| 1. |
- Hansson, L, et al.
(författare)
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The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study
- 2003
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 57:1, s. 5-11
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.
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| 2. |
- Andersson, Maria, et al.
(författare)
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Frames for choice and market characteristics - a Swedish case study of community mental health services in change
- 2015
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Ingår i: Nordic Social Work Research. - 2156-857X .- 2156-8588. ; 5:3, s. 227-243
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe and analyse structural frames for choice, as well as characteristics of a free-choice market, implemented in community mental health services in Sweden. Day centres were focused. A case study was conducted. Documents were collected and semi-structured interviews were conducted with twenty-eight agents involved in the implementation process. Content analysis of data showed that users’ freedom of choice was influenced by detailed regulation. Freedom of choice was extended, but it was also substantially reduced. The gain or loss of freedom of choice depended on which aspects of the system were emphasised. Features, which could be interpreted as paternalistic, were once again structurally embedded, despite a system addressing individual freedom of choice. Further, the market did not seem to be adjusted for the average user of community mental health services.
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| 3. |
- Andersson, Maria, et al.
(författare)
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Freedom of choice or cost efficiency? : the implementation of a free-choice market system in community mental health services in Sweden
- 2016
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Ingår i: Scandinavian Journal of Disability Research. - : Stockholm University Press. - 1501-7419 .- 1745-3011. ; 18:2, s. 129-141
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Tidskriftsartikel (refereegranskat)abstract
- This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.
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| 4. |
- Andersson, Maria, 1976-, et al.
(författare)
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The implementation of a Free-choice Market System in Swedish Community Mental Health Services by the Example of Day Centres
- 2014
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Ingår i: Jubilee Congress 50 years WASP World Association of Social Psychiatry, London, November 13-15, 2014..
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Konferensbidrag (refereegranskat)abstract
- Marketization in community mental health services is a new phenomenon and might be the most comprehensive reform in the field since the deinstitutionalisation that occurred during the second half of the twentieth century. Historically, mental health services have been characterized by discipline and paternalistic practices.There has been an absence ofwhat is now, due to the new organizational model based on individual freedom of choice, is to be introduced. The aim of this study was to investigate the implementation of a free-choice market system in community mental health services, using the example of day centres for people with psychiatric disabilities. The study was conducted in a major city that was about to implement a free-choice market system due to a new legislation. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top-down political process. The policy intentions of the new Act were in focus when studying the relation between policy and practice during the implementation process. A majority of the policy intentions of the new Act advocated individual autonomy as the market system’s main purpose, only one intention concerned organizational efficiency. Interview data reflected, however, that financial efficiency dominated the agents’ experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, when managers mainly focused on the market as a resource allocator.
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| 5. |
- Arndtzen, Mats, et al.
(författare)
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To live with a Schizoaffective disorder
- 2022
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : John Wiley & Sons. - 1351-0126 .- 1365-2850. ; 29:1, s. 4-8
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Tidskriftsartikel (refereegranskat)abstract
- This article tells about how it is to live with severe mental illness, but primarily it is a story about how to recover with the help of mental health professionals, friends and medication. The overarching aim is to convey a message of hope. Even great difficulties may be left behind. As a summary, four key points for staff members to reflect on are mentioned: Nurses should often encourage their patients and acknowledge their progress; Nurses should remember that there is hope, for everybody; Nurses should be encouraged to use their creativity when working with patients; If the alliance between nurse and patient is working well in a bilateral sense, nurses should have the opportunity to keep in touch with the patient as long as the patient needs and benefits from it.
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| 6. |
- Bejerholm, Ulrika, et al.
(författare)
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Individual Placement and Support in Sweden-A randomized controlled trial
- 2015
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 69:1, s. 57-66
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. Aims: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. Methods: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. Results: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. Conclusions: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.
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| 7. |
- Bendtsen Kronkvist, Maria, et al.
(författare)
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Service user participation in decision-making : a qualitative study from a services user’s perspective
- 2023
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Ingår i: Journal of Public Mental Health. - : Emerald Group Publishing Limited. - 1746-5729 .- 2042-8731. ; 22:4, s. 157-169
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study is to describe participation in decision-making among service users with severe mental illness.Design/methodology/approach: Service users want to participate in decision-making and in the planning of their care. There are widely known methods, such as shared decision-making, that could be used to facilitate service user participation. Three focus group interviews were conducted with the participation of 14 persons with mental illness and/or substance abuse who were service users at two Swedish Homes for Care and Residence (HVB). Data were analyzed by qualitative content analysis.Findings: Two themes emerged: service users’ involvement in decisions is hampered by the professionals’ approach and adequate information and experience of participation means greater empowerment.Research limitations/implications: Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve the decision process, research on these matters is limited.Practical implications: This study reveals that there is a need of more systematic decisional support, such as shared decision-making, so that service users can be seen as important persons not only in guidelines and policy documents but also in clinical practice.Social implications: The findings indicate that service users do not participate in decisions systematically, although policies, guidelines and laws providing that service users should be offered an active part in decision-making with regard to their care and treatment.Originality/value: Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve their decision process, research on these matters is limited. The findings indicate that service users do not participate in decisions systematically, even though policies, guidelines and laws are in place stipulating that service users should be offered an active part in decision-making with regard to their own care and treatment. The results of this project bring improvement opportunities to light.
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| 8. |
- Bendtsen Kronkvist, Maria, et al.
(författare)
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User participation in decision-making : a qualitative intervention study on mental health professionals’ experiences
- 2022
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Ingår i: Journal of Public Mental Health. - : Emerald Group Publishing Limited. - 1746-5729 .- 2042-8731. ; 21:3, s. 250-261
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study was to describe mental health professionals’ experiences of changes in attitudes towards, and knowledge about, users of mental health-care recovery and decisional participation in clinical practice after an educational intervention.Design/methodology/approach: Users of mental health care want to participate in decisions regarding their own mental health care. Shared decision-making as a method is coherent with recovery orientation in mental health services and results in better-informed patients and fewer conflicts regarding decisions. A qualitative intervention study was designed to evaluate changes in attitudes and knowledge about mental health recovery in Sweden. Nine participants were interviewed, and the data were analysed by content analysis.Findings: Three categories were generated from the analysis: Increased theoretical knowledge, changing attitudes about practical approaches and the significance of social factors in recovery.Originality/value: When shared decision-making is to be implemented in mental health, professionals need to gain knowledge about recovery and need to adopt changed roles as health professionals. Educational interventions therefore seem necessary if such changes are to happen.
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| 9. |
- Bengtsson-Tops, A, et al.
(författare)
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Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: A Nordic multicentre study
- 2005
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 1573-2649 .- 0962-9343. ; 14:1, s. 221-229
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients. Method: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning. Results: The correlation between subjective and interviewer-rated quality of life was moderate (ICC=0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1 of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5 of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network. Conclusion: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected.
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| 10. |
- Björkman, Tommy, et al.
(författare)
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Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial.
- 2002
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 37:4, s. 147-152
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The outcome of less intensive case management services, such as the strengths model, is still inconclusive, which suggests a need for more controlled studies. The aim of the present study was to investigate the outcome of a strengths model of case management service (SCM) compared to standard care. METHODS: Seventy-seven clients with a mental illness and a serious impairment in functioning in social contacts, housing or work situation were randomly allocated to SCM or standard care. Outcome was assessed with regard to use of psychiatric services, changes in symptomatology, psychosocial functioning, social network, needs for care, quality of life and client satisfaction with care. The follow-up period was 36 months. RESULTS: The results showed a greater reduction in needs for care in clients receiving SCM. No differences in clinical or social outcome were shown. Clients receiving SCM also used significantly less days in psychiatric inpatient services and were generally more satisfied with the psychiatric services offered. CONCLUSIONS: SCM failed to improve clinical and social outcome compared to standard care, but was more successful in reducing days spent in hospital, and the clients were also more satisfied with the service compared to standard care.
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