Sleeping in a winter snow cave or picking berries in the fall aren’t typically part of mental health and substance abuse recovery programs. But for the Saami in northern Norway, whose culture is deeply tied to the land and sea of the Arctic outdoors, such approaches continue to show signs of success.

The Saami Norwegian National Advisory Unit on Mental Health and Substance Use, or SANKS as it is better known, was born in an effort to help members of the Saami community, who, like other Indigenous peoples across the Arctic, take their lives in disproportionate numbers. In northern Norway, the rate of suicides in the Indigenous Saami community across a 28-year period was 50 percent higher than that seen in Norwegians. Earlier studies had already revealed that each Indigenous Arctic population has its unique problems: Certain subgroups of the Saami – male reindeer herders, for example – are at greater risk of depression and alcoholism than their Saami peers.

Securing Support for Saami

There are estimated to be between 50,000 and 65,000 Saami in Norway, with the core population living above the Arctic Circle. (An exact figure is impossible to come by because Norway – like each of its Nordic neighbors – doesn’t track ethnic identity in its health databases. That means researchers studying Saami suicide rates have had to deduce Saami identity by looking at spoken languages, family histories and other indicators among study participants.) In response to a so-called “suicide cluster” (where a number of suicides in a connected group of people occur in a very short space of time) among young Saami men in the mid-1980s, a small team was established in 1990 to provide psychiatric help to Saami youth. In 2001, additional teams had been brought together to help younger children, families and adults, and SANKS was established.

SANKS “has a national responsibility for securing access to support for mental health and substance abuse issues for the Saami population,” said Gunn Heatta, its director. SANKS has clinics in three locations in Finnmark, the northernmost county of Norway, and team members are also based in other parts of middle and southern Norway. SANKS provides short-term, long-term and acute treatment for mental health, alcohol and substance abuse issues, combined with cultural education, research facilities and support training programs. SANKS receives the majority of its funding from the Finnmark Hospital Trust, the state body responsible for health care in Finnmark.

Lars Helander, a SANKS psychologist working with Saami patients suffering with alcohol abuse issues, said the type of approach advocated in the Western health-care system is traditionally “a top-down process – the patient goes to the doctor and the doctor should have the answers.” Helander believes that’s not suited to the Saami. Historical traumas inflicted on the Saami – the process of assimilation of the Saami traditions into a unified Norwegian culture (known as Norwegianization) – have caused unease between the state and Saami residents. Accordingly, “we have to think in new ways with people who might not have the same trust in the system as fully assimilated citizens. It is important that you bring the people with you in finding the right method in each case and that we don’t stand on different sides and throw balls at one another.”

SANKS has developed a number of its strategies with this principle in mind.

Treatment Away From the Treatment Room

The traditions of Saami culture and economy are based on activities that are anchored in the natural landscapes and resources of the northernmost part of mainland Europe: reindeer husbandry, fishing, hunting and farming. It is no surprise, then, that incorporating exposure to these activities is a staple of SANKS’ treatment strategy. There is a great emphasis on being outside.

A four-week program for families affected by substance abuse and mental health issues involves a number of days spent outdoors undertaking traditional, seasonal activities – berry picking in the fall, sleeping in a lavvu (a traditional, temporary shelter used by the Saami) in summer and ice-fishing in the winter. “It is often the dads that find it easier to really express themselves away from a treatment room,” Heatta said.

Helander mentions an instance where he was struggling to help a reindeer herder, “so we started to walk together every day instead of having our regular appointment at the office. For the Saami, nature is so implicit in the way we live.” And a program for troubled adolescents might involve constructing and then sleeping in a snow cave. “This gives these kids strength,” Heatta said, “the strength to know they can do something and can cope.” Last year, 21 families and more than 1,000 children and adolescents received support. Readmission rates are extremely low: Last year, only 4 percent of adolescents returned to SANKS for further help after their program had finished.

There is also no red tape, or a time-sapping process of referrals for those who wish to receive support from SANKS. Those who need help can just pick up the phone and contact any member of staff. Many staff speak Saami and identify as Saami.

‘The Funding Isn’t Going the Right Way’

The core population of Norwegian Saami lives in the county of Finnmark. Finnmark is larger than Denmark, stretches eastwards beyond Istanbul, and road conditions are often dicey at best in the winter. I asked both Heatta and Helander whether this was a problem in terms of ensuring the right level of support is made available to all who need it. Both politely scoffed: “If everywhere is a long way away, you get used to it,” Helander joked, before making the more serious point that one obstacle for his work is that those struggling with alcohol issues are often sent to the city of Tromsø for rehabilitation and after that period must travel back to Finnmark unaccompanied. The availability of alcohol for purchase at the airport has often dismantled progress all too quickly.

One outcome of the success of SANKS’ strategies has been an increasing number of Saami in both Sweden and Finland turning to SANKS. “The Saami across Scandinavia have confidence in us now,” Heatta said. However, SANKS only receives state support to help Saami based in Norway. There are agreements in place with two counties in Sweden and Finland to cover the cost of treating Saami coming to SANKS from those particular areas, but SANKS must cover the cost of patients coming from elsewhere in Sweden and Finland. A 2017 report by SANKS and the Saami Council on suicide prevention calls for an increased regional approach to the issue.

According to Heatta, the thorniest problem is of a type that has been seen before in the relationship between state and Saami in Norway. SANKS receives most of its funding from the regional state body responsible for health care in the northern part of Norway. “The funding isn’t going the right way,” Heatta said, and those making the decisions at the state level are usually not Saami. “Even in 2017, the Saami can’t decide for themselves.”

This story has been updated to clarify that it was Helander who walked with a reindeer herder.