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.

BackgroundIn recent decades many indigenous communities, policy makers and researchers worldwide have criticized the academic community for not being aware of the specific challenges these communities have faced and still are facing with regard to research. One result of the decades of discourse in indigenous communities is the development in many Western countries of indigenously sensitive ethical research guidelines. In 1997 the Sami Parliament (SP) in Norway reached a unanimous decision that ethical guidelines for Sami research had to be drawn up. Such guidelines are however still to be created.ObjectivesThe objectives of this article are to enquire into what happened to the Norwegian SP's decision of 1997 and to reflect on why the issue seems to have disappeared from the SP's agenda. Finally, we consider whether research ethics is to be a subject for the research community only.MethodsA review of parliamentary white papers on research and SP documents relating to research ethics.FindingsThe response to the SP's decision in 1997 took place in two different channels, both of them national, namely the research ethics channel and the political channel. Thus, there were actually two parallel processes taking place. In spite of nearly two decades of reports, the concept of the participation of indigenous communities in research is still not an integral part of Norwegian ethical guidelines.ConclusionsThe issue of indigenously sensitive research ethics seems to have disappeared from the SP's agenda and the research ethics review system with regard to Sami research is with minor adjustments the same as when the SP asked for a revision.

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.

We explored the effects of ethnicity on mental health treatment in the population of North Norway that largely consists of indigenous Sami and non-Sami Norwegians. As the two groups are comparable in their socio-economics, ethnic effects can be separated from their most common confounders. The effect of client and therapist ethnicity and client-therapist ethnic match on treatment was examined among psychiatric outpatients in this setting. Client (n=335) and therapist (n=33) demographics and ethnicity were recorded prior to intake. Self-reported psychosocial distress was recorded at intake, termination and 20-month follow-up. Therapists reported their clinical assessment, treatment delivery at intake and discharge. The results indicated that therapist ethnicity was associated with the amount and type of service provided but improvement was not. Both the delivery of treatment and improvement did not differ significantly by client ethnicity. Ethnic matching was associated with greater symptomatic improvement in treatments of moderate duration.