Health in Sweden

Helsinki, Feburary 7th 2017

”Hälsa i Sverige för asylsökande och nyanlända” [SWE]. Uppdrag Psykisk Hälsa, SALAR

Improving mental health of asylum seekers and new arrivals in Sweden*

The Swedish Associations of Local Authorities and Regions (SALAR)

SALAR represents Sweden’s: 290 municipalities 20 county councils/regions We act as an employer’s

organisation, and defend and promote the interests of our members.

Background The process Health in Sweden - National

implemenation Outcome

Schedule

Largest number of people of displaced people since WWII

Photo source: http://www.dailymail.co.uk/news/article-2304980/Images-war-A-child-wanders-amid-rubble-dust-town-called-home-looks-like-film-set-apocalyptic-future.html (17-01-16 11:31)

Asylum applicants in the EU 2005-2015 (Thousands)

Source: http://www.migrationsinfo.se/migration/eu/asylsokande-i-eu/

http://www.unhcr.org/576408cd7.pdf

http://www.unhcr.org/576408cd7.pdf

Asylum seekers in Sweden

163 000

Humanitarian causesMultiple stresses of migrationPoor mental health1

Economically (Samhällsekonomiskt lönsamt) Ill health interferes with integration Strain on public systems Potential to benefit Sweden

1) Socialstyrelsen. Psykisk ohälsa hos asylsökande och nyanlända migranter - Ettkunskapsunderlag för primärvården. Socialstyrelsen, Artikelnummer 2015-1-19

Motivation to act on mental health?

Background The process

- SALAR applied to the Ministry of Health and Social Affairs to do a preporatory study

Health in Sweden - National implementation

Outcome

Schedule

PurposeImproving the immigration process (in terms of health care). To increase mental health and to reduce suffering among asulym seekers and newly arrived

Preporatory studyOctober 2015 – March 2016

KNOWN CHALLENGES MEANS TO CHANGE Identify ill health Health Exams

More (baseline 43 percent) Better (incl. mental health)

Better interventions Competence to identify, cultural sensitivity, self-care, trauma care

Sharing best practice, planning & follow-up

Online tool sharing, easy access.Data management tool.

Health promotion Information on how to access Swedish healthcare.Education about reactions to migration & self care

management/personnel

asylumseekers/newly arrived

How?Preporatory study

October 2015 – March 2016

1. Identification of good practice (tools and methods)

Tool enhancement together with national experts

Live test in a ”pilot County”

Products ‘tried and tested’ for nation wide dissemination

StepsFrom good examples to nation wide dissemination

2.

3.4.

Preporatory studyOctober 2015 – March 2016

Severe mental illness

Mild to moderate mental illness

Health promotion & prevention

Telephone-/video support

Health Group Group Session Guide

Basic education Migration & mental health

Health Screening

Health information Adapted for

language/culture

Basic education of specialists

Online self-care advice (in progress)

End ”Products”Digital tool for

planning/follow-

up Online sharing of best practice

Preporatory studyOctober 2015 – March 2016

Example Materials for personell that perform Health Screenings

Model for improved process

Picture based information/invitation

Questionnaire (template)

Preporatory studyOctober 2015 – March 2016

ExampleAids for personell to manage support groups

1. Screening questions

4. Diploma template (for participants)

2. Template to introduce offer

3. Session guide (preparations, topics, movies)

Preporatory studyOctober 2015 – March 2016

ExampleInformation films for asylum seekers Topics

• Health effects of migration• Trauma and stress• The Swedish healthcare system• Sleep, excercise & nutrition• Alcohol and narcotics

Languages • Swedish• English• Arabic• Somali• Tigrinja• Dari

Preporatory studyOctober 2015 – March 2016

17

Online tool for sharing good examples - 89 so far

6

15

74

Severe

Mild to moderate

Health promotion

& Prevention

Preporatory studyOctober 2015 – March 2016

Background The process Health in Sweden - National

implementation Outcome

Schedule

2016 – Health in Sweden For asylum seekers and newly arrived

GoalImplementation i all regions 2016 (30 million SEK in June)

MethodTrain trainers to reach all personel with tools and knowledge

Program plan (Timeline)1. Needs assessment

Per county. SALAR supports with- Local Coordinator - Digital form (webb)- Analysis- Pairing needs with national education offer

2. Planning County commitment and reimbursement - Comprehensive plan for for local dissemination (WHO, WHAT, WHERE, WHEN)

3. Dissemination of knowledge and skills

Training trainersa) National educationb) Local educationc) Follow up (target completion rates

according to plan)

21

20 of 21 counties analyzed the need for better ways to aid asylum seekers and new arrivals  

17 counties gathered in total 310 webbforms from different services.

3 counties did indepentent analyses.

1 county is planning to a needs assesment.

Counties that undertood a needs assesment.

In cooperation with SALAR

Independently

Planning to

Assement reveals big needs over all

Källa: Behovsanalyser i 17 landsting/regioner genomförda via webbformulär under aug-okt 2016 * Genomsnittlig andel som uttryckte ett behov i de 17 landstingen/regionerna

Severe mental illness

Average percentage of reported need*

• Materials and metods to give health information • Materials and methods to conduct health exams• Offer promotive and preventive care• Educate personel on migration and effects om mental health 78%

• Offer services• Educate personel• Guidance to personel (tutoring)

75%31% 63%

62% 66% 60%

• Offer services• Educate personel• Guidance to personel (tutoring)

47% 66% 60%

Health promotion/prevention

Mild to moderate mental illness

23

Courses and materialsDaycourses for trainers + materials

Severe mental illness

Mild to moderate mental illness

Health promotion & Prevention

Basic knowledge about Trauma Lifespan Integration (Treatment method)* Migration and mental health – for psychiatrists

To give health information + health support in group Basic knowledge about Trauma Lifespan Integration (Treatment method)* Migration and mental health – for Primary Care Migration and mental health – for School Health Services Managing group support and transformation

What the entire organization should know! To give health information + health support in group Orientation skills for unaccompanied minors New arrivals as a resource Improved metods for health exams Migration and mental health – basic knowledge

*Not in train the trainer concept

”Products”, tools

- For trainers

- For professionals

- For asylumseekers

For trainers

Outlay of courses• Theory• Tools• Discussion on implementation

Ex. materials for training others• Manual• Presentation (slides, movies)

Background The process Health in Sweden - National

implementation Outcome

Schedule

Fall/winter daycourses have been given 23 times with 1000 participants in total

14 different daycourses (8 on multiple occations) 1000 participants 2016, 500 spring 2017 Ca 88% of participants from counties, others from

municipalities or governmental agencies (ex employment office).

55% of participants are explicitly commited to training others.

Average appreciation of cources: 4,17 out of 5

1000 participants

If every other participant trains 5 collegues the program will have reached 3750 persons!

attended national daycources

more have signed up for spring courses…

~1000

~500

=~1500 trained personnel

9 counties affiliated with national tool for monitoring and planning health care services for asylum seekers 

Affiliated

InterestedConnecting in feb-17

Turned down offer

Affiliated counties

Report (+eng version) 28 feb 2017

Many challenges remain…