Cooperationon thedevelopment ofpsychiatric healthservicesinArkhangelskoblastemphasizing relational capital and

local ancorageToreSørlie

GrigoryRezvyVeraJashkovich

DepartmentofClinicalMedicineUiTUniversityHospitalofNorthNorway

FinnmarkCountyHospitalArkhangelskOblastPsychoneurologicalDispenser

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Historicalrootsforcooperation

• InterpersonalcooperationintheBarentsregionhashistoricalrootsbacktotheVikingage

• PomortradebetweennorthernNorwayandnorthwesternRussiawasanecessaryandnaturalexchangebetweenneighborsinthenorthfromthe1740suptotheRussianrevolution

• Apidginlanguage,Russo-Norwegian, wasdevelopedtopromotecommunicationandtrade("moja på tvoja“)

• TheredarmyliberatedFinnmark attheendofWorldWarII• Theperiodofthe“ironcurtain”

Mentalhealthandpsychiatryafterperestroika• ThecollapseofSovietUnionledtoincreasingsocialinsecurity,inequalityandunemployment

• Prevalentmentalhealthproblems:highincidenceofdepressivedisorders,suicide,andalcoholdependency

• Strongimpactuponsomaticmorbidity- cardiovasculardiseasesinparticular

• Greatneedtointergratementalhealthservicesinprimaryhealthcareinacountrywerementalhealthcaretraditionallyonlyhasbeenprovidedbyspecializedservices

Projectactivitiesduring20yearsPsychiatrichospital• Developingenvironmental,familyandoccupationaltherapy• Improvedwardatmosphereatincludedwards• Bettercooperationbetweenstaffandmorehorizontalstructures• MaterialrenewalCommunityMentalHealthCentre• Trainingindiagnosticandfamilytherapeutic,andsuicidepreventionskills• StrongerinvolvementinempoweringprimaryhealthcarePrimaryhealthcare• ClosecooperationbetweenspecialistsandGPs(thePomormodelinpsychiatry)allowsforidentificationandtreatmentofmentaldisordersinprimaryhealthcare

ThePomormodelinpsychiatry

• Organizedcompetencenetworks,face-to-faceandbyinformation-communication-technology(ICT),thatgivesprimaryhealthcareprovidersaccesstospecialist’adviceandhelpwhentheyneedit

Inareaswithlonggeographicdistancesbetweenlocalprovidersandavailablespecialists,suchasinArkhangelskandNorthernNorway,theadvantagesofICT-basednetworkingpossibilitiesareincreasing• Systematictrainingofprimaryhealthcareprovidersinpsychiatricdiagnosticsandtreatment

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Central success criteria• Agreementsoninternationalcooperationandfundingonapoliticalandinstitutionallevel

• Projectgoalsinaccordancewithlocalneedsandnationalplansforthedevelopmentofservicesinquestion

• ProjectgroupincludingrepresentativesofinvolvedRussianandNorwegianpartners

• Continuoustranslationforrelationshipbuilding,optimizingunderstandingandcooperation

• Implementation,evaluation,dissemination,andsustainabilityofmeasuresandmodelswithRussianleader- andownership

Agreementsoninternationalcooperationandfundingonapoliticalandinstitutionallevel

• CooperationagreementsbetweencountiesanduniversitiesinNorthernNorwayandAkhangelskfromearly90s

• KirkenesDeclaration1993• HealthcarecooperationUNN- Arkhangelskfromtheearly1990s• Firstformalcooperationagreement1993• FundingviaBarentshealthprogramsince1999

Projectgoalsinaccordancewithlocalneedsandnationalplansfordevelopmentofservices• Projectgoalselaboratedonthebasisoflocalneeds.Appliedmethodsandmodelsareadaptedtolocaltraditionandcontext

• Since 1992theserviceshavegradually developed inthedirection ofEuropeanstandards:decentralizing,strengthening ofsocialpsychiatric approaches,incorporating new treatment methods,andintegrating psychiatry andsomatic medicine

• Primaryhealthcareisbeingstrengthenedandgeneralpractitionerstreatdepressiveandpsychosomaticdisorders,diagnoseseriousmentaldisordersandfollow-upofpsychiatricpatientsafterhavingbeentreatedinthespecializedhealthservices

PartnersProjectgroupincludingrepresentativesofinvolved

RussianandNorwegianpartners

Continuoustranslationforrelationshipbuilding,optimizingunderstandingandcooperation

• Onekeypersonintheprojectisfluentinbothlanguages,knowsbothcultures,andhasextendednetworksinbothcountries

• QualifiedasaspecialistinpsychiatrybothinNorwayandRussiawithaPhDonacomparativestudyofmentalhealthcareinnorthernNorwayandArkhangelsk.Hehasalsobeenacentralteacherandmodel

• Hispresenceinallformalaninformalmeetingsduringtheprojectperiodhasallowedforcontinuousclarificationsofambiguitiesandmisunderstandingsandpromotedmutualtrustandengagement

Implementation,evaluation,dissemination,andsustainabilityofthePomormodelwithRussianleader- andownership• Developmentandevaluationofthemodelinonemodeldistrictwheretheleaderismemberoftheprojectgroup

• TheRussianprojectmanagerisleadingtheAPND,whichisalsothecentralICTguidancecenterforthemunicipalitiesinPomormodel

• Theministryofhealthhasdecidedthatthemodelshallbeimplementedinthewholeoblast

• ExperienceswiththemodelinArkhangelskwillcontributetodevelopmentofmentalhealthcareinothercountiesoftheRussianFederation

Officialinternetsite- http://pomormodelproekt.ru/