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Description
The main goal of the project is to introduce the idea of milieu therapy as an integrated rehabilitation service and the idea of milieu therapy homes in Estonia and thus protect the interests of the target group. The target group of the project and the direct beneficiaries are children with severe and permanent mental and behavioral disorders, who have been diagnosed with a mental disorder, as a result of which children are unable to cope with schooling and daily life. The age group of the project is a child aged 12-18.
The target groups of the project are also: a) network members who could be interested in the development of milieu therapy homes or service (local governments, substitute homes, NGOs in the field, school- homes); (b) the local community, which is to be involved in the development of the milieu therapy home in Peedu with the aim to reduce ignorance, unfounded fear and prejudice towards the main target group (children); (c) the NGOs team whose knowledge and competence are being enhanced. During the project, information days, trainings, mutual study trips will be organized, the website of Peedu Milieu Therapy Center will be created and a book on milieu therapy will be translated from Norwegian into Estonian.
Summary of project results
The project was needed because mental health challenges among children in Estonia are becoming increasingly pressing. Studies by the National Institute for Health Development (TAI) estimate that between 20,000 and 40,000 children in Estonia may face psychological issues, with nearly 6,000 new psychiatric diagnoses made in children aged 0–18 in 2018 alone. Long-term forecasts suggest that the number of children with mental health problems is likely to continue rising.
While these figures are not higher than in other EU countries, those countries have had more developed and integrated support systems in place for years. In Estonia, however, the support system is fragmented across three sectors: education, social rehabilitation, and healthcare. For decades, specialists in Estonia have been advocating for a unified approach that combines these sectors to address children''s needs holistically, but the necessary understanding and action have been insufficient.
Several factors contribute to inequality in accessing services in Estonia, including the fragmented nature of the system, regional disparities, a shortage of qualified specialists, and a lack of appropriate services. For example, existing services for children with severe behavioral issues often fail to meet the needs of children with complex psychological problems who do not fit into special schools and require a combination of healthcare, educational, and social support.
A 2018 analysis by the Praxis Center for Policy Studies highlighted the need to develop therapeutic residential care services that integrate these sectors. Such a service would provide children with the holistic support they need to address their mental health challenges effectively.
In Estonia, the development of community-based mental health services is still in its early stages. However, this approach represents an untapped opportunity to reduce stigma, discrimination, and social exclusion faced by children and youth with mental health issues.
To address this need, the nonprofit organization Oskar Alliku Kodu has started building a therapeutic residential care home and competence center. This initiative envisions creating a community-based model that serves as an ideal society in miniature, helping children in need to safely and gradually reintegrate into society.
The project implemented three main activities aimed at introducing and promoting milieu therapy as an effective treatment approach for children with mental health issues in Estonia:
1. Knowledge Exchange and Training
The team participated in a study trip to Norway to gain deeper insights into mentalization-based milieu therapy, which has proven effective in Scandinavian countries like Sweden, Norway, and Denmark. The visit focused on learning from the Larkollen model in Norway, covering:
- Teamwork and organizational structure.
- Management of therapeutic residential care and daily milieu-therapeutic activities.
- Collaboration with local communities and municipalities.
- Funding models and methods for evaluating the impact of services.
This hands-on experience provided valuable knowledge for developing similar practices in Estonia.
2. Translation of Milieu Therapy Literature
To make milieu therapy more accessible in Estonia, the project translated the Norwegian psychiatrist and psychotherapist’s book “Miljøterapiboken: Mentalisering som holdning og handling (MBT-M)” into Estonian. This practical guide serves as a key resource for professionals working in the field and helps public and nonprofit organizations understand the essence of milieu therapy. The translation allows for broader dissemination of this therapeutic approach and provides actionable guidance for those interested in implementing it.
3. Awareness, Training, and Empowering CSOs
The project conducted introductory training sessions titled “Introduction to Milieu Therapy” for a wide range of professionals and stakeholders across Estonia, including school homes, foster homes, family homes, CSOs, and local government specialists. These sessions covered the basics of milieu therapy, its requirements for staff, and its practical applications. The training successfully expanded the network of partners within Estonia, with 50 specialists participating in total.
In addition, meetings were held with other key stakeholders, including police prefectures, the Mental Health Support Group of the Estonian Parliament, and local government specialists. These discussions helped raise awareness about the potential of milieu therapy and facilitated collaboration across sectors.
Through these activities, the project laid the groundwork for adopting milieu therapy in Estonia, providing knowledge, resources, and connections to make this therapeutic approach more widely available.
The project resulted in notable progress in introducing and promoting milieu therapy in Estonia, enhancing the support system for children with mental health needs. Network members, including specialists from foster homes, school homes, youth homes, and other organizations, gained a deeper understanding of milieu therapy principles. This increased awareness allows them to identify and refer children and families to appropriate services, such as therapeutic residential care and counseling, and to request tailored training for their institutions to implement these principles effectively.
Another key outcome was the development of an introductory training program on milieu therapy, enabling organizations to align their practices with its principles. This training not only helps institutions create a therapeutic environment but also equips their teams with the necessary knowledge to foster a supportive and healing atmosphere.
The translation of a book on milieu therapy by Norwegian specialists into Estonian provides a vital resource for specialists and organizations. The book serves as a practical guide for specialists and organizations, enabling them to understand and apply milieu therapy in their work.
Additionally, the project fostered collaboration with various stakeholders, including government ministries, members of the Estonian Parliament, police prefectures, and local authorities. These meetings created a foundation for the broader implementation of milieu therapy.
The team’s professional development was another significant achievement. Through a study trip to Norway, the team gained valuable insights into milieu therapy practices, organizational structures, and effective collaboration with local communities. The knowledge and skills acquired during this trip reinforced their commitment to lifelong learning and professional growth, ensuring the continued success of the initiative.
Overall, the project has established a strong foundation for the development and implementation of milieu therapy in Estonia. By enhancing awareness, providing training, and fostering collaboration, it has contributed to reducing stigma and improving access to integrated, community-based support for children and families in need.
Summary of bilateral results
The donor country partner for the project was the Larkollen therapeutic residential home in Norway. Larkollen is a Norwegian institution specializing in milieu therapy, which has been operational since 1961. Currently, the facility accommodates 16 adolescents aged 13–18 with mental health disorders, with an average stay of one year. Referrals to Larkollen typically come from child psychiatry clinics. The institution also houses a local school unit on-site. The young people referred to Larkollen often have complex issues, including mental health disorders, challenging family and social relationships, and prolonged absence from school. The team at Larkollen possesses extensive expertise in this field, making them an ideal partner for the project.During the visit to Norway, the project team met with Norwegian clinical psychologist Erik Larsen, known as the "father" of milieu therapy and the author of several books on the subject. Larsen conducted a seminar on the history and development of milieu therapy in Norway and the Nordic countries.The team also visited the eating disorder treatment center "Villa Sult" and the Norwegian Mentalization Institute. Meetings were held with the institute''s director, psychiatrist and author Finn Skårderud, and clinical psychologist Bente Skoglund, who are the authors of the book being translated into Estonian, "The Milieu Therapy Book: Mentalization in Milieu Therapy."Additionally, the group visited the "Heggeli" substitute home, where they met with the management team and familiarized themselves with the milieu therapeutic organizational structure and its three distinct departments: two substitute homes accommodating a total of six children; a department for assessing the caregiving capacity of families; a collaboration unit working with biological parents who have lost custody of their children.Cooperation with Larkollen continues.