A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.

<h4>Background</h4>This article explores mental health services in Norway and their availability for women subjected to female genital mutilation/cutting (FGM/C). The article focus on the system of communication and referrals from the perspective of health workers, and aims to identify b...

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Main Authors: Inger-Lise Lien, Cecilie Knagenhjelm Hertzberg
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2020-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0241194
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spelling doaj-309679f244a545dcb482ea709b39718d2021-03-04T12:25:34ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011511e024119410.1371/journal.pone.0241194A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.Inger-Lise LienCecilie Knagenhjelm Hertzberg<h4>Background</h4>This article explores mental health services in Norway and their availability for women subjected to female genital mutilation/cutting (FGM/C). The article focus on the system of communication and referrals from the perspective of health workers, and aims to identify bottlenecks in the system, what and where they are to be found, and analyze how different mental health services deal with Sub Saharan African (SSA) women in general, but in particular with respect to FGM/C.<h4>Method</h4>The study was conducted in Oslo, Norway, using a qualitative fieldwork research design, with the use of purposeful sampling, and a semi-structural guideline. One hundred interviews were done with general practitioners (GPs), gynecologists, psychologists, psychiatrists, midwives and nurses.<h4>Analysis</h4>A system analysis is applied using socio-cybernetics as a tool to identify the flow of communication and referrals of patients.<h4>Findings</h4>The study shows that borders of subsystems, silencing mechanisms, regulations and "attitudes" of the system can lead to women with SSA background having difficulty getting access to the specialist services. High standards for referral letters, waiting lists, out pushing to the lower levels, insecurities around treatment and deference rules silencing mental health issues during consultancies, have a negative impact on the accessibility of services. Consequences are that mental health problems due to FGM/C are under-investigated, under-referred, and under-treated and a silenced problem within the mental health services for women.<h4>Conclusion</h4>A better integration of subsystems at the specialist level with the GP scheme is necessary, as well as providing competence on FGM/C to the different levels. It is also important to strengthen and integrating the services at the Municipal level and provide information to SSA women about the low threshold services.https://doi.org/10.1371/journal.pone.0241194
collection DOAJ
language English
format Article
sources DOAJ
author Inger-Lise Lien
Cecilie Knagenhjelm Hertzberg
spellingShingle Inger-Lise Lien
Cecilie Knagenhjelm Hertzberg
A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.
PLoS ONE
author_facet Inger-Lise Lien
Cecilie Knagenhjelm Hertzberg
author_sort Inger-Lise Lien
title A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.
title_short A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.
title_full A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.
title_fullStr A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.
title_full_unstemmed A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.
title_sort system analysis of the mental health services in norway and its availability to women with female genital mutilation.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2020-01-01
description <h4>Background</h4>This article explores mental health services in Norway and their availability for women subjected to female genital mutilation/cutting (FGM/C). The article focus on the system of communication and referrals from the perspective of health workers, and aims to identify bottlenecks in the system, what and where they are to be found, and analyze how different mental health services deal with Sub Saharan African (SSA) women in general, but in particular with respect to FGM/C.<h4>Method</h4>The study was conducted in Oslo, Norway, using a qualitative fieldwork research design, with the use of purposeful sampling, and a semi-structural guideline. One hundred interviews were done with general practitioners (GPs), gynecologists, psychologists, psychiatrists, midwives and nurses.<h4>Analysis</h4>A system analysis is applied using socio-cybernetics as a tool to identify the flow of communication and referrals of patients.<h4>Findings</h4>The study shows that borders of subsystems, silencing mechanisms, regulations and "attitudes" of the system can lead to women with SSA background having difficulty getting access to the specialist services. High standards for referral letters, waiting lists, out pushing to the lower levels, insecurities around treatment and deference rules silencing mental health issues during consultancies, have a negative impact on the accessibility of services. Consequences are that mental health problems due to FGM/C are under-investigated, under-referred, and under-treated and a silenced problem within the mental health services for women.<h4>Conclusion</h4>A better integration of subsystems at the specialist level with the GP scheme is necessary, as well as providing competence on FGM/C to the different levels. It is also important to strengthen and integrating the services at the Municipal level and provide information to SSA women about the low threshold services.
url https://doi.org/10.1371/journal.pone.0241194
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