In recent years, many municipalities in Sweden are using a standardised method – the ‘Individual’s Needs in Focus’ (IBIC) for investigating needs of social support, as recommended by the National Board of Health and Welfare. The model is based on the International Classification of Functioning, Disability and Health (ICF), with a so called ‘biopsychosocial’ approach and predefined categories and classifications. The article takes a critical perspective on standardised methods in social work, specifically examining language, content, and structure in the documentation of the IBIC. We problematise how well the IBIC’s documentation fit social work in general and investigations concerning individuals with psychiatric disabilities requiring support in daily living in particular. A total of 80 investigations from four municipalities were examined in regard to language, content, and structure in relation to the context of social work. The study identified three main linguistic trends: biomedical, task-oriented, and bureaucratic language. However, none of these trends were anchored in the nomenclature of social work

The living conditions for persons with severe mental illness have undergone substantial change in Sweden as well as in the rest of the Western world due to the downsizing of inpatient care and the development of community-based interventions. However, there is a lack of knowledge concerning the “trajectories of interventions” in this new, fragmented, institutional landscape. The aim of the study was to explore types of interventions and when they occur in a 10-year follow-up of 437 women and men diagnosed with psychosis for the first time. Based on registers and using a timegeographic visualization method, the results showed a great diversity of trajectories and differences between sexes. The aggregate picture revealed that over the 10-year period there were considerable periods with no interventions for both men and women. Furthermore, institutional interventions more commonly occurred among women but appeared for longer periods among men. Community-based interventions declined among women and increased among men during the period.

Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004-2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period.

People with severe mental illness face a different 'interventional' landscape compared to some decades ago, when mental hospitals were dominant, in Sweden as well as in the rest of the Western world. The aim of the research reported in this article was to follow men and women diagnosed with psychosis for the first time over a 10-year period, and to explore what interventions they experienced. The interventions, here defined as spheres, were either community-based or institutional. A third sphere represents no interventions. Based on data from registers and using a time-geographic approach, the individuals were visualised as 10-year trajectories where their transitions between the different spheres were highlighted. The results show a great diversity of trajectories. Two main categories were detected: two-spheres (community-based and no interventions) and three-spheres (adding institutional interventions). One third of the population experienced only community-based interventions, with a higher proportion of men than women. Consequently, more women had institutional experience. Two sub-categories reveal trajectories not being in the interventional sphere in a stepwise manner before the 10th year, and long-term trajectories with interventions in the 10th year. The most common pattern was long-term trajectories, embracing about half of the population, while one-fifth left the institutional sphere before the 5th year.

Social support in independent living for persons with psychiatric disabilities – meanings and impactsSocial support in independent living is the most common social intervention for persons with psychiatric disabilities in Sweden. This article investigates what constitutes supportive social support, its meanings and impacts in respect of context, interaction and time. The article emanates from a reanalysis of the results of three user-oriented studies. In total, 56 persons with experience of this type of social support were interviewed. The analytical framework derives from theories of social interaction. The findings reveal that supporting social support is a complex social intervention conveyed through ”the doing”, the talking and the company of the support worker. The findings also show that the restraints of everyday life are allayed or abrogated due to the support: the undoable becomes doable. Finally there are impacts on the psychosocial situation: it contributes to increased well-being and improved psychiatric conditions.

Research shows that children with disabilities are victims of violence and abuse to a higher extent than other children and thus need support from social services. In Sweden, cooperation between two different social services units is required to support children with disabilities in socially vulnerable families. In this study, we have examined the intersection between children and disability in a Swedish social services context from the perspective of childhood studies and disability studies. The reasoning of the two units including the child perspective emerged during focus group interviews based on two vignettes. The results show two different rationalities, which has consequences for the disabled child. In spite of a social policy where the ‘best interests of the