Sami Psychiatric Youth Team

1. Sami Psychiatric Youth Team A cultural sensitive treatment approach of suicidal behaviour problems and substance abuse in indigenous Sami 23th September 2005 Making it Work 2

2. 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

3. Indigenous peoples of the Arctic 23th September 2005 Making it Work 2

4. 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)

5. Sami Psychiatric Youth Team • Established in 1990after acluster 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 23th September 2005 Making it Work 2

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7. 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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9. 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 23th September 2005 Making it Work 2

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11. 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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14. 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 23th September 2005 Making it Work 2

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16. 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) 23th September 2005 Making it Work 2

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18. 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”) 23th September 2005 Making it Work 2

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20. 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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22. 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) 23th September 2005 Making it Work 2

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24. 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 23th September 2005 Making it Work 2

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29. 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 23th September 2005 Making it Work 2

30. Questions?? Thank you for your attention! 23th September 2005 Making it Work 2