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28. febrúar 2019 Heilbrigðisráðuneytið

Opening the Gender Blinds - opnunarávarp heilbrigðisráðherra á málþingi um kynjaða heildarsýn á áföll og fíkn

Ávarp Svandísar Svavarsdóttur heilbrigðisráðherra á málþingi Rótarinnar, Rannsóknastofu í jafnréttisfræðum, Alþjóðajafnréttisskólanum og Jafnréttisstofu þar sem fjallað var um kynjaða heildarsýn á áföll og fíkn. Málþingið fór fram á ensku.

Ávarp heilbrigðisráðherra er eftirfarandi: 

Ladies and Gentlemen.

I am delighted and honored to be here with you today.

These are incredibly exciting times. I feel genuinely inspired by the rapid progress in mental health awareness, including increasing awareness of the many nuances of addiction.

The public discussion about mental health and addiction has never been as open and honest as it is now. We are really in a place where there is a momentum in research, practice and public discussion that can propel important breakthroughs in the field. It is my hope that we will indeed continue to open the gender blinds in more ways than just in terms of addiction.

There have been many important developments in the field of mental health and addiction in the past few decades. We now understand that well-being is the cornerstone of our lives and the foundation for our health in general. We want to increase our well-being, as people and as a nation, so that we can develop our talents and use our abilities to the fullest, enjoy actively participating in society in a fulfilling way and so that we are able to successfully tackle life´s inevitable hassles. We are now increasingly highlighting the importance of fostering well-being rather than only intervening when there is a problem present.

Perhaps one of the most significant breakthroughs in improving mental health, on a national and global level, is the realization that mental health is a joint venture that requires the dedicated collaboration and financing of many systems, such as: health care, educational institutions, social services, judicial system and of the people themselves.

The focus on human rights and empowerment is an important step forward for us all. We recognize the malignancy of stigma in addiction and mental health in general and we in order to remedy that we are building bridges to normalize the human condition. It is human to have feelings. We all have feelings. It is human to struggle. It is human to feel empathy and help one another.

Our focus is genuinely more humane, and we are focusing on empowering people on their respective roads to recovery. Ladies and gentlemen, I say roads to recovery, because we now have scientific evidence that there are many roads to recovery. One size does not fit all. The road to recovery is different for each person and largely depends on how severe the problem is, along with other individual needs and preferences. The route is not always a straight line, and setbacks are repeated, and attempts are common. We are human after all. Progress in the long run is what matters.

We understand now that we need to see the whole person and see her from a bio-psycho-social perspective. Addiction is not a dichotomous stigmatizing condition: addict vs. not an addict. Addiction is not a moral failure. Rather, addiction like other mental health conditions functions as a cluster of cognitive, behavioral and physiological symptoms that operate on a spectrum ranging to mild and temporary use of substances to serious and life-threatening conditions.

Clinical guidelines are evidence-based recommendations intended to optimize patient healthcare. and provide integrated care where people live. Clinical guidelines are point out that we need to reach people via a variety of channels, including interdisciplinary patient-centered primary health care. Institutions are indeed needed for the severe cases, but we are gradually understanding that whenever it is possible we are more likely to be successful in preventing and treating substance abuse and addiction if we move our efforts closer to people in their own environment.

Whatever a person´s age, treatment is certainly not “one size fits all.” We now know that we have to take into account the needs of the whole person. We are sons, we are daughters, we are mothers, we are father, we are people with families, responsibilities, hobbies and all sorts of aspirations.  We need to treat the whole person in her environment, not just the addiction, but rather treat all of her health needs, taking into account her developmental stage, cognitive abilities and gender. We need to offer the family support and services as needed. The best treatment programs provide a combination of therapies and other services to meet the needs of the individual patient.

For us to be successful social and health services need to work hand in hand. For children we also need to enlist the assistance and understanding of the educational system. Together we need to support ongoing recovery, strengthen ways to sustain treatment gains and prevent relapse.

Research has shown us that adverse childhood experiences are strongly related to the development and prevalence of a wide range of health problems throughout a person’s lifespan, including those associated with substance misuse. Many adolescents who abuse drugs have a history of physical, emotional, and sexual abuse or other trauma. It is clear that we need to provide trauma-informed care.

The adolescent years are a key window for both substance use and the development of substance use disorders. Brain systems governing emotion and self-inhibition are still maturing, causing teenagers to act on impulse, see new sensations and be easily swayed by their peers -all of which my draw them to take risks such as trying drugs of abuse. Historically the focus with adolescents has tended to be on steering young people clear of drugs before problems arise. But the reality is that different interventions are needed for adolescents at different places along the substance use spectrum. Again, we need to meet people where they are, in their own circumstances.

We recognize that prevention is an integral facet of improving mental health and preventing addiction problems. We have a prevention policy and are working on a strategic plan for it. We have in fact done remarkably well with substance abuse prevention in Iceland, and in recent years we have seen a significant reduction in adolescent use of alcohol and other substances. Although this is good news we realize that we need to do even better.

We are coming to understand the importance of gender difference in the addiction process and treatment effectiveness. Research has shown that women often use drugs differently, respond to drugs differently, and can have unique obstacles to effective treatment as simple as not being able to find child care or being prescribed treatment that has not been adequately tested on women. Also, due to socialization and cultural differences the genders are exposed to different life experiences and may have survived different kinds of trauma -all of which a successful approach to addition prevention and treatment needs to take into account.

Men are more likely than women to use almost all types of illegal drugs and misuse of prescription drugs, and this drug use is more likely to result in emergency department visits or overdose deaths for men than for women. For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women. However, women are just as likely as men to develop a substance use disorder. In addition, women may be more susceptible to craving and relapse, which are key phases of the addiction cycle.

Approximately half of those who are dealing with an addiction problem is also dealing with another concurrent mental health issue. It is crucial that those issues are treated simultaneously as they interact and can have detrimental effects on a person’s prognosis of recovery.

We have been lucky that our island has progressive people with a “can do” attitude and consequently many of our treatment resources have grown from the grassroots. We are immensely thankful for the great work of idealists and progressive organizations. Here in Iceland we have accomplished a lot of good things. But we humbly recognize that we need and can do better. We are taking stock of our resources, our prevention efforts and treatment offers.

If one could say that mental health matters have been marginalized, one could say that addiction matters have been on the marginalized even further.  This stigmatization needs to stop.

We recently launched a project at the Landspítali University Hospital to meet the emergency needs for children and adolescents with substance misuse and addiction problems.

The Ministry of Health and the Ministry of Social Affairs are actively working together to address the needs of children and adolescents with substance misuse and addiction problems.

The Ministry of Health is actively collaborating with other ministries, the municipalities, Non-Governmental Organizations, stakeholders and experts-by-experience towards building better mental health. Our goal is that our nation will be one of the healthiest nations by year 2030.

Iceland recognizes the importance of science and evidence-based policies and innovations. We respect that all people have the right to make their own informed decisions about their health and that they have the right to treatments that have been scientifically proven successful.

These are exciting times for me as the Minister of Health. We are taking important steps toward a healthier future for us all.

We are opening our eyes. We are opening the blinds. We can see a better future.

Thank you for your attention!


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