1.4. El entorno geográfico de los yacimientos
1.4.1. Los suelos de la región de ocurrencia de los yacimientos
Four regional psychosocial teams for refugees and asylum seekers existed until 2004 (in the south, west, middle and northern part of Norway). The Psychosocial teams were created based on an experience at Vinderen psychiatric clinic in Oslo developed by Prof. Edvard Hauff, Prof. Nils Johan Lavik and Nora Sveaass in the late 1980s.25 Following this, a centre called The Psychosocial centre for refugees (PSF) was created at the University of Oslo in 1990 led by Lavik. Prof. Sverre Varvin was Senior Consultant and the centre had 4-5 clinicians in addition to other staff. Their occupations were treatment, rehabilitation, teaching and research, and they gave comprehensive guidance to second line psychiatry services. The four regional psychosocial teams for refugees and asylum seekers were created and connected to it in kind of a network where PSF functioned as a mother centre. According to Varvin the centre had good collaboration with the four regional teams and the structure functioned well. It was considered by primary and specialised health services as a place they could seek advices and support. It was also known among refugees to be a place where they felt safe, according to Varvin.
PSF was closed in 2004 due to a reorganization process, led by the Directorate of Health (Ibid.). The Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS) was established in order to strengthen knowledge and competence regarding violence and abuse, refugees, catastrophes and traumatic stress (Helsedirektoratet 2010: 11). NKVTS does research and consultation, but does not have clinical treatment. At the same time Regional Resource Centres for Violence, Traumatic Stress and Suicide Prevention (RVTS) were established in order to give guidance to professionals, including those working with migration.
25
Email correspondence with Prof. Sverre Varvin, Oslo and Akershus University College of Applied Sciences 28.01.2015
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These centres have, according to a guideline of the Directorate of Health from 2010, a professional team within the area of refugee health and migration that should contribute with teaching, consultancy and multidisciplinary collaboration. Employees at PSF protested against closing the centre and the regional teams. Refugee patients lost a specialised centre where they could receive treatment, and guidance to the mainstream system based on both clinical work and research disappeared. This reorganization is, however, part of a larger political discussion about providing asylum seekers and refugees specialised health services or include them in the mainstream system.
In Stavanger, on the West coast of Norway, a new centre has opened called the Transcultural
centre, with support from the regional health authorities (Helse Vest). The centre is a
collaborative project between adult psychiatry and child-and adolescent psychiatry, formally administered by the Department of Child and Adolescent Psychiatry at Stavanger University Hospital. The main aim of the centre is to provide specialised mental health services for war- traumatized and tortured asylum seekers and refugees:
(…) to contribute to giving asylum seekers and refugees equitable mental health services. We collaborate closely with important actors working with refugees: Primary health service, second line health services, asylum centres and refugee services in the municipalities. Cooperation with civil society organization will also be relevant (Helse Stavanger. Stavanger Universitetssjukehus 2014, author`s translation).
The Transcultural centre is a two-year pilot project. The centre has been planned for several years and started in August 2014. It is unique in its form in Norway, but has been inspired by the earlier Psychosocial centre for refugees in Oslo, and by exchanges with colleagues in Scandinavia as well as internationally. A family-focused approach in dealing with traumatized children is an important focus, and treatment is accessible to all ages, according to Aina Basilier Vaage, who is, as a child psychiatrist, one of four therapists working at the centre (interview with Vaage). The centre is open to all regardless of their residence status, with or without legal stay in Norway. The centre is intentionally located in a building away from the hospital area so that it is considered less stigmatizing than going to the Department of Psychiatry. Vaage argues that it is an advantage to be an interdisciplinary team working with these kinds of difficult issues and stories. The other therapists are an adult psychiatrist, a clinical social worker and a psychologist.
The Transcultural centre is a clinical competence centre, working with referred patients as well as offering consultation, counselling and teaching to others working with refugees and asylum seekers, such as asylum centres, refugee services and municipalities. The therapists are also available for assisting clinical personnel in patient assessments and treatment. It is crucial that this centre provides both clinical work with patients, consultation and research. Colleagues at the psychiatric division may refer patients to the centre and exceptionally, the centre receives patients directly from primary health services or others meeting refugees and asylum seekers in need of help, if other sources for help have been insufficient. To increase accessibility is an important goal for the centre. If patients are afraid to come to the centre, e.g.
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due to stigmatization related to mental illness, the therapists may meet the patients where they live or feel safe, for example at their school.
The background for the establishment of this centre was research findings and clinical experience showing that people from non-Western cultural settings may have great problems accessing the specialised mental health services, and have more serious conditions at referral compared to Norwegians. Vaage refers to barriers such as language and often a lack of trust in interpreters, lack of knowledge of the Norwegian system, stigmatization connected to seeking psychiatric help, stereotyping of the patient group in the health system, the possibility of misdiagnosis related to lack of knowledge of the role of culture in mental health, and not least the vulnerable situation of asylum seekers and refugees due to their past and the asylum phase. Both adults, UAMs and children arriving with their parents meet these different kinds of barriers. Vaage argues that often asylum-seeking children arriving with their families do not get help as their parents might have to cope with their own problems and lack of knowledge about the system. In addition many children are careful not to share their problems with their parents, as they want to protect them.
The centre is commissioned by the regional health authorities to develop methodologies in assessment and treatment of traumatized and tortured refugees and asylum seekers, to reduce barriers to mental health services and increase accessibility, working with a human-rights perspective. According to Vaage, there is need for such a centre, offering culturally competent psychiatric services with knowledge and awareness concerning the specific challenges meeting asylum seekers and refugees. She has seen examples of misdiagnosis due to lack of competence in cultural awareness, as traumatic experiences or culture all too often become the only explanation for the patient‘s problems. For instance challenges among children suffering from problems related to neuropsychological defects, explained as being due to multilingualism alone, and children suffering from autism being diagnosed as traumatized, with no assessment of other conditions. For all refugees and asylum seekers there is a need for extra awareness and proper assessment, with a focus on cultural factors, migration and refugeedom in order for equal health services to be fulfilled.
The refugee and asylum-children often have combined problems related to traumatization and attachment problems. They may also have additional challenges in that they often have war and war-related experiences, being uprooted from their society and networks of friends and family. Living with traumatized and anxious parents adds to this, and trans-generational transference of trauma is an important problem and focus of discussion. This adds to the problem of attachment. In addition it is necessary to be conscious about the fact that trauma may also be experienced by a person within his or her socio-cultural context. How a person, and a child, reacts and how trauma is perceived is individual and relates to many factors, one of them being the socio-cultural context of the person, both before and after the flight.
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