Visit to Ylinen

Today - I have at last caught up with my blog! My first meeting was at 8am with Hanne and Mikko. This was to look at some more data collection. At last this started to make more sense as I got a better grasp of how the funding system worked. Hanne was responsible for extracting the figures from the various systems to produce the monthly reports which showed where the income from the municipalities was being spent. The report is then presented to the board and it was at this point that I could start to understand it as this is part of our board meetings. Mikko then went into more detail about how they receive their monies and the expenditure showing me the very detailed budgeting and cost breakdowns.

I then met Pirjo back in her office. It was great to see her again and catch up after my days away. Pirjo then drove me to Ylinen to the Care of the mentally disabled hospital of Ylojari.  I then spent time with Liisa, the physiotherapist and Carita, the psychologist. The hospital has 226 residential long-term clients and 22 short-term. There is also an out-patient clinic at Tampere which has over 3,500 patient contacts a year. I discovered that there are two types of nurses - Practical nurses who have done two and a half years of training and Registered nurses who have done a further year. It would seem very similar to our old RGN and EN system.

The clients range from a few months old - and I met the youngest one, a baby of about 6 months to elderly patients in their 80's. The thinking now is that clients should only stay in units like this if they really cannot be maintained in the community and so the site will close and they will move to a new area in 2 years time which will only have 80 long-term residents. There are two schools on the site one which is for the severely disabled and this also has a behavioural unit for excluded children and a vocational school which only has 5 places. The Finnish system does not put mentally disabled people who are convicted of crimes in prison - they come to Ylinen and are placed on one of their secure, locked units. They showed me around the site:

Me in the sauna - note the sexy footwear!

The hydrotherapy room

Some of the equipment in use

I then met with the speech therapist whose aim is to try to help the clients improve their communication skills in a functional way so that they can be understood. She went through several methods that are used including the AAC method - augmentative alternative communication, which can also be used by people with stroke and dementia. She may use signing or Bliss symbols. I liked this system - it is a series of pictograms such as \ means pen, * is a star, and a basic house outline means a house but if a heart is put next to the house it means home. However, this is quite a complex method of communicating which is often only suitable for clients with conditions such as cerebral palsy. The most popular method used is PCS (picture communication symbols) and there are many ways of using this from simple picture cards to electronic recorders and voice software programmes. The most important part of the speech therapist's work has been to ensure that ward staff are on board and continuing these communication methods with the clients. She is also starting to introduce an intensive interactive UK programme developed by Hewitt and Caldwell which is based on reflective behaviour techniques to try to engage the client and enter alongside them in their world by copying the behaviours that they are demonstrating. This establishes a relationship which can then be developed. She is shown below with one of the new t-shirts which had a first pictogram stating (in Finnish) "I am..." and then there are pictures showing different moods.

I then met with the occupational therapist who discussed some of the work that she is starting to take on as she has only been there 3 weeks. She showed me the gym room above and the programme that she had set up for her next client. It was fascinating to learn that many of the wards and support services will be closing now for the summer so she cannot implement many of her treatments until they reopen in 4-5 weeks.

Liisa and Carita then took me round the rest of the site visiting the units or wards. We went to one ward which used the system of Privilege and Stepwise that they had mentioned to me at the start. This focuses on accountability (responsibility for actions), therapy and community spirit. The chart shows the weekly programme which includes all of these elements:

Two of the clients who were young teenage boys wanted to show me their rooms. They were interactive and sociable and enjoyed talking about the chart and the sanction system. It later transpired that they had severe behavioural problems. However, the unit structure helps them to control and manage their own behaviour. The staff also use Aggression Replacement Training which is a cognitive behavioural intervention programme to improve social skill competence, moral reasoning, anger management and reduce aggressive behaviour.

The environment was very peaceful and beautiful as the next pictures show:

one of the units

One of the units focuses on the OIVA model a Finnish process which means Participation through Interaction. It has some links with the intensive interaction theory and each patient has a passport which shows pictures of them when they are happy and what makes them happy and the same for when they are sad and angry. They video tape interactions between staff and clients to recognise what improves or impedes relationships.

We then walked down to the lake where they often have summer events including BBQs:

It was a really interesting afternoon and I was very grateful to my hosts. I think I know far more about current mentally handicapped care in Finland than I do in the UK!

Liisa and Carita

I then had a taxi ride back to Tampere and Pirjo picked me up to go to Tuomas' concert. It was a trumpet concert for his music school held at his day school. The building was very beautiful and I met Pirjo's husband too.

The central hallway and staircase

The impressive glass ceiling

The weather has changed today - it is much cooler and quite overcast. However, it was lovely to sit out in the grounds of the school and listen to young people performing a wide range of trumpet pieces including Brahms, George Michael and Gershwin. Tuomas played "Keltainen lintu" - Yellow bird and his parents were very proud of him.

Pirjo, Tuomas and I then went into Tampere and had a really nice meal and a quick visit to the shops to buy Vilpo a shirt to go with his new suit for his confirmation next month. I then came back and have now, at last, caught up with my blog. Another early start tomorrow so off to bed now!