“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

Abstract

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.

Clinicians’ assumptions about Sami culture and experience providing mental health services to Indigenous patients in Norway

“…Consequently, clinicians may refrain from reflecting on patients' cultural backgrounds and fail to identify cultural aspects of clinical relevance unless they fit the stereotypical characteristics of Sami culture. In a previous study, clinicians identified patients' Sami language competence only if they observed what they considered typical Sami characteristics, such as speaking Norwegian with a Sami accent, "looked like a Sami" or had a typical Sami name or place of residence, failing to identify Sami-speaking patients from the coast, who therefore did not receive language appropriate mental health care (Dagsvold, Møllersen, & Stordahl, 2016).…”

“…Norwegian language in therapy were discussed in the interviews and the results are presented in other publications resulting from this study (Dagsvold et al 2015(Dagsvold et al , 2016. The interview questions were open-ended and the order flexible.…”

“If you do not birget [manage] then you don’t belong here”: a qualitative focus group study on the cultural meanings of suicide among Indigenous Sámi in arctic Norway

“…For example, Sámi in Norway are entitled to equal mental health care services, but participants maintained that shortcomings in the health system were structural and included lack of language competency, lack of culturally adapted services and prejudiced health care personnel. This is well known, and research has confirmed that Sámi patients are more dissatisfied than the majority population with primary health care [37], that use of Sámi language in the Norwegian health system is complicated (even when language competency is available) [38,39] and that ethnic matching in clienttherapist relations (Sámi-Sámi, Norwegian-Norwegian) might have positive treatment effects in psychiatry [40], implying that cultural competence is beneficial.…”

Exploring why and how encounters with the Norwegian health-care system can be considered culturally unsafe by North Sami-speaking patients and relatives: A qualitative study based on 11 interviews

“…By contrast, one study interviewing four patients from mental healthcare revealed that some clients define being bilingual as a positive factor, because when they could not find words, they sometimes chose to speak Norwegian, especially when describing feelings and emotions in therapy [14]. However, Dagsvold et al [15] also report that clinicians do not know prior to admission if patients are Sami-speaking, and their patients do not identify a need for interpreting in the clinical context. Some do share their needs afterwards and/or to others.…”