End of Week 4...

I have now completed week 4 here in Umea

On Monday afternoon, Helena and I visited a community mental health team named “TIPS” which is early intervention for first episode psychosis. This community mental health team are based in a large house in the community. This type of environment seemed to me to be very relaxing and therapeutic and therefore a really interesting use of space. TIPS are often used for various types of therapies including family therapy. The environment was bright and spacious and very “non-clinical”. Most referrals to this team are made by the mental health A&E department as it is crucially important to begin care interventions as soon as possible after first episode psychosis. As it is in a large house, there is also a kitchen which can be used by service-users, garden space, and large sitting rooms for relaxing, as well as other rooms containing space for tables, chairs and flip charts used during therapy. TIPS appeared to be entirely person-centred and recovery-focussed and my visit there was thoroughly worthwhile.

On Tuesday, I spent the day at the mental health A&E department. I spent most of my time with the lead nurse and ward manager, Erik. We spent the day by the phone which is very similar to NHS 24, however, set up specifically for mental health crisis and emergencies. People can also call this line if they simply wish to discuss their concerns with a professional or have a chat. This was a really interesting experience as nothing this specific exists within Scotland, the closest thing is our crisis teams, however, it was really motivating to see mental health and illness dealt with in the exact same way as physical health and illness. This was also a really unique opportunity as I was able to understand more about the process of mental health law here in Sweden as several of the calls we received resulted in communicating with key workers, consultants and the police to ensure the safety of service-users and consequently resulted in the use of “LPT” which is similar to the Mental Health (Care and Treatment) (Scotland) Act.

On Wednesday morning I spent time on the in-patient ward. This in-patient ward is for the care and treatment of people who are addicted to drugs and/or alcohol. As previously mentioned, drug and alcohol addiction are included in Swedish mental health law and therefore in-patient treatment for these illnesses within the mental health care sector are the norm. On the ward I was able to participate in the medicine round including morning meds and vitamin B12 injections. All record keeping here is done on a computer system, including drug Kardex’s. Which seems like a far more convenient and safe way of keeping records.

Wednesday was a half day for Helena and I as it was my birthday! We finished on the ward at 12pm and had lunch; we then went into town to do a bit of shopping! Helena knitted a beautiful scarf for my birthday and gave me some home-made lavender soap. After shopping, we met another friend, Stina and we went for the best sushi I have ever had in my life! It was delicious!

Later, Helena and I went to the airport to pick up my boyfriend, Gavin, who is here to visit for two weeks. Gav brought with him lots of birthday cards and gifts from my family and friends at home, I felt very lucky!

This weekend here in Sweden has been “Mid-Summer Weekend”. Midsummer celebrates the longest day of the year and it’s a very long-standing tradition here. Traditionally it is a fertility celebration of the animals on the land, it is said that at mid-night on mid-summers eve everything comes to life. I spent mid-summer at Stina’s house with Helena, Gav and Stina’s family. Mid-Summer traditions also include a lot of eating and a lot of drinking! We had a BBQ and tried to some Swedish delicacies including different flavours of pickled herring, which we really enjoyed, and shots of “Schnapps” which is Swedish herbal liquor. There is also a traditional song which is sung before drinking the schnapps, it was so great to see and experience a real Swedish tradition. Stina’s house also has a Sauna, which seems to be pretty standard for the Swede’s. Gav and the men spent time in the sauna before eating. Later on we played “Kubb” which is a traditional Swedish game, where you are divided into two teams; the object of the game is to knock over the other team’s wooden blocks, using a wooden baton. By this point, everyone had had a few drinks too so there was a lot of laughs during this and we really enjoyed it! It is also a mid-summer tradition for girls to wear flowers in their hair, and at midnight on mid-summer ever, she is to give the flowers to her one true love, and this will secure their love forever. Helena made me my very own flower arrangement for my hair which I will attach a photograph of. We also had a “may-pole” which is put up for mid-summer and traditional is danced around to celebrate the fertility and “coming alive” of the wildlife and animals. We did not do the dancing around the pole, but it was great to see how this tradition is done. On Saturday we had a pretty lazy day, all exhausted from Fridays celebrations. Mid-summer was without doubt the best day I have had here in Sweden so far!

On Saturday night Gav and I enjoyed a good cycle along the river, I’ll attach a short video.

Beginning of a new working week tomorrow. Will update as and when. Apologies this entry was so long, but it was quite an eventful week!

Photos attached. Julie :)

End of Week 3...

