Psychiatry and shopping

I've just remembered I said I would put the education slide in:

This took ages to put in with Helen talking me through how to change it to a JPEG file! I now realise it is probably far too small to read but you may be able to get the gist of it!! (just made it bigger so that should help - in case anyone is interested!).

Back to today - I met with Marja who is the hospital ombudsman. She was really interesting and we got on very well. Her job  is to manage all the complaints. This is a role that is supported by the government and she is independent of the hospital so that she can be truly independent. It would seem that people in Finland are very aware of their rights and so she is very busy. The most common complaints are around clinical errors; poor communication and rude behaviour. We had a very interesting discussion around the use of volunteers as there was an article in the newspaper about this - at the moment there are people waiting several months to have a volunteer as there are few people offering their services. When i got back to her office, I mentioned this to Pirjo and she had also been following up this theme after my experience at the hospice and has arranged for me to visit "Granny's Corner" in my last week. It is a centre of voluntary elderly work in Tampere and a drop-in centre open to people of all ages so this will be really interesting to see. Yet again Pirjo had anticipated my needs and was already sorting it! She really is an amazing host and she should get a prize for being the best host! 

I then met with one of the data collectors - she tried hard to enthuse me about data! It was interesting to see the variety of data that they collect and collate linking together many different IT systems. We then talked about her coming leave - she has only taken 15 days annual leave for the past 10 years and so now has saved 100 days and will be taking it all in September to spend some time with her grandson.

My next visit was to the children's psychiatric unit. On my arrival I found that Kaija had been asked by her boss to present at a conference so I was going with her to this. Kaija told me that she did not have a very good sense of direction and she soon admitted she had taken the wrong road. It was very pleasant driving around the suburbs of Tampere until we eventually found the UKK Instituutti where she was presenting! During this time she told me so much about her work. I think I now know far more about child psychiatry in Finland than I have ever known about the English system! There is a very comprehensive screening programme for babies and children to detect any early concerns. These can then be followed up in the health centres, family guidance clinics (if the municipality has this service) or for the most severe by referral to the psychiatric unit. The child psychiatry unit at the hospital is based in the same department as maternity to try to remove some of the stigma and fear. 

It is recognised that many of the problems are due to parenting and so work begins during pregnancy now both with mother and the father. They use a tool - "The Canadian Waiting list" to identify problems and then start some early work to manage problems at this stage. One of the key questions that they ask the child and the parents in the early ages is "Do you think there are any concerns?" This simple statement often helps to uncover many issues and worries. The conference had been organised by the leader of one of the municipalities to look at how they can implement the government legislation to integrate health and social care. Kaija's boos presented how this can occur in child psychiatry - using the Canadian tool and ensuring that they use a case management approach so that there is only one key worker who can then build a trusting relationship with the child and family throughout their care. It was very interesting for me to see case management being used in a different field. They recognise that they need to build treatment chains or pathways to ensure that everyone is aware of their responsibilities.She warned that they are not seeing all the children who should be referred partly because they are not referred, often their is a reticence to refer. Often there is a delay in starting treatment so problems are more severe, she advocated starting treatment before a diagnosis had been agreed. 

Up until this point Kaija had been translating for me. She then gave her presentation and as she said "Penny this is where I leave you!" I did start to recognise a few word including "Lastenpsykiatrian" - child psychiatry but I didn't have much more of a clue. I knew what she was speaking on as this was what we had been discussing in the car. However, it is not really possible to guess at words or phrases to I resorted to looking to see which letters were in the English alphabet that did not seem to appear in the Finnish - I decided q w x z and c only occurs very infrequently!!!

Kaija's colleague from adolescent psychiatry then presented. It in interesting that they have a separate adolescent unit. It used to have quite fluid movement between child and psychiatry but Kaija commented that this has unfortunately become more rigid with the introduction of waiting time targets. I was interested to learn that under the Finnish legal system adolescents are treated more leniently until they are 29 years old. Her colleague spoke extremely fast and her speech sounded like a machine-gun! I did feel after these presentations though that mine yesterday was probably what the Finnish were expecting - traditional talked through power points! 

Later in the afternoon I went into town. I walked back to the library and this time the Moominvalley museum was open. Tove Jansson who wrote the Moomin books was Finnish and this has many of the original writings, drawings and models. I could not take any photos but for those of you unfamiliar with this children's author here are the Moomins:

I then took the chance to photograph the library and the church which I struggled to do last week due to my camera

The library (the wood-grouse) which houses the museum

The neo-gothic Alexander church with the fountain sculpture "Spring"

I then found the souvenir shop and got a few "Finnish" souvenirs! Then I met up with Chris and took her to the shopping centre and then the department store where we both bought some tinned and packaged reindeer meat - so Heather, you will be able to try reindeer, although I suspect Cally (our cat) may well get the tinned variety! We then went back to the French market and bought a roll and drink from the bar and enjoyed the hot summer's evening.