| 1. |
- 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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| 2. |
- Bergmark, Magnus, 1975-, et al.
(författare)
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Policy Changes in Community Mental Health : Interventions and Strategies Used in Sweden over 20 Years
- 2017
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Ingår i: Social Policy & Administration. - : John Wiley & Sons. - 0144-5596 .- 1467-9515. ; 51:1, s. 95-113
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Tidskriftsartikel (refereegranskat)abstract
- The deinstitutionalization of mental health care has changed the responsibilities of involved authoritiesand has led to a continuous need for new treatment forms and interventions. This articledescribes this development in Europe, and in particular how these new conditions have been handledin Sweden over the past 20 years at the level of governmental policy-making. Three major policydocuments from 1994, 2009 and 2012 were included in this study. To increase our understandingof the policies’ contents, we have used theoretical concepts concerning governance,implementation and political risk management. Although our main interest was to find out howthe government handles interventions for users of the mental health care system, we found that thepolicy work is progressing stepwise. The first document, from the deinstitutionalization era, did notdiscuss interventions clearly. Instead, it was mainly concerned with both practical and economicalareas of responsibility. The second document, from the post-deinstitutionalization era, was morefocused on what services should be delivered to the users, while the most recently published documentto a greater extent addressed the question of how the support is supposed to be designed. The trendin European community mental health policy has been to advocate services in open forms that areintegrated into the society’s other care systems. This is also the case in Sweden, and continuous workis being done by the government to find strategies to support the development, and to meet the needs atboth political and local levels.
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| 3. |
- Eklund, Mona, et al.
(författare)
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Outcomes of a freedom of choice reform in community mental health day center services
- 2015
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Ingår i: Administration and Policy in Mental Health. - New York : Springer Science+Business Media B.V.. - 0894-587X .- 1573-3289. ; 42:6, s. 664-671
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Tidskriftsartikel (refereegranskat)abstract
- A freedom-of-choice reform within mentalhealth day center services was evaluated. The reformaimed to (1) facilitate users’ change between units and (2)increase the availability of service providers. Seventy-eightusers responded to questionnaires about the reform,empowerment, social network, engagement and satisfactionand were followed-up after 15 months. Fifty-fourpercent knew about the reform. A majority stated thereform meant nothing to them; *25 % had a negative and*20 % a positive opinion. Satisfaction with the serviceshad decreased after 15 months. Empowerment decreasedfor a more intensively followed subgroup. No positiveconsequences of the reform could thus be discerned.
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| 4. |
- Fjellfeldt, Maria, et al.
(författare)
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Implementation of choice from participants' perspectives : a study of community mental healthcare reform in Sweden
- 2016
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Ingår i: Journal of Social Work in Disability & Rehabilitation. - : Taylor & Francis Group. - 1536-710X .- 1536-7118. ; 15:2, s. 116-133
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.
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| 5. |
- Hansson, Lars, et al.
(författare)
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The effectiveness of an anti-stigma intervention in a basic police officer training programme : a controlled study
- 2014
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Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 14, s. 55-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stigma and discrimination are still prominent features of the life situation of persons with mental illness, adding to the burden of the illness, causing a lowered self-esteem, quality of life and affecting possibilities of adequate housing and work. It is also a major barrier to help seeking. The deinstitutionalization of mental health services has led to a significant increase in contacts between the police and persons with mental illness. It has been argued that police officers should be provided education and training to enable them to interact adaptively and with good outcomes with people with mental illness. The present study is investigating the effectiveness of an anti-stigma intervention in a basic police officer training programme at a university in Sweden. Methods: The study was performed as a controlled pre-post intervention study using a comparison group, and a 6-month follow-up of the intervention group. Attitudes, mental health literacy and intentional behaviour were assessed. Main analyses were made on an intention to treat basis using repeated measures ANOVA. A total of 120 participants at a basic police officer training programme were included. Results: Time by group analyses showed improvements in the intervention group in overall score of attitudes and regarding the subscale Open minded and pro integration, in intentional behaviour (willingness to work with) and in 4 out of 6 items assessing mental health literacy. At the 6-month follow-up the intervention group had, as compared to baseline, improved attitudes in both overall score and in two of the subscales. Intentional behaviour had also improved in terms of an increased willingness to live or work with a person with mental health problems. Mental health literacy had improved in 3 out of 6 items. Conclusions: The anti-stigma intervention proved to be effective in changing attitudes, mental health literacy and intentional behaviour. Improvements mainly endured at the 6-month follow-up. The intervention seems promising in facilitating encounters between the police and persons with mental illness. Further studies are needed to disentangle the relative effectiveness of the components of the intervention before further implementation.
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| 6. |
- Hultqvist, Jenny, et al.
(författare)
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Programme characteristics and everyday occupations in day centres and clubhouses in Sweden
- 2017
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 24:3, s. 197-207
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Tidskriftsartikel (refereegranskat)abstract
- Background: Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features. Objective: This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored. Methods: Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments. Results: DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time. Discussion: Clubhouses seemed more advantageous and DC services may consider developing users' opportunities for choice and decision-making, and peer support.
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| 7. |
- Hultqvist, Jenny, et al.
(författare)
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Social networks and social interaction among people with psychiatric disabilities : comparison of users of day centres and clubhouses
- 2017
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Ingår i: Global Journal of Health Science. - : Canadian Center of Science and Education. - 1916-9736 .- 1916-9744. ; 9:6, s. 107-120
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to compare users of community-based mental health day centres (DCs) and clubhouses in Sweden regarding reported social networks and social interaction and the stability of these over time. A further aim was to investigate social network predictors both cross-sectionally and longitudinally. METHODS: People regularly attending DCs (n=128) or clubhouses (n=57) completed questionnaires about social network and social interaction (social engagement and social functioning), self-esteem and socio-demographics at baseline and a nine-month follow-up. RESULTS: Perceived social engagement and social functioning did not differ between the groups and remained stable over time. Fewer in the DC reported having a close friend but there was no difference regarding having recently (the past week) seen a friend. When naming "someone with whom you can share your innermost thoughts and feelings", the DC group named more professional contacts, fewer friends and more often "nobody" compared to the clubhouse group. Finally, on both occasions the DC group scored significantly lower on size of the social network compared to the clubhouse users. Self-esteem and having recently seen a friend could predict size of the social network in the cross-sectional perspective. Strong indicators of belonging to the group with a larger social network at follow-up were being a woman, attending a clubhouse programme and having scored high on social network at baseline. CONCLUSION & IMPLICATION FOR PRACTICE: Having friends and strengthening one’s self-esteem may be essential factors for the social network of people with psychiatric disabilities in a short-term perspective. Visiting clubhouses seems advantageous in a longer-term perspective.
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| 8. |
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| 9. |
- Johanson, Suzanne, et al.
(författare)
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Enabling the return-to-work process among people with affective disorders : a multiple-case study
- 2019
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 26:3, s. 205-218
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.Methods: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.Results: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.Conclusion: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.
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| 10. |
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