Background
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.
Method
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.
Analysis
A system analysis is applied using socio-cybernetics as a tool to identify the flow of communication and referrals of patients.
Findings
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.
Conclusion
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.