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Sami Psychiatric Youth Team

A cultural sensitive treatment approach of suicidal behaviour

problems and substance abuse in indigenous Sami

Using contemporary methods to reach young people at risk – the Sami Psychiatric Youth Team (Samisk Psykiatrisk Ungdomsteam) using sms messages and multiprofessional

training

Anna Rita Spein, M.D., Sami Psychiatric Youth Team

Sami National Competence Center for Mental Health Services (SANKS)Box 4, N-9735 Karasjok, Norway.

E-mail: anna.rita.spein@helse-finnmark.no

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Indigenous peoples of the Arctic

The Sami people

Residing in the northern Fenno-Scandinavia and the Russian Kola Peninsula

Estimated population size: 100 000, different subgroups/dialects (e.g. mountain/reindeer Sami, sea-Sami, Lule-Sami, Eastern Sami etc.)

70% of the Sami is residing in (Northern) Norway

Have their own culture and language

~10% occupied in semi-nomadic reindeer herding

Formal status as indigenous people in Norway (1988)

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Sami Psychiatric Youth Team Established in 1990 after a cluster of suicids among young

people in living in the community during the 1980s

The Team`s main office is located in Karasjok municipality

Our Team are the only Pscyhiatric Youth Team in Northern Norway

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Sami Psychiatric Youth Team The Team`s catchment area is the highland area of

Finnmark County comprises 5 municipalities; Karasjok, Kautokeino, Porsanger, Tana & Nesseby

The 5 municipalities are all included in ”The Saami Language Act of Norway” (1990)

All clients admitted to the Team from the the catchment area receive treatment independent of their ethnic heritage

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23th September 2005 Making it Work 2

Sami Psychiatric Youth Team Target group: age 15 – 30

In 2001: 36% of the clients were 20 years

The Team`s main issues are prevention and treatment of suicidal behaviour problems and substance abuse.

Outpatient clinic

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Patients/clients 20% has been admitted by their G.P. (=fastlege/

kommunelege)

Others have been admitted by social workers, school nurses, teachers, family members, friends etc.

Many clients admitt themselves for treatment

Tentative diagnosis at the time of admission: 25% sucidal thoughts or behaviour, when including sadness, depresion 35%, substance abuse 22% (mainly alcohol abuse)

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23th September 2005 Making it Work 2

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Cultural sensitivity approach

The Team`s stuff are multidiciplinary including psychologist, social workers and a medical doctor

The staff have either indigenous heredity and/or native Sami language competence themselves, or formal education in Sami culture

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Low thresfold for offered services No waiting Own referral No charge Cell phone/SMS: regular and emergency appointment in

case of suicide risk (crises and attempts) Patient decides where the conversation should take place

(mostly at the clinic, but also in the clients home)

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23th September 2005 Making it Work 2

Early intervention: Focus on age group 20 ”Small problems” may

be difficult enough

Preventive work: Information in schools

(substance use primarily) Training/guidance ASIST (Applied Suicide

Intervention Skills Training (=”første hjelp ved selvmordsfare”)

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Cooperation meetings Regular meetings with primary care services (GP,

psychiatric nurses, social workers etc.), frequently contact with acute hospital ward for adolescents with mental health problems (UPA/Tromsø) and District Psychiatric Centres (DPCs) and ward treating substance abuse problems

Meeting with social services and school teachers

Telemedicine & telephone (due to long distances!)

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SMS Use of private cell-phone; voluntary Appointments only, not treatment, primarily during day

time; 8.00. – 15.30. Less paper work, fewer mailed letters! A sms remainder the day before the appointment – fewer

drop-outs (economical benefits!) Sms use and young people: sometimes they don`t have

money for using their cell-phone (e.g. are not able to reply our sms)

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23th September 2005 Making it Work 2

Substance use in the Sami highland Alcohol is the most commonly used substance use

among Sami and non-Sami clients residing in the Sami highland

Polydrug use is common

Drop outs rates are high among young people and especially high among substance abusers

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23th September 2005 Making it Work 2

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Conclusion

When working in a clinical setting with indigenous adolescents with mental health problems it is important to emphasize both a cultural sensitive approach and easy access to treatment facilities

Using sms is a modern way of communicating with adolescents and young adults

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Questions??

Thank you for your attention!