Togetherness in Iceland: a Whole System approach gaining pace

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Togetherness in Iceland: a Whole System approach gaining pace

By Kjartan Valgardsson, Director of Geðverndarfélag Íslands (The Icelandic Mental Health Association), a non-governmental organisation.

Founded by doctors, nurses and social workers more than 70 years ago to enhance and improve knowledge and mental health support, Geðverndarfélag Íslands has been delivering Togetherness training for almost 20 years.

A nationwide ambition

“What began as Foundation Training to a small group of nurses at Iceland University has grown into our ambition to embed Togetherness across municipalities, schools and services, whilst reaching parents directly through accessible online learning. By building shared understanding and connecting the different services around children and families, we are helping to create a standardised, relationship-centred approach to supporting children’s mental health and wellbeing in Iceland.”

Developing a shared language

“There is no direct translation for ‘containment’ in Icelandic, so in translating the Togetherness materials and training we have created our own word, umhygð – a combination of umhyggja and samhygð (caring and empathy), which has become a byword for the Solihull Approach model and Togetherness. In any health setting or school where Togetherness has been deployed, umhygð is known and understood.

The concepts, too, have filtered through. By coincidence, drawing out the visual representation of a ‘full-up’ head in our training was in a violet colour – so this concept has become the phrase, ‘violet head’. Those trained in this fully understand this communication ‘shortcut’ to a bigger idea or feeling – it becomes a known shorthand for professionals, who feel better prepared to facilitate open discussions with parents, support them in their approach to decision-making and offer them a shared language across their welfare services.”

System-wide change

“When we began delivering Togetherness training, we originally focused on delivering the 2 Day Foundation courses to the general professional public, many of whom are funded by their workers’ unions. That is shifting now more to national institutions and municipalities that are funding their employees’ training at scale; generating an income for the charity, and helping to further expand Togetherness. My aim is to create a ‘Solihull City’ in the city of Akureyri in Northern Iceland, setting a precedent for how the Togetherness ideology can effectively support all teams and services working with children through this cross-disciplinary approach.

We have now trained approximately 300-400 professionals, the majority of which are social workers, followed by nurses. The shift in these professionals’ perception of parents and parenting is clear. Anecdotal feedback from many social workers has praised how the training has equipped them to step back and guide, rather than assume or ask closed questions. With this feedback comes a need to conduct qualitative research at scale, especially in school settings, as we begin deploying more and more training to teachers, who often have a very different perspective to other professionals.”

“We began training teachers in a school in Mosfellsbær town, close to Reykjavik, concluding again that the person-centred, relationship-driven approach led to better understanding of children’s behaviour and reactions. We are now embedding this understanding in as many schools as possible across Iceland, delivering the Understanding your pupils’ behaviour course. We’re currently preparing workshops for parents of school-aged children (primary years 1–4). It’s extremely important we reach the parents directly, as information and teaching is crucial to their understanding of childhood behaviour and mental wellbeing. Geðverndarfélag Íslands further expanded its offering with Togetherness in 2024 by funding free access to online learning resources for all residents of Iceland through the Heilsuvera website. Around 250,000 parents, carers and grandparents are able to explore the online learning pathways. Working with the Togetherness team, we have implemented promotion of the tools and services in waiting rooms, reaching parents directly. And of course we have the entire suite of support available on our Heilsuvera website. This push and pull of self-service support and support from welfare systems is how we ensure the population – based across smaller regions, spread out across the country – can access and be supported by the foundations of Togetherness, at every step of their parenting journey.”

From support to prevention

“When I began at Geðverndarfélag Íslands it quickly became clear that in Reykjavík we were behind in comparison to the state provision and its approach to Mental Health. Initially formed in the 1970s, Geðverndarfélag Íslands had traditionally been running specialist Mental Health homes to address the unmet needs of the area. With a new Foundation president, in 2010 we handed the homes over to Reykjavik City and the Health Ministry, who had taken responsibility for patients in the region. Then we radically shifted the Foundation’s mission, with ambitious plans to transform the way we approach and support mental wellbeing in the region and — eventually, we hope — the country. We slowly grew the scope and reach of our Foundation training and our ambition was reinforced when we adopted Togetherness into our strategy and began our partnership in 2019.”

Building for long-term change

“Over the years, we have developed a more disciplined, focused approach to delivering the Solihull Approach model. We initially found that delivering training to a municipality through the 2 Day training alone didn’t necessarily embed the concepts or approach. Without follow up, the concepts are not revisited and ultimately helped to embed within the everyday practice of these professionals. And so we are working with the municipalities to ensure follow-up support from both the charity and their teams, and we offer them consultation from a solely trained nurse on a regular basis. We find this effectively embeds and reinforces the training to become an everyday approach.

As our Whole System approach to Togetherness gathers pace, we are working to increase our research via university partnerships that will measure the long-term impact on children, whilst also lobbying municipalities and healthcare departments to ensure sustained follow-up and funding. Our integrated, ‘Solihull City’ approach is by far the best way to achieve the most for our country’s healthcare and the future wellbeing of children.”