English Summary

The priority area is mainly based in the Department of Mental Health and Social Science (POS) and is especially connected with the open special field of mental health care. Mental health care is a relatively new collective concept which includes various professions with their respective professional perspectives. The special field is concerned with improving people’s mental health both at individual, group, community and system levels. The work is aimed both at prevention, rehabilitation and treatment. This means that mental health care depends on a multi-disciplinary and cross-sectoral collaboration – and co-operation with user groups and voluntary organisations. The focus for mental health care in the local community is health: therefore the care will be based on knowledge about factors and processes that promote health and social belonging for individuals and groups and about what alleviates mental health disorders (cf. Hummelvoll 2006, Almvik & Borge 2006).

Connection with Hedmark University College’s strategic priorities

This priority area is connected with the public health priority at Campus Elverum. It is to function as an active research field that is highly relevant for continuing education courses on substance abuse, addiction and mental health disorders, for the continuing education course and Master’s Degree programme in mental health care (MMHC) and for the Master’s Degree programme in health promotion and care in the local community (MHPCC). The priority area will enhance competence for the new regional University of Hedmark and Oppland by providing the Master’s Degree programmes and through research and collaboration with our Nordic research partners. Taken all together this activity may contribute to a future doctoral programme in health studies/public health sciences.

Mental health from a public health perspective

Mental health and preventive health care is a national priority area. [1] White Paper (Report to the Storting) “Prescription for a Healthier Norway. Public Health Policy” (16: 2002/03) emphasises preventive mental health care in a broad sense, and the White Paper states that action-oriented research is to be given priority. Generally speaking, focus has shifted from psychiatry to mental health care as a cross-disciplinary and cross-sectoral service in co-operation with users and population through the building of alliances. WHO’s health policy document Health21 (1998) has expressed an overall perspective on mental health care in the local community. The ethical foundation rests on three values: 1) Health as a fundamental human right, 2) equity in health and solidarity in action between and in all countries and their inhabitants, and 3) participation and accountability for individuals, groups, institutions and communities for lasting health promotion. These values are fundamental to the action strategies of mental health care. To ensure the implementation of Health21, four main strategies for action are highlighted:

1. Multi-sectoral strategies to deal with conditions that affect health – such as physical, economical, cultural and gender perspectives.

2. Result-oriented health programmes and investments that stimulate health and clinical care.

3. An integrated family and primary health service that is supported by a flexible and responsive specialist health service.

4. A mobilising health promoting process that involves relevant partners at all levels –homes, schools and workplaces, local communities and national authorities – and that promotes joint decisions, implementation and accountability.

The basic idea of the priority area Mental Health and Society: Knowledge Development in Practice is based on these public health strategies, i.e. to strengthen the awareness of mental health care at all levels through a systematic, research-based development of competence as close to professionals and users as possible. At the same time, the theoretical basis for the priority area is founded on a complex understanding of the concept and phenomenon of society/local community – with special emphasis on the tension between normalisation and empowerment (Askheim 2003) and integration versus marginalisation (Drevdahl 2002, Ramon 2001).

The promotion of mental health necessitates constant attention and efforts to protect mental health throughout people’s lifetimes, especially when it comes to socially underprivileged groups (because poor socio-economic conditions are a risk and vulnerability factor for mental ill-health). Well-planned programmes aimed at living and work environments can help people achieve a perception of coherence, build up and maintain mutually supportive social relationships and master stressful situations and events. The incidence of suicide can be considerably reduced if all health care workers are trained to discover early signs of depression and if adequate treatment is given. Stress in the workplace plays a considerable role with regard to sick leave and premature death related to social status. An improved working environment will mean a healthier labour force, which in turn increases productivity. Unemployment is both a physical and a psychological health risk. But it is not enough to provide work: one must also ensure qualitatively good working conditions.

With regard to injuries caused by violence and accidents, Health21 points especially to the necessity of giving higher priority to conditions related to social integration and belonging. Special attention must be given to the major causes of violence (including family violence) – first and foremost with emphasis on alcohol.

