health in sweden -improving mental health of asylum seekers and new arrivals in sweden
TRANSCRIPT
Health in Sweden
Helsinki, Feburary 7th 2017
”Hälsa i Sverige för asylsökande och nyanlända” [SWE]. Uppdrag Psykisk Hälsa, SALAR
Improving mental health of asylum seekers and new arrivals in Sweden*
The Swedish Associations of Local Authorities and Regions (SALAR)
SALAR represents Sweden’s: 290 municipalities 20 county councils/regions We act as an employer’s
organisation, and defend and promote the interests of our members.
Background The process Health in Sweden - National
implemenation Outcome
Schedule
Largest number of people of displaced people since WWII
Photo source: http://www.dailymail.co.uk/news/article-2304980/Images-war-A-child-wanders-amid-rubble-dust-town-called-home-looks-like-film-set-apocalyptic-future.html (17-01-16 11:31)
Asylum applicants in the EU 2005-2015 (Thousands)
Source: http://www.migrationsinfo.se/migration/eu/asylsokande-i-eu/
http://www.unhcr.org/576408cd7.pdf
http://www.unhcr.org/576408cd7.pdf
Asylum seekers in Sweden
163 000
Humanitarian causesMultiple stresses of migrationPoor mental health1
Economically (Samhällsekonomiskt lönsamt) Ill health interferes with integration Strain on public systems Potential to benefit Sweden
1) Socialstyrelsen. Psykisk ohälsa hos asylsökande och nyanlända migranter - Ettkunskapsunderlag för primärvården. Socialstyrelsen, Artikelnummer 2015-1-19
Motivation to act on mental health?
Background The process
- SALAR applied to the Ministry of Health and Social Affairs to do a preporatory study
Health in Sweden - National implementation
Outcome
Schedule
PurposeImproving the immigration process (in terms of health care). To increase mental health and to reduce suffering among asulym seekers and newly arrived
Preporatory studyOctober 2015 – March 2016
KNOWN CHALLENGES MEANS TO CHANGE Identify ill health Health Exams
More (baseline 43 percent) Better (incl. mental health)
Better interventions Competence to identify, cultural sensitivity, self-care, trauma care
Sharing best practice, planning & follow-up
Online tool sharing, easy access.Data management tool.
Health promotion Information on how to access Swedish healthcare.Education about reactions to migration & self care
management/personnel
asylumseekers/newly arrived
How?Preporatory study
October 2015 – March 2016
1. Identification of good practice (tools and methods)
Tool enhancement together with national experts
Live test in a ”pilot County”
Products ‘tried and tested’ for nation wide dissemination
StepsFrom good examples to nation wide dissemination
2.
3.4.
Preporatory studyOctober 2015 – March 2016
Severe mental illness
Mild to moderate mental illness
Health promotion & prevention
Telephone-/video support
Health Group Group Session Guide
Basic education Migration & mental health
Health Screening
Health information Adapted for
language/culture
Basic education of specialists
Online self-care advice (in progress)
End ”Products”Digital tool for
planning/follow-
up Online sharing of best practice
Preporatory studyOctober 2015 – March 2016
Example Materials for personell that perform Health Screenings
Model for improved process
Picture based information/invitation
Questionnaire (template)
Preporatory studyOctober 2015 – March 2016
ExampleAids for personell to manage support groups
1. Screening questions
4. Diploma template (for participants)
2. Template to introduce offer
3. Session guide (preparations, topics, movies)
Preporatory studyOctober 2015 – March 2016
ExampleInformation films for asylum seekers Topics
• Health effects of migration• Trauma and stress• The Swedish healthcare system• Sleep, excercise & nutrition• Alcohol and narcotics
Languages • Swedish• English• Arabic• Somali• Tigrinja• Dari
Preporatory studyOctober 2015 – March 2016
17
Online tool for sharing good examples - 89 so far
6
15
74
Severe
Mild to moderate
Health promotion
& Prevention
Preporatory studyOctober 2015 – March 2016
Background The process Health in Sweden - National
implementation Outcome
Schedule
2016 – Health in Sweden For asylum seekers and newly arrived
GoalImplementation i all regions 2016 (30 million SEK in June)
MethodTrain trainers to reach all personel with tools and knowledge
Program plan (Timeline)1. Needs assessment
Per county. SALAR supports with- Local Coordinator - Digital form (webb)- Analysis- Pairing needs with national education offer
2. Planning County commitment and reimbursement - Comprehensive plan for for local dissemination (WHO, WHAT, WHERE, WHEN)
3. Dissemination of knowledge and skills
Training trainersa) National educationb) Local educationc) Follow up (target completion rates
according to plan)
21
20 of 21 counties analyzed the need for better ways to aid asylum seekers and new arrivals
17 counties gathered in total 310 webbforms from different services.
3 counties did indepentent analyses.
1 county is planning to a needs assesment.
Counties that undertood a needs assesment.
In cooperation with SALAR
Independently
Planning to
Assement reveals big needs over all
Källa: Behovsanalyser i 17 landsting/regioner genomförda via webbformulär under aug-okt 2016 * Genomsnittlig andel som uttryckte ett behov i de 17 landstingen/regionerna
Severe mental illness
Average percentage of reported need*
• Materials and metods to give health information • Materials and methods to conduct health exams• Offer promotive and preventive care• Educate personel on migration and effects om mental health 78%
• Offer services• Educate personel• Guidance to personel (tutoring)
75%31% 63%
62% 66% 60%
• Offer services• Educate personel• Guidance to personel (tutoring)
47% 66% 60%
Health promotion/prevention
Mild to moderate mental illness
23
Courses and materialsDaycourses for trainers + materials
Severe mental illness
Mild to moderate mental illness
Health promotion & Prevention
Basic knowledge about Trauma Lifespan Integration (Treatment method)* Migration and mental health – for psychiatrists
To give health information + health support in group Basic knowledge about Trauma Lifespan Integration (Treatment method)* Migration and mental health – for Primary Care Migration and mental health – for School Health Services Managing group support and transformation
What the entire organization should know! To give health information + health support in group Orientation skills for unaccompanied minors New arrivals as a resource Improved metods for health exams Migration and mental health – basic knowledge
*Not in train the trainer concept
”Products”, tools
- For trainers
- For professionals
- For asylumseekers
For trainers
Outlay of courses• Theory• Tools• Discussion on implementation
Ex. materials for training others• Manual• Presentation (slides, movies)
Background The process Health in Sweden - National
implementation Outcome
Schedule
Fall/winter daycourses have been given 23 times with 1000 participants in total
14 different daycourses (8 on multiple occations) 1000 participants 2016, 500 spring 2017 Ca 88% of participants from counties, others from
municipalities or governmental agencies (ex employment office).
55% of participants are explicitly commited to training others.
Average appreciation of cources: 4,17 out of 5
1000 participants
If every other participant trains 5 collegues the program will have reached 3750 persons!
attended national daycources
more have signed up for spring courses…
~1000
~500
=~1500 trained personnel
9 counties affiliated with national tool for monitoring and planning health care services for asylum seekers
Affiliated
InterestedConnecting in feb-17
Turned down offer
Affiliated counties
Report (+eng version) 28 feb 2017
Many challenges remain…