I am now at the end of my third week here in Umeå...

I've had another busy, but brilliant week. On placement this week I began my first appointments with my own patients. It was great to finally get started on this and book future appointments. This is the first time, in a community setting I have had the opportunity to build my own therapeutic relationships which is something I'm really looking forward to. My own patients are happy to communicate with me in English, some of my mentor's patients aren't so confident in this. However, I have also found this to be very valuable: as I am unable to understand their verbal communication, and them mine, I have appreciated this to be a truly unique opportunity in which to build upon my non-verbal communication skills. Not only am I able to authentically assess the service-user's non verbal communication, but I too am able to assess my own non-verbal communication and how this reflects my attitude, skills and practice to the service-user. I have to constantly mindful of my own non-verbal communication to ensure I am reflecting myself well as a mental health practitioner.

I also spent a morning this week on the in-patient ward. As this is where the majority of my experience has been in Scotland, this was a fantastic opportunity to compare practice between the two country's. I only got a snapshot at some of the work done here, but as the weeks continue I will be spending more time on this unit. 

I also had my first visitor from home this week - my lecturer, Lesley. It was really good to see a familiar face and spend time with her on practice. Picture to follow!

Yesterday, Helena took me with her and her friends to a summer party BBQ. Here I met a lot more Swedish people. Helena's friend gave me a tour of her house, which was very unique and typically "Swedish". Out in the middle of no where with plenty of land and loads of space. The homes here are generally a lot bigger than at home, and more open planned. Having green space around your home seems to be important to the Swede's and seems like such a brilliant way to live. Being so close to the city yet feeling a million miles away. After the BBQ, they started several party games. I didn't get involved in this as there were so many people there, but it was great to watch and see how family and friends gatherings here are done. Generally speaking it was different from what I'm used to in Glasgow! I will attach a video of one of the games where balls are placed on the grass, and players must cover there faces with just a small hole to look through and be the first to find the balls. 

After this, we went back to another friend of Helena's and drank some wine and enjoyed good conversation. Here we discussed more about the societal differences between Sweden and Scotland and this proved to be really interesting for me! Just small differences, but that would make a difference to our daily lives. 

I have always admired Scandinavia's social and political policy for example higher taxes, fairer society generally by way of education and welfare. While I still believe this to be true, I have learned that social interaction and way of life here is different from what I am used. Last night's conversations reinforced my life-long love for Scotland, and in particular Glasgow as a friendly, inclusive city where often you can truly be yourself, celebrate your success with people and drown your sorrows with them also. I appreciate even more now how friendly a city Glasgow is. 

Anyway, I can feel myself rambling a bit here and don't want to bore my loyal readers! 

Start of another working week tomorrow and the arrival of my second visitor which I am very excited for!

Julie :)

Quick update

My plan is to update this blog once a week, but I have been finding I forget some stuff and since today was such a good day, I thought I'd do a quick update in case I leave it out at the weekend...

Today I learned a lot more about the Swedish mental health care system and law. This was mainly positive, some negative and some just different... I will begin with the negative so as to finish of a positive note!

The first major difference is the use of physical restraint. Just as in Scotland, physical restraint is always a very last resort and not something any person or health professional would ever like to be involved in. However, what is different here, than in Scotland, is the use of belts and isolation rooms as a form of restraint. This form of restraint must be approved by a specialized doctor, and as I said, as a very last resort. However, even the thought of this kind of restraint has proved to be distressing to me. A person may be kept in an isolation room, for the safety of themselves or others, for up to 8 hours. After 8 hours, a doctor must review the situation carefully, and if he/she decides this restraint is still necessary, it may be continued for a further 8 hours. As for the use of belts - belts may be used to physically restrain a person - a belt around the torso, and one around each ankle and each wrist. A person may be kept in this restraint for up to 4 hours, and then reviewed by a doctor. As I said, I find the thought of this very distressing and very far removed from restraint procedures in Scotland, of which I have fortunately not yet witnessed.

Now on to the "just different" ... here in Sweden dementia care is not under the umbrella of "mental health" instead it is under the umbrella of "geriatric" or "somatic" care. Therefore, mental health nurses generally do not work in the care of people with dementia. Furthermore, there is no such nursing field here as Learning Disability nursing. Instead, learning disabilities come under mental health. And therefore, the care of people who have a learning disability is the responsibility of mental health nurses. These two seemingly small differences actually change a big part of the role of a mental health nurse between Scotland and Sweden.

