Cultural adaption of mental health services to the Sami.
A qualitative study on the incorporation of Sami language and culture into mental health services

Dagsvold, Inger

dc.contributor.advisor	Blix, Bodil Hansen
dc.contributor.author	Dagsvold, Inger
dc.date.accessioned	2019-10-24T12:44:23Z
dc.date.available	2019-10-24T12:44:23Z
dc.date.issued	2019-10-18
dc.description.abstract	<p>The Sami people in Norway have a statutory right to receive equitable health services, adapted in accordance with Sami language and culture. However, limited research is available regarding the impact and of Sami culture and language within mental health services. <p><i>Aim - </i>The overall aim of the study was to explore, identify and describe the significance of culture and language in mental health services as experienced by clinicians and Sami patients, to enhance the understanding of the cultural and linguistic adaptation of the services to the Sami. <p><i>Methods - </i>The data was co-constructed in individual interviews with clinicians and Sami patients in mental health clinics in northern Norway. The data were analysed thematically. <p><i>Results - </i>The study demonstrated that Sami patients’ language choice is influenced by a complexity of social and cultural factors. Bilingual Sami patients have different preferences for what they can talk about, in which language, in what way and with whom. However, the result must not be confused with saying that Sami-speaking patients do not need Sami-speaking therapy. Essentialist descriptions of Sami culture were several, but ways to incorporate cultural and linguistic aspects into mental health services were limited. Organisational support for language appropriate services was limited. Culturally adapted clinical interventions were lacking. Incorporation of culture and language was random, provided by the individual clinician within the structural frames and with the knowledge available. <p><i>Concluding remarks - </i>The study indicates that the incorporation of language and culture into mental health care is a complex process involving strategies at three levels; institutional systems and structures, health professionals’ cultural assumptions and analytical competence, and cultural assessment of interventions within mental health treatment. Stereotypical portrayals of Sami culture narrow the understanding of Sami identity, delimit the identification of Sami-speakers and simplifies possible impacts of culture within health care. Therefore, the question is not what culture “is”, but how culture unfolds in human encounters.	en_US
dc.description.doctoraltype	ph.d.	en_US
dc.description.popularabstract	<p>Research has indicated that the indigenous Sami population experiences more communication problems and is less satisfied with mental health services than the Norwegian majority population. The Sami people in Norway have a statutory right to receive equitable health services, adapted in accordance with Sami language and culture. However, there is limited research on the impact of culture and how to provide culturally and linguistically adapted mental health services to Sami patients. Hence, this thesis aimed to explore the significance of culture and language in mental health care as experienced by clinicians and Sami patients. The study is based on thematic analyses of individual interviews with clinicians and Sami patients in mental health clinics in northern Norway. <p>The study demonstrated that bilingual Sami patients’ language choice in different communication situations is influenced by a complexity of social and cultural factors. The participants reported extensive use of language switch both in everyday life and in therapy, indicating that a person’s status as a Sami speaker is not always a question of either-or. Sami patients may have different preferences for what they can talk about, in which language, in what way, and with whom. However, the results must not be confused with the idea that Sami-speaking patients do not need Sami-language therapy. Bilingualism, constant language awareness, exploration of language switch, and knowledge about Sami culture and history may enhance the understanding of Sami patients’ needs and preferences when in mental health therapy. <p>The interviews with the clinicians demonstrated that identification of Sami patients’ language needs and preferences as well as offers of language-appropriate services are random. Also, the clinicians referred to Sami culture predominantly in terms of essentialized cultural traits, defining the Sami as “different”. The clinicians had several essentialist assumptions about Sami culture but provided limited descriptions of ways to incorporate cultural and linguistic aspects into clinical encounters with Sami patients. The incorporation of culture and language in therapy was, for the most part, a “private matter”; in team discussions at the clinicians’ workplaces, Sami cultural issues were seldom included. <p>The study indicates that the incorporation of language and culture into mental health care is a complex process involving strategies at three levels; institutional systems and structures, health professionals’ cultural assumptions and analytical competence, and cultural assessment of interventions in mental health treatment. <p>Approaches to culturally adapt health services depend on the underpinning notions of culture. In this study, essentialist, stereotypical descriptions of Sami culture dominated. However, stereotypical portrayals of Sami culture narrow the understanding of Sami identity, delimit the identification of Sami speakers and simplify possible impacts of culture within health care. A more dynamic understanding of culture as a continuum between common cultural traits and individual experiences and preferences can increase the understanding of the individual patient’s situation. Therefore, the question is not what culture “is”, but how culture unfolds in human encounters. <p>Knowledge of the particular elucidates the general; the study of the possible impact of Sami culture and language in therapy might thus provide general insight into being a patient in need of health care. Also, focusing on Sami language and culture sheds light on the culture and structures inherent in the health care system.	en_US
dc.description.sponsorship	This project received funding from The Sami Norwegian National Advisory Unit on Mental Health and Substance Abuse, (SANKS), the Research Unit of Finnmark Hospital Trust, and the Northern Norway Regional Health Authority (Startstipend), and from the Centre for Sami Studies at the UiT Arctic University of Norway in Romsa/Tromsø (travelling fundings).	en_US
dc.identifier.uri	https://hdl.handle.net/10037/16468
dc.language.iso	eng	en_US
dc.publisher	UiT The Arctic University of Norway	en_US
dc.publisher	UiT Norges arktiske universitet	en_US
dc.relation.haspart	<p>Paper 1: Dagsvold, I., Møllersen, S. & Stordahl, V. (2015). What can we talk about, in which language, in what way and with whom? Sami patients’ experiences of language choice and cultural norms in mental health treatment. <i>International Journal of Circumpolar Health, 74</i>(1), 26952. Also available in Munin at <a href=https://hdl.handle.net/10037/8726> https://hdl.handle.net/10037/8726</a>. <p>Paper 2: Dagsvold, I., Møllersen, S. & Stordahl, V. (2016). “You never know who are Sami or speak Sami.” Clinicians’ experiences with language-appropriate care to Sami-speaking patients in outpatient mental health clinics in Northern Norway. <i>International Journal of Circumpolar Health, 75</i>(1), 32588. Also available in Munin at <a href=https://hdl.handle.net/10037/10126> https://hdl.handle.net/10037/10126</a>. <p>Paper 3: Dagsvold, I., Møllersen, S., Blix, B.H. Clinicians’ assumptions about Sami culture and their experiences with providing mental health services to indigenous Sami patients in Norway. (Accepted manuscript).	en_US
dc.rights.accessRights	openAccess	en_US
dc.rights.holder	Copyright 2019 The Author(s)
dc.rights.uri	https://creativecommons.org/licenses/by-nc-sa/4.0	en_US
dc.rights	Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)	en_US
dc.subject	VDP::Medisinske Fag: 700::Helsefag: 800	en_US
dc.subject	VDP::Medical disciplines: 700::Health sciences: 800	en_US
dc.title	Cultural adaption of mental health services to the Sami. A qualitative study on the incorporation of Sami language and culture into mental health services	en_US
dc.type	Doctoral thesis	en_US
dc.type	Doktorgradsavhandling	en_US