BackgroundThe Sami in Norway have a legal right to receive health services adapted to Sami language and culture. This calls for a study of the significance of language choice and cultural norms in Sami patients’ encounters with mental health services.ObjectivesTo explore the significance of language and cultural norms in communication about mental health topics experienced by Sami patients receiving mental health treatment to enhance our understanding of linguistic and cultural adaptation of health services.MethodsData were collected through individual interviews with 4 Sami patients receiving mental health treatment in Northern Norway. A systematic text reduction and a thematic analysis were employed.FindingsTwo themes were identified:(I) Language choice is influenced by language competence, with whom one talks and what one talks about.Bilingualism was a resource and natural part of the participants’ lives, but there were limited possibilities to speak Sami in encounters with health services. A professional working relationship was placed on an equal footing with the possibility to speak Sami.(II) Cultural norms influence what one talks about, in what way and to whom.However, norms could be bypassed, by talking about norm-regulated topics in Norwegian with health providers.ConclusionSami patients’ language choice in different communication situations is influenced by a complexity of social and cultural factors. Sami patients have varying opinions about and preferences for what they can talk about, in which language, in what way and with whom. Bilingualism and knowledge about both Sami and Norwegian culture provide latitude and enhanced possibilities for both patients and the health services. The challenge for the health services is to allow for and safeguard such individual variations within the cultural framework of the patients.

BackgroundThe Indigenous population in Norway, the Sami, have a statutory right to speak and be spoken to in the Sami language when receiving health services. There is, however, limited knowledge about how clinicians deal with this in clinical practice. This study explores how clinicians deal with language-appropriate care with Sami-speaking patients in specialist mental health services.ObjectivesThis study aims to explore how clinicians identify and respond to Sami patients’ language data, as well as how they experience provision of therapy to Sami-speaking patients in outpatient mental health clinics in Sami language administrative districts.MethodData were collected using qualitative method, through individual interviews with 20 therapists working in outpatient mental health clinics serving Sami populations in northern Norway. A thematic analysis inspired by systematic text reduction was employed.FindingsTwo themes were identified: (a) identification of Sami patients’ language data and (b) experiences with provision of therapy to Sami-speaking patients.ConclusionFindings indicate that clinicians are not aware of patients’ language needs prior to admission and that they deal with identification of language data and offer of language-appropriate care ad hoc when patients arrive. Sami-speaking participants reported always offering language choice and found more profound understanding of patients’ experiences when Sami language was used. Whatever language Sami-speaking patients may choose, they are found to switch between languages during therapy. Most non-Sami-speaking participants reported offering Sami-speaking services, but the patients chose to speak Norwegian. However, a few of the participants maintained language awareness and could identify language needs despite a patient's refusal to speak Sami in therapy. Finally, some non-Sami-speaking participants were satisfied if they understood what the patients were saying. They left it to patients to address language problems, only to discover patients’ complaints in retrospect. Consequently, language-appropriate care depends on individual clinicians’ language assessment and offering of language choice.

This qualitative study explores Sami and non-Sami clinicians’ assumptions about Sami culture and their experiences in providing mental health services to Sami patients. The aim is to better understand and improve the ways in which culture is incorporated into mental health services in practice. Semi-structured interviews were conducted with 20 clinicians in mental health outpatient clinics in the northern Sami area in Troms and Finnmark County in Norway. The findings show that clinicians’ conceptualizations of culture influence how they take cultural considerations about their Sami patients into account. To better integrate culture into clinical practice, the cultures of both patient and clinician, as well as of mental health care itself, need to be assessed. Finally, the findings indicate a lack of professional team discussions about the role of Sami culture in clinical practice.

Norgga sámi álbmogis lea lága bokte nannejuvvon riekti oažžut ovttadássásaš dearvvašvuođabálvalusaid mat leat heivehuvvon sihke sin giela ja kultuvrra ektui. Dát doavttergrádaprošeakta lea jearahallamiid bokte guorahallan maid sámi pasieanttat ja terapevttat geain lea iešguđetlágan etnalaš duogáš oaivvildit makkár mearkkašupmi sámegielas ja sámi kultuvrras sáhttá leat ja movt dat sáhttet boahtit ovdan psyhkalaš dearvvašvuođasuodjalusa dikšundilálašvuođain Norgga davvisámi guovllu spesialistadearvvašvuođabálvalusas. Bohtosat čujuhit ahte gielalaš ja kultuvrralaš heiveheapmi lea kompleaksa, ja ahte daid heiveheapmi orru gártan ovttaskas terapevtta duohkai. Terapevttat vásihedje ahte dearvvašvuođainstitušuvnnat dávjá eai kárte pasieanttaid gielladárbbuid ovdal go dikšun álgá. Terapevttat fertejedje ieža identifiseret pasieanttaid giela ja fállat sámegielat bálvalusaid aitto go pasieanttat bohte. Dat attii unnit vejolašvuođa fállat bálvalusa mii lei gielalaččat heivehuvvon. Bohtosat čujuhit ahte guovttegielat pasieanttat ja terapevttat lonohallet sámegiela ja dárogiela gaskkas divššus. Giellaválljemii váikkuhit máŋggabealat sosiála ja kultuvrralaš fáktorat. Váilu diehtu das leatgo váikkuhusat giellalonohallamis dikšuma oktavuođas. Terapevttain geat serve guorahallamii ledje máŋga oaivila das mii sámi kultuvra lea, muhto digaštalle hárve pasieanttaid «kultuvrralaš vásáhusaid» bargoustibiiguin. Moadde terapevtta suokkardedje movt iežas ja/dahje dearvvašvuođasuodjalusa kultuvra sáhttá váikkuhit dasa movt sii ipmirdit sámi pasieanttaid vásáhusaid ja muitalemiid. Sii ohcaledje fágalaš digaštallamiid movt láhččet sámi kultuvrii saji oppalaččat, ja adde ovdamearkan konkrehta pasieanttaáššiid. Bohtosat čujuhit ahte dearvvašvuođainstitušuvnnain lea dárbu systemáhtalaččat kártet pasieanttaid giela ja plánet sámegielat dikšofálaldaga ovdal konsultašuvnna. Bohtosat čujuhit maiddái ahte lea dárbu máhttui movt ja mainna lágiin sáhttá «sámi kultuvrralaš» beliid sajáiduhttet psyhkalaš dearvvašvuođasuodjalusbálvalusaide klinihkalaš relevánta vugiin. Lea dárbu eanet dihtui das movt kollektiiva rivttiid sáhttá ovddidit dearvvašvuođa – ja fuolahusbálvalusan nu ahte váldet vuhtii sámi pasieanttaid individuála dárbbuid.