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.

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.

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" 

Loneliness and confidence

Sakari Kainulainen told in his presentation that loneliness is the same feel inspite of how much money you have. That point was very interesting. We can easily think that people how are rich are happiness and they have everything , but I think  that the feel of happiness you can not buy. 

Next notice I made was one of the most wonderful story  that Päivi Rissanen told about her experience. Nearly the experience of her process of mental health rehabilitation.

I learnt that our society have still, lots of developing, how we have to trust people and that no-one psychiatric patient is not hopeless! We have to organizate and have new ways to learn how we can get patients and psychiatric clients to take part in their rehabilitation and support activity, studying or working. It doesn't succes if only professional persons are building and  developing social- and healt services. We need also the people who have experience of psychiatric healt care and who could tell the succesful treatments to everyone. Päivis presentation was very needfull to me because  i got more data that no one is not hopeless "case". As professional confidence with the patient is the way to  change. That confidence have to base together with the patient.

At the end i could  abstract that the money do not make the feel of  happiness and confidence with the real meeting without preconceptions open challenges to change and give richer life to each other!

Who am I?

Student of master  degree in healt promotion in Finland

Kaarina Mertaniemi 

Head Nurse

Helsinki Deaconess Institute

Addiction and Mental Health Services

THOUGHTS ABOUT MENTAL HEALTH AND WELLBEING INTENSIVE COURSE

The first key note lecture was poverty in welfare state by Sakari Kainulainen. It woke me up to think about the supporting of mental health and well-being among the homeless and underprivileged groups. We have structural things that are causing a poverty and sooner than you know, there's a possibility to go from mainstream to marginal. The thing is that we need to shake those peoples a littlebit to wake up for their own situation, not just give them something to stop the freefall. I actually got very much knowledge of this lecture about Finland's current situation and how it's showed on different areas. The main point is that we have to pay attention to that group of peoples, who are living on social, because they have learned to be helpless.

The thing that I liked most about this weekend was that we had honor to listen Päivi Rissanen and her story. It reminded me, how important it is, to treat others as you wish that you would have been dealed with. Patient's service map in Finland can be quite large and it is very important that the patient feels that there is really somebody who cares for him/her. You might be his/hers only hope.

I think that the most interesting part of this weekend was the study tour in Global clinic. It's producing health services for paperless immigrants. It gave me very much new knowledge, and the work that they do, is amazing. I wasn't aware that things here in Finland are in so bad condition. The thing is that limiting access to health care does not save money. But if we treat people when they need necessary healthcare and not only when they need emergency healthcare, we could save resources and money in a long term. To get more information about their work, go to www.globalclinic.fi

This weekend was a good experience also because there were students from our group but also from Norway and Sweden. It was nice to have a 'coffee table conversations' about the differences and similarities in education systems and work as a nurse, in our respective countries.

Who am I?

Mirikle Nousiainen, Student in Diaconia University of Applied Sciences, Helsinki, Master degree programme in health promotion, Finland.

Study Weekend – Head Full of Lessons Learned

Norddiakoni intensive course exceed my expectations. When we heard that the seminar is going to be on weekend I wasn't very cheerful. But when the program was published it started to interest me more. Some lectures more than others sounded very compelling.

Saturday, good day

On Saturday most of program was very rewarding and invited reflections. The lecture of Poverty in welfare state by Sakari Kainulainen was one of the interesting parts of the day. Even if some of the issues were quite familiar already, some issues made think about the topic more deeply and from another point of view. There were some interesting facts I would like to mention. In Finland it appears South and Western parts have less problems than North and East. A research about poverty of young people between years 1991-2013 obtained that situation have been bad all the time for example in Lapland. Lapland and the situation of poverty there interests me especially because my homecity is located in Lapland and I have been living there my whole childhood and teenage years. Now after living away almost ten years I actually can see the difference and things that might cause that the situation with young people is really worse in North that it is in South. You can't even compare the services between North and South and I think it is a big factor. For example in my homecity there isn't all needed services and some of the services offers only the essential affairs. It's sad that the habitation has a wide meaning in person's mental health and well-being. To improve this we have a lot to do!

The other very interesting part in program was the story of Päivi Rissanen. Päivi has walked her own path from serious mental health illness to scholar. With her story she gives hope to other rehabilitees and also to professional helpers. She urged that everyone has their own way to rehabilitate and have their own experiences to share. In her story turned out that it is possible to reach your dreams. But there was something in her story that made me uncomfortable. Päivi showed one slide of the services she had to use on her way. There was so many doctors and nurses she had met, so many units and proceedings. That is not the way it should be and hopefully in future the plan wouldn't be like that.

All different, all equal       

At the end of Saturday's session there was presentation of Global Clinic. I found it very interesting and timely as the situation in Europe is mutable. There were many good and interesting points in demonstrator's presentation and it somehow opened my eyes. I have to admit that I didn't know well enough how dissonant things are between for example constitution law and the practice of health care for undocumented migrants. How much cheaper and easier, not to mention how humane it would be to treat these people way they should! The interesting fact was that there wasn't so many people coming to Global Clinic because of the mental health problems. But it made sense what demonstrator told about it. The number is low because of many reasons. Global Clinic is not able to prescripe medicine that they can't organize follow-up. Patients of Global Clinic don't usually speak the same language as the helpers. Concentration to mental health problems would require high-quality of interpretation and understanding. Also mental health problems can be tabu in some cultures. Mental health can be understood in different ways in other cultures. Of that I have an example in making our thesis. We were interviewing a muslim woman and one question in our interview was how does the religion affects to mental health. The word mental health she had to look from the dictionary. After she answered the question it was obvious that in her culture mental health means a bit different that how we understand it.

On Sunday we continued with the same theme, undocumented migrants, refugees and asylum seekers in Europe. On sunday we were having much more group tasks with the visiting students from other Nordic countries. It was opening to hear their experiences and thoughts. To conclude I must say that even if these days required a lot of concentration, it was really worth of it. I'm glad I was able to be part of this intensive course.

Who am I?

My name is Jenna Tervaniemi. I am studying master degree program in Diaconia University of Applied Sciences. Studies focuses on health and welfare promotion of people who are at risk of exclusion. My basic education is nurse.

Interaction - the medicine for the poverty

One big reason for the poverty in welfare state is the lack of interaction, says Sakari Kainulainen based on his research. That said aloud awakens me to realize even deeper how important interaction between people is. I started to value my own work with young people even more after hearing this since I'm organizing the peer groups for lonely youngsters. And since I hear  foreign youngsters being even in bigger risk to exlude, I would love to start working more with them too. People just need people.

Kainulainen talks about loneliness how serious problem it is in our society. For example drinking, eating, drugs, internet, porno is often used to get rid of the feelings of loneliness. Money is not the answer but connections between people are. Poor and rich can be as happy, says Kainulainen. Already Aristotele said that without friends no one would want to live, even if he had all other goods. People are important!

The role of the social workers is to awaken our customers to think about their own lives, says Sakari Kainulainen. Also Päivi Rissanen said how the turning point in her life was when the worker saw her as a person, not as a patient.  Dreams started to take role in her life. She also mentioned peer support being an important part of her rehabilitation. I want to be the social worker who can see and hear the people who need my help. Empowering them is my goal.

Also when visiting Lehmuskoti, what is the last place to live for drug users, we hear how good the community and togetherness is for the customers' rehabilitation. They believe in "housing first" idea in Lehmuskoti but as soon as the person lives in Lehmuskoti they start building trust with him or her. The worker says how the trust is often very difficult to build but once you get it it's very rewarding. So empowering our customers starts by building trust, we know that, but I can only imagine how difficult it is in Lehmuskoti. What I was easily able to sense is that especially those people have been lonely in their lives and I am so happy seeing this type of place where they are so well taken care of. Enormous amount of respect for the workers!

Our group work with Norwegian students about asylym seekers and how could they adapt better in Scandinavian countries brought us to think about how important it is that people do co-operate in every level. We ended up to discuss how interaction is the answer to reduce the fear what both asylym seekers and residents often feel and what is often the cause of the problems. Interesting is that also in our final group work we found out that the connection between people was the most important thing in one of the studies what compared two different type of therapy orientations, not what exact type of therapy person gets. So interaction between people is the answer!

Who am I?

Anne Elojärvi

Student of Diakonia University of Applied Sciences

Master's Program in Social Services

Mental health and Wellbeing – focus on homeless and underprivileged population

We had a very interesting and tought-provoking NordDiakoni intensive Course weekend. Sakari Kainulainen gave us good introduction about poverty in Finland. It was interesting to see in wich municipalities has the most low economy based populaition. That made me think about the supporting system in Finland, do we have the same resoursers in small municipalities than in large citys? I don't think so. Small places and the municipalities in northen Finland don't have equal resoursers to handle poverty in their area. 

Päivi Rissanen made me think about our mental rehabilitation system, she showed how many people she had met and how many nursers and doctors had tryed to help her. Allthough it needed a one nurse who asked her the right question in a right time. That made me think that every meeting in your life can be meaningfull. 

Our group get to know Lehmusrinne wich offers housing first services to a heavy drug users. Place was a kind of a shock wake up call to see how helpless hevy users can be. It gave names and faces of the huge problem of homless people who has problems with intoxicants. It made me feel quite speachless just to think the life of people who has nothing. In same time i think of the people who nowdays has the knowledge of drug using and the other intoxicants, why they don't choose otherwise, why they are in those same situations than the old generation who didn't have the same knoweledge than we do. Is it the chaing of poverty and some kind of problems in menthal health? Who knows, it made me really think how we can make the difference in younger generation.

In the second day we get to know better the students of Sweden, Norway and Denmark. It was refressing to get known the practises of other countries and get other kind of perspective.

Who I am?

I am Katri Krigsholm 38 years old social councellor in city of Vantaa. I am studying masters program in Diakonia ammattikorkeakoulu.