And finally, what in my own opinion, is a very positive difference. I have been fortunate enough to work, for only short periods of time on placement, with people who are addicted to substances such as drugs and/or alcohol. What has saddened me, however, has been our society's attitude at times, towards such people. Very negative language is often thrown around with a very little insight of a person's circumstances. Furthermore, what has disappointed me is the fact that addiction does not fall under mental health law. In many ways it is still viewed as "an adult choice" of which I, personally, strongly disagree. Here in Sweden, there is a law named "the Care of Alcohol and Drug Abusers (Special Provisions) Act (LVM)" generally called "LVM" I will include a short description of the development of LVM and a link which concisely and shortly describes the act for anyone who is further interested. I feel this law proves the general reputation of Sweden as a socially inclusive country, one in which it's citizens strive to take care of one another. One in which prejudice does not belong. From speaking with Swedish people both in a professional and a social capacity I have been informed that unfortunately, this culture is changing. Social tolerance and compassion is running low. And therefore I am aware this country is not perfect. I am still in love with Scotland and it's fantastic health care system and mental health care system. However, I believe it is good to learn and take form each other what we can.

LVM:

The Swedish Act on ward for substance abusers in certain cases (LVM). In 1980 a new
Social Service Act passed the Swedish Parliament. This law did not contain any legal
foundation for real compulsory interventions. An important aspect of the act was that individual measures should be based on voluntariness and the right of self-determination (SOU 1981:7, p 7). However, the Parliament expressed a strong wish to elucidate the topic of coercion further, and in 1981 the Social Committee presented a proposal for a new bill (LVM) (SOU 1981:7). This proposal was introduced to the Parliament without any mayor changes (Prop 1981/82:8) and passed the Parliament in December 1981 (Rskr 91). According to this act compulsory placing was permitted for 2 months with an opportunity to prolong the stay for another 2 months under certain circumstances.

During this time it was important to motivate the substance abuser to accept further treatment on a voluntary basis. The conditions for compulsory interventions were attached to different kinds of dangers. Firstly, the health condition of the abuser and other kinds of serious dangers to him-/herself related to certain situations (for example risks of accidents or freezing to death). Secondly, possible risks related to the security of his family. The reason for this last condition was, according to the committee, that family members were not properly protected from domestic violence by the Penal Code. Due to loyalty and fear such cases were rarely reported to the police. Since substance abuse often was an important cause of such violence, the committee at the time found it adequate to regulate these kinds of problem in social law (SOU 1981:7).

In 1987 the Social Committee presented a proposition for a revision of the act (SOU 1987:22) that also lead to an extension of the foundation of compulsory intervention. The committee emphasized that the respect for the client as a person should not result in passivity concerning a previous heavy substance abuse. It could not be accepted that the social workers just waited for a client to change his/her motivation for treatment (op.cit. p 245). The Social Service had a duty to initiate an investigation to make sure that the substance abuser was given proper support and help. The co-operation between the Social Service and the police ought to be intensified. As a result of the committee’s proposals the scope of time for compulsory placing was increased from 2 to 6 months. The reason was to give the substance abuser a realistic foundation to fulfil a long-range treatment program. In section 4 the word “can” was replaced by the word “shall”, meaning that compulsory intervention had to be decided if the criteria of the law were fulfilled. The committee also discussed if the protection of the family should comprise an unborn child (foetus), but concluded that such an interpretation was not to be recommended. One main argument was that this might scare the woman away from contacting the relevant public services and thus decrease the chances to help her by voluntary measures.

The revised act was effectuated the first of January 1989. Even though the respect for individual autonomy and integrity (as formulated in the Social Service Act) was emphasized as the founding principle in the care of substance abusers, the decisive factor of the LVM was the need of help related to substance abuse (Norström & Thunved 2001). The act does not request that voluntary treatment have to be tried (and failed) before compulsory interventions may be effectuated. Related to the health-criteria (serious risk of damaging mental or physical health) the committee had added a “social indication” which emphasized the risk of substance abusers to damage their lives more generally (related to work, education and “normal behaviour”). The reason for doing this was to enable the Social Service to intervene at an earlier stage, especially towards young adults.

More info on this link which is short & easy to read! It's a bit more concise too:
http://www.domstol.se/Funktioner/English/Matters/Compulsory-care/Substance-abusers/

Hope this post was too boring for those of you who are not nurses/mental health professionals.
Julie :)

End of Week 2...

Week 2 here in Umea has been a busy one!

I have had a great week on placement continuing in the rehab clinic.This week I met with more service-users and luckily many of them were happy to communicate in English for me. My mentor, Helena and I planned my next seven weeks at the rehab unit and worked with service-users, booking in future appointments which I will lead myself.. I now have 4 of my very own patients here. Helena also talked me through some of the assessment tools they use here which was really interesting. Most of which is similar to in Scotland. 

On Tuesday I met with my clinical supervisor, Genny. Genny took me to the mental health Accident & Emergency unit in the hospital.. This was a very interesting experience for me. Unlike in Scotland, here in Umea, they have a specialized A&E department here for mental health and a different one for physical health. This means that people get specialized help immediately from health professionals who are trained in mental health. Luckily, Genny was able to arrange for me to spend the day there in a couple of weeks time which I am really looking forward to. I am most interested to see how this affects stigma and discrimination of mental illness which I know a lot of people in Scotland face and if it has a significant impact on internalised self-stigma also. This mental health A&E department has expanded in recent years and is now available in 5 city's in Sweden. From what I have seen so far I believe this is a truly excellent, person-centred model of care.

On Friday night Helena took me to one of her friends house for a BBQ. This was a great opportunity to meet more Swedish people and see what socializing in Sweden was like. After the BBQ we then went to a Social Dancing event! This gave me a great insight into Swedish culture. This happens every Friday night  in a barn, in the middle of nowhere, in Northern Sweden. The dance is from 9pm-1am with a half hour break in the middle. A live band plays, it was really busy with ages ranging from about 18-80! There are quite specific steps which Helena and her friends tried to teach me before we left the BBQ. However, a lot of people put their own style on to the traditional dance. It was an experience that was out with my comfort zone as this is not the type of thing I would usually get involved in. But I really enjoyed the experience and learned a lot more about Swedish culture.

Last night I went out clubbing with some Swedish students which was another great opportunity to meet new people and enjoy new experiences.

The weather this weekend has been absolutely gorgeous! So I have spent the day relaxing and enjoying the sun before another working week begins tomorrow.

I have attached a video of the social dancing 

Julie :) 

End of week 1...

I have now completed week 1 of 13 here in Umea!

I am just about getting the hang of things here... 

Umea is designed as much for cyclists/walkers as it is cars, so I have spent a lot of time this weekend travelling on cycle routes to see where I end up... It only takes 10 minutes to get from where i live into the city centre, so of course, I did a bit of shopping there. There's loads of market stalls in town selling all sorts of stuff, i'm not sure if this is the norm or if it's just in place for summer, or maybe the fact that Umea is European Capital of Culture 2014.

On Friday morning I spent time at the ECT department here in Umea. The procedure here is pretty much exactly the same as in Scotland. However, the procedure is carried out and overseen by specialist nurses! and there are less MD professionals present during the procedure. Again, ALL staff were so friendly and welcoming, often switching from speaking Swedish to English purely for my benefit. The lead nurse spent a lot of time teaching me more about the procedure and explaining everything to me. Just like mental health nurses in Scotland, the mental health nurses here too have an excellent sense of humour! I wonder if its a requirement for the job...
We then enjoyed "Fika" and my working day ended about midday.   

On Friday night I went out with a couple of my room mates, (luckily i still had one of the bottles of wine i had bought at the liquor store), we met up with two more of their friends and travelled between different student accomodation as there were a lot of party's going on this weekend! It is was great to spend a bit of time with people my own age too. It's quite surreal experiencing the social scene here...

For a start they don't get taxi's places or walk...everyone cycles, which is a but dodgy after a few. But so fun all the same, especially because where I am is the "land of the midnight sun" during the summer so it's pretty much always light! it gets a little dark between 1am-2.30am and then it brightens right up again. I also found it strange to be in the company of so many people form so many different countries yet everyone communicates in English! I was with a Norwegian, a Swede, a German, and later on a guy from France and a guy from Spain... but everyone communicates in English - i find this really impressive and also i feel soooo lucky to have English as my mother tongue.  

Unfortunately, classes here are now finished, which was the reason for all the party's this weekend! ... so most students, including those I met on Friday are all leaving Umea for the summer!

But starting from tomorrow I will begin full weeks of shifts, and the first of my visitors arrives a week today! 

I'm gonna chill out today and catch up on some reading.

I will update as and when!

Thanks, Julie :)

(ALSO, I saw a REALLY massive dog in town and HAD to take a photo!!! seen below.