the residents by escorting them to municipality arranged activities such as AA-meetings but also by encouraging them to participate in activity groups at the housing unit. By facilitating different groups and engaging residents in forming their own groups, the residents are active participants in positive and beneficial activities.
That being said we were surprised that there were no alternative housing or other activities for the people wanting to change and waiting to get a rental at the housing. Furthermore we wondered why there were no limitations to how long the residents could stay at the housing unit. The residents we met were both planning on staying in the facility, which we have ambivalent thoughts about since it is important for the residents to feel that they have a safe permanent place to stay for as long as needed, but at the same time the people waiting for a rental might be in greater need of a place to stay.


Who are we?

Marie Kofoed Hutters (23), Danmark, UC Diakonissestiftelsen, 3rd year Nursing student
Line Aagaard Pedersen (31), Danmark, UC Diakonissestiftelsen, Nursing student
Nicoline Ellebæk Pedersen (22), Danmark, UC Diakonissestiftelsen, 2nd year Nursing student

Considerations of the seminar presentations


In many EU countries sick leaves from work are caused of work related stress and mental health. Long term sick leave and long term unemployment cause of that are increasing.
The event started at Saturday with amusing music performance by "Ganthy". The first lecture was "Poverty in Welfare state" and a speaker Sakari Kainulainen. Kainulainen introduced concept of absolute poverty and related poverty and challenges because of those. Next speaker was Heini Kapanen. Her lecture was very informative but little hard to follow.
The most interested lecture was performed by Päivi Rissanen. She bring along brave and personal survival strory about strong depression with many diagnosis. She can managed to do possible from impossible. I hope and believe that Päivi`s story will give hope many persons who are suffering with mental health issues.
End of the Saturday we did study visits five different mental health, supported housing and addiction treatment services places in the area.
Next day at Sunday I was only participate in the morning lectures because of illness. The day was started with the silent moment and after that there was the key note lecture by the researcher of Ikali Karvinen. He was speaks about the undocumented migration in Finland. After that we were do some teamwork and discussed and answered some questions give us by teachers.
The weekend was interestning and instructive. I wish personally that we could have more of these kind of teaching metod. I was learning more about the statistics of mental health and also the poverty (absolute and relative). It was useful to communicate with the Nordic students. There is always some hope to left. You should never give up. (Rissanen 2016). 
Who am I?
I am Tenho Tamminen and I am studying at Diak in Master Degree Programme. I took part to NordDiakoni intensive Course in 23rd – 24th of April 2016. The Event was very interesting and activating. The aim of event was "Mental Health and Wellbeing – focus on homeless and underprivileged populations"