RESUMEN
BACKGROUND: Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions. METHODS: Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009-2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership. RESULTS: The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors. CONCLUSIONS: This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.
Asunto(s)
Trastornos Mentales , Humanos , Trastornos Mentales/terapia , Trastornos Mentales/psicología , Psiquiatría Forense/métodos , Análisis de Clases Latentes , Cuidados Posteriores , Alta del Paciente , Pacientes AmbulatoriosRESUMEN
Compulsory community care (CCC) was introduced in Sweden in 2008. This article investigates all written court decisions regarding CCC over a 6 month period in 2009 (N=541). The purpose is to examine how the legal rights of patients are protected and what forms of social control patients are subjected to. 51% of CCC patients are women and 84% are being treated for a psychosis-related disorder. In the court decisions, only 9% of patients are described as dangerous to themselves, while 18% are regarded a danger to others. The most common special provisions that patients are subjected to are medication (79%) and a requirement that they must maintain contact with either community mental health services (51%) or social services (27%). In the decisions, both the courts and court-appointed psychiatrists agree with treating psychiatrists in 99% of cases. Decisions lack transparency and clarity, and it is often impossible to understand the conclusions of the courts. There is considerable variation between regional courts as regards the provisions to which patients are subjected and the delegation of decision-making to psychiatrists. This means that decisions fail to demonstrate clarity, transparency, consistency and impartiality, and thus fail to meet established standards of procedural fairness. Surveillance techniques of social control are more common than techniques based on therapy or sanctions. Because of the unique role of medication, social control is primarily imposed on a physical dimension, as opposed to temporal and spatial forms. The article concludes that patients are at risk of being subjected to new forms of social control of an unclear nature without proper legal protection.
Asunto(s)
Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Servicios Comunitarios de Salud Mental/legislación & jurisprudencia , Programas Obligatorios/legislación & jurisprudencia , Trastornos Mentales/terapia , Enfermos Mentales/legislación & jurisprudencia , Conducta Peligrosa , Bases de Datos Factuales , Femenino , Humanos , Masculino , Derechos del Paciente/legislación & jurisprudencia , Control Social Formal , Justicia Social/legislación & jurisprudencia , SueciaRESUMEN
As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim with this study was to understand how participants made sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of "rediscovering agency," referring to occupational and identity transformations. A parallel outcome study has shown positive results for participants, and by using narrative inquiry we contribute with a deeper understanding of the meaning making of their transformations and mechanisms of the intervention; i.e., hope, extended value of reaching goals, reentering the majority world, transparency of process, and attunement to the individual. The findings support the use of the ELR intervention.
Asunto(s)
Hogares para Grupos/organización & administración , Terapia Ocupacional/métodos , Trastornos Psicóticos/rehabilitación , Esquizofrenia/rehabilitación , Actividades Cotidianas , Adulto , Anciano , Femenino , Hogares para Grupos/normas , Servicios de Atención de Salud a Domicilio , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Observación , Terapia Ocupacional/psicología , Satisfacción del Paciente , Relaciones Profesional-Paciente , Trastornos Psicóticos/psicología , Investigación Cualitativa , Psicología del Esquizofrénico , SueciaRESUMEN
The aim of this article is to understand how compulsory community care (CCC) has become a solution in mental health policy in so many different legal and social contexts during the last 20 years. The recent introduction of CCC in Sweden is used as a case in point, which is then contrasted against the processes in Norway, England/Wales and New York State. In Sweden, the issue of CCC was initiated following high-profile acts of violence. Contrary to several other states, there was agreement about the (lack of) evidence about its effectiveness. Rather than focusing on dangerousness, the government proposal about CCC was framed within an ideology of integrating the disabled. The new legislation allowed for a broad range of measures to control patients at the same time as it was presented as a means to protect positive rights for patients. Compared to previous legislation in Sweden, the scope of social control has remained largely the same, although the rationale has changed - from medical treatment via community treatment and rehabilitation, to reducing the risk of violence, and then shifting back to rehabilitation in the community. The Swedish approach to CCC is similar to Norway, while New York and England/Wales have followed different routes. Differences in ideology, social control and rights orientations can be understood with reference to the general welfare and care regimes that characterize the four states.
Asunto(s)
Servicios Comunitarios de Salud Mental/legislación & jurisprudencia , Reforma de la Atención de Salud , Política de Salud/legislación & jurisprudencia , Enfermos Mentales/legislación & jurisprudencia , Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Humanos , New York , Noruega , Conducta de Reducción del Riesgo , Control Social Formal , Suecia , Reino Unido , Violencia/legislación & jurisprudenciaRESUMEN
BACKGROUND: The study illuminated how persons with psychiatric disabilities experienced the processes of change in a residential context. MATERIAL: Qualitative interviews with residents living in supported housing were conducted and analyzed using constant comparative analysis. DISCUSSION: Residential conditions appear to provide a complex structure that facilitates rehabilitative interactions, in which 'progressive tensions' arise between opposing values, such as authentic versus artificial, and independence versus dependence, both of which are important in the process of change. CONCLUSIONS: A client-centred approach could be taken further if clients are engaged in productive discussions about challenging these 'progressive tensions'. Awareness of the meaning of home also emerged as central.
Asunto(s)
Trastorno de Personalidad Limítrofe/rehabilitación , Hogares para Grupos , Vida Independiente/psicología , Alta del Paciente , Rehabilitación Vocacional , Esquizofrenia/rehabilitación , Psicología del Esquizofrénico , Medio Social , Adulto , Trastorno de Personalidad Limítrofe/psicología , Femenino , Humanos , Masculino , Terapia Ocupacional , Asistencia Pública , Asistencia Social en Psiquiatría , SueciaRESUMEN
This research investigates how the term "insight" was employed in 25 decisions from mental health review proceedings in Victoria, Australia. The application of insight appears problematic in these decisions. First, there is little clarification of its meaning. Second, the logic applied when insight is related to compliance is often unclear. Third, there are frequent allusions to an implicit and undefined scale of insight, offering the appearance of objectivity. We have analysed insight as an 'interpretive resource', focusing on its various functions in the complex social context of commitment hearings and with a view to its therapeutic jurisprudence implications. The variable application of insight-its interpretive flexibility-appears useful in addressing complex problems faced by review boards. Hence, a key function of insight is to bridge between legal and clinical discourses. Insight is also a convenient means to avoid complicated debates regarding the person's credibility. By analysing insight in Victoria, we hope to contribute to better theoretical understanding of decision-making patterns in mental health law in general.
Asunto(s)
Servicios de Salud Mental/legislación & jurisprudencia , Australia , Conflicto Psicológico , Toma de Decisiones , HumanosRESUMEN
This article draws on observations from ethnographic fieldwork to develop a theoretical understanding of the power dynamics in psychiatric care. The aim is to analyze how psychiatric clinicians solve compliance problems by invoking "coercion context". It is suggested that clinicians take a rather instrumental approach to laws regulating coercive intervention. Clinicians may invoke a coercion context even with voluntary patients. For example, they may use wordings that connote coercion, or they may make use of how treatment wards are set up to accommodate involuntary patients, thus stalling voluntary patients who cannot exit through locked doors. A coercion context can also be invoked to solve mundane practical problems, e.g. when clinicians talk about "coerced showers". The management of information and maintaining a suitable "awareness context" with regards to coercion is an essential feature in clinical attempts to achieve compliance from patients. In conclusion, the notion of coercion context helps explain the confusing findings from previous research about patients' apparent misconceptions of their formal legal status. Furthermore, it is argued that research that rely on decontextualised, objectifications of "coercion" risk to miss the meaning coercion is assigned in everyday clinical practice.