The Science of Public Health is generally concerned with “Studies of how factors in our surroundings affect people’s health and well-being. It is a question of environmental issues, social conditions, factors we can influence ourselves by our lifestyles, but also of the organisation and working methods of the health service” (the Nordic School of Public Health 1993). Public Health Care is the practical implementation of scientific knowledge in public health and may be defined as “the science and art of how disease may be prevented, life prolonged and health promoted through organised social measures”(The Acheson Report 1988). It means reducing the conditions and factors that represent a health risk and strengthening those that contribute to improved health. [2]

Generally speaking there are two ways of understanding how good health can be achieved and how health can be improved and maintained. One is oriented towards the individual and is concerned with the prevention, diagnosis and treatment of disease. This model is connected with the medical model (the prevention model). The other approach is on a group and society level with its main emphasis on health promoting and preventive strategies and on the planning and organisation of efforts to promote changes at society level (the health promotion model). These two ways of dealing with public health issues must be perceived as complementary in the task of improving the health of the population. This means that promoting health and preventing disease are both partial aspects of an understanding of the health concept as a whole. Both models must use varying methods, in addition to including influences and changes in the environment.

Mental health care can also be perceived as an activity that can strengthen individuals, families and local communities so that they become more resistant to the stress that inevitably accompanies everyday life and social life. One cannot remove all risks because these are factors that are an integral part of an active life. On a practical level, work to promote public health requires cross-sectoral collaboration, with the population in general being stimulated to engage themselves in their own health situation and in issues regarding health and well-being in society.

If health promoting and preventive work connected with mental health care in a broad sense is to succeed, one must include mental health components in national health policy programmes, in curricula for health and social care education and training programmes, and in municipal and national health plans.

The basic idea of the priority area and main research design

Basic idea: The professional education programmes have apparent advantages over universities and research institutions when it comes to the “theory-practice question”. This is because they have close connections with the practical field they are training their students to function in. If this advantage is to be exploited, it would obviously be useful to try to find opportunities for combining research and education activities (Stafseng 2001). This could be for example a systematic and binding research collaboration involving the practical field, teachers and students. The potential profit of this kind of collaboration is that knowledge development comes as a result of practical research questions. There could be many spin-off effects: the practical field could get external support to shed light on concrete issues, and the students’ interest for systematic knowledge development through research and development could be aroused. By participating in projects close to their work experience the students would gain insight into the research process – and besides, those taking part as co-researchers would have a practical relationship with concrete research methods. They could constructively help reflect practice through their teacher-assisted in-depth studies. The teachers in their turn will have the opportunity to make research-based teaching more realistic. Besides, co-operative inquiry will be one of several strategies used to realise the requirements of this kind of teaching, while helping to establish the desired collaboration between the training institution and a part of society and working life (cf. Section 2. Changes in The Act Concerning Universities and University Colleges 2001).

Overall research design: The priority area at the Faculty for Health and Sports will continue the same profile of being close to the practical field as the earlier priority area PHIL. Research in proximity to the practical field means developing knowledge about patients/users and staff which is contextual and based on experience as well as context-free research-based knowledge. The latter means helping to make the research-based knowledge accessible so that its potential relevance to the practical field can be tested. Research designs characterised by action-oriented research collaboration , which has previously proved fertile, will be continued in the new priority area. The research design has been inspired by “co-operative inquiry” (Reason & Heron 1986, Reason 1988, 1994) and is founded in humanistic psychology. The approach to knowledge creation is primarily hermeneutic-phenomenological (Hummelvoll 2003).

The research design is based on two main ideas: a) people are considered to be self-determining , i.e. as creators of their own actions and b) an extended perception of knowledge, i.e. propositional knowledge, practical knowledge, presentation knowledge and experiential knowledge. To claim that people are self-determining means that their actions are caused by their intentions, objectives and deliberate choices. It means that they themselves must decisively determine what they do and experience as a result of the research. All the people who are involved are both co-researchers (helping to create ideas, designing/carrying out a project and making conclusions from experiences) and co-subjects (taking part in the enterprise being studied). The core element of co-operative inquiry is a conscious and self-critical movement between experience and reflection (Reason & Heron 1986).

Objectives

The objectives for the priority area “Mental Health and Society: Knowledge Development in Practice” are:

• to maintain and strengthen national top competence in research that involves the users and is close to the practical field
• to develop and carry out research projects that contribute to measures promoting health and preventing ill-health, with especial emphasis on the mental health of children and young people
• to make Hedmark University College and its priority area visible as a central participant in Nordic networks related to mental health research
• to stimulate student participation in research initiated by teachers and contribute to making the teaching research-based
• to contribute to a scientific and professional competence enhancement in the Faculty of Health and Sports, with special emphasis on increasing the percentage of senior academic positions

The basic idea and the objectives should be attempted realised through the current and planned research projects that will be part of the priority area.

Organisation

Steering group: The Management Group of the Faculty of Health and Sports (with the dean acting as leader of the steering group)
Project management: Professor Jan Kåre Hummelvoll and Professor II Bengt G. Eriksson (scientific responsibility) and Assistant Professor Arild Granerud (General Manager) and Head of Department of Mental Health and Social Science Gunvor Volla Stensrud, Hedmark University College, Faculty of Health and Sports (HI).

Reference group
The reference group has approximately three meetings per year. The group is represented in the following manner:
Arild Granerud, General Manager for the priority area, HUC
Jan Nordengen, Rendalen. Mental Health Hedmark
Linda Granlien, Åmot
Bjørn Stensrud, Hedmark and Oppland Hospital, Department of Mental Health Care
Eva Nyhus, Hamar municipality
Arild Ottesen, Åmot municipality
Jo Stuan, HUC, Department of Sports
Ida Eggen, HUC, Department of Nursing

The Association for Families of Psychiatric Patients, Hedmark, will appoint a representative.

Project Forum
This research forum is the priority area’s own meeting place for methodological issues – with a special emphasis on different methods for knowledge development in practice and with a particular focus on action research plans. The priority area’s sub-projects will be presented, examined and discussed in this forum as the projects progress. It is meant to act as a research and professional safety net.

In addition to the priority area’s researchers, the Project Forum will be open for participants from the practical field, user representatives, students (from continuing education courses and Master’s Degree programmes) working as co-researchers in research projects run by teachers, and staff from the Faculty of Health and Sports who are taking part in action research projects (without the topic necessarily being strictly connected with mental health).

Professionals who will take an active part in the priority area
The priority area for the Faculty of Health and Sport is mainly founded in the Department of Mental Health and Social Science (POS). The department’s collective R&D competence has developed well and in POS the R&D qualifications cover specialised fields such as social work, sociology, social anthropology, education, nursing, public health sciences and philosophy. The department has also entered into several agreements on research collaboration with the practical field and with academic institutions that strengthen the department’s research competence.

Central personnel in the priority area are:
Gunvor Volla Stensrud, Head of Department
Jan Kåre Hummelvoll, Professor
Bengt G. Eriksson, Professor II
Gro Beston, co-researcher/user representation (20 % position)
Arild Granerud, Assistant Professor, Doctoral Research Fellow (Department of Nursing)
Ragnfrid Kogstad, Associate Professor
Inger Helen Solheim, Lecturer, Doctoral Research Fellow
Jan Stensland Holte, Lecturer
Randi Jørstad, Lecturer
Ingeir Raukleiv, Lecturer
Bodil Gjestvang, Lecturer
Erik Hoel, Lecturer
Stein Erik Bårdseng, Lecturer
Willy Berger, Lecturer
Anna Ottosen, Associate Professor

Professional personnel from the Department of Sport and the Department of Nursing will be actively involved as the concrete projects are drawn up and presented. To be eligible to take part the research topics must fit in logically with the precise wording of the priority area.

Collaboration partners

Main collaboration partners:
Hedmark and Oppland Hospital, Department for Mental Health Care, Department for The Treatment of Psychoses and Rehabilitation, repr. by R&D Manager Kjell Nordby and Project Co-ordinator Kari Nysveen.

Mental Health Competence, National Resource Centre for Users’ and their Families’ Experiences, Skien, repr. by General Manager Ragnfrid Kogstad. In addition we aim to establish collaboration agreements with one or two municipalities on health promoting mental health care.

External collaboration partners:

Nordic Research Academy in Mental Health, repr. by Senior Lecturer Lars Fredén, Head of Studies, Nordic School of Public Health, Göteborg.
Nordic Research on Social Networks (Norsnet) repr. by Coordinator Mark Steven Hopfenbeck, Gjøvik University College (Hummelvoll is member of the Nordic coordination group).
The University of Karlstad
Vestfold University College, repr. by Associate Professor Anne Lyberg.
Gjøvik University College, repr. by Professor Tor Inge Romøren
Gentofte Psychiatric Centre, Copenhagen, repr. by Research Manager Lene Berring
The University of Växjö, the Southern-Danish University (Kolding Pedagogical Seminar) and Hedmark University College: Work is in progress on organising a Master’s Degree programme in intoxication and addiction. Contact person at the Faculty of Health and Sports /POS: Lecturer Erik Hoel.

Quality assurance procedures

The most important forum for local peer review will be the Project Forum (see above). Each project manager must hand in a report to the general manager before the priority area is to submit its annual report each November. Project managers without doctoral competence will be given research supervision. When it comes to professional and scientific publications, the peer review of the journals will act as a quality assessment.

Utility value

The results from the various sub-projects will be published in the University College’s report series, scientific and professional articles and dissertations. The results will furthermore be mediated through lectures and seminars at the Faculty of Health and Sports and through external presentations at research conferences and workshops.

A lasting focus on action-oriented research collaboration may well contribute to the research strategy being further developed, thus strengthening the clinical profile of the Faculty of Health and Sports when it comes to knowledge creation. Here results from current projects collaborating with the practice field could provide valuable experiences with respect to how the University College can become a major collaboration partner in the region.

By involving students in the priority area’s research activities they may, after having finished their studies, improve their competence in seeing opportunities for knowledge development in the practical field.

Literature

Almvik A. & Borge, L. (2006 ed.). Psykisk helsearbeid i nye sko. (Mental Health Care in New Shoes.)Bergen: Fagbokforlaget.

Askheim O.P.(2003). Fra normalisering til empowerment. Ideologier og praksis i arbeid med funksjonshemmede. (From Normalisation to Empowerment. Ideologies and Practice in Working with People with Disabilities.) Oslo: Gyldendal Akademisk.

Drevdahl D.J. (2002) Home and Border: The Contradictions of Community. Adv Nurs Sci, 24(3): 8-20.

Hummelvoll, J.K. (red. 2003). Kunnskapsdannelse i praksis. Handlingsorientert forskningssamarbeid i akuttpsykiatrien. (Knowledge Creation in Practice. Action Oriented Research Collaboration in Emergency Psychiatry.) Oslo: Universitetsforlaget.

Hummelvoll J.K. (2006). Handlingsorientert forskningssamarbeid - teoretisk begrunnelse og praktiske implikasjoner. (Action-oriented Research Collaboration – Theoretical Reasons and Practical Implications) Norsk Tidsskrift for Sykepleieforskning, 8(1): 17-30.

Ramon, S. (2001). Defining ’community’: meanings and ideologies. In: Thornicroft, G. & Szmukler G. (eds.). Textbook of Community Psychiatry . Oxford: Oxford University Press.

Reason P., Heron J. (1986). Research with people: The paradigm of co-operative experiential inquiry. Person Centered Review, 1: 456-475.

Reason P. (1988). Human Inquiry in Action. London: SAGE Publications.

Reason P. (1994). Three Approaches to Participative Inquiry. Art. i: Denzin N.K., Lincoln Y.S. (eds.). Handbook of Qualitative Research. London: Sage Publications.

Stafseng O. (2001). Kunnskapsteoretiske perspektiver på forholdet mellom profesjonsutdanning og forskning i høgskolesystemet. (Epistemological Perspectives on the Relationship between Professional Education and Research in the University College Sector.) Norsk Pedagogisk Tidsskrift, 2(3): 131-148)

St.meld. nr. 25 (1996/97). Åpenhet og helhet. Om psykiske lidelser og tjenestetilbudene. (White Paper no.2 (1996/97). Openness and Wholeness. About Mental Health Disorders and the Services Offered.)Oslo: Sosial- og helsedepartementet.

St.prp. nr. 63 (1997/98). Opptrappingsplanen for psykisk helse 1999-2006. (Proposal to the Storting 63: 1997/98 Escalation Plan for Mental Health 1999-2006.9 Oslo: Sosial- og helsedepartementet.

St.meld. nr.16 (2002/03). Resept for et sunnere Norge. Folkehelsepolitikken. (White Paper (Report to the Storting) “Prescription for a Healthier Norway. Public Health Policy” (16: 2002/03) ) Oslo: Helsedepartementet.

The Acheson-Report (1988). Public Health in England. The report of the Committee of Inquiry into the future development of the Public Health Function. London: Her Majesty's Stationary Office.

WHO (1998). Health21: an introduction to health for all policy framework for the European Region. Copenhagen: WHO Regional Office for Europe.

[1] Cf. White Paper 25: 1996/97, Proposal to the Storting 63: 1997/98 Escalation Plan for Mental Health 1999-2006.

[2] White Paper 16 (2002-2003) points out that public health care is about making efforts for physical health, including influencing habits and circumstances. But it is also about efforts for mental health, by facilitating feelings and experiences of coping, good self-esteem, human worth, security, respect and being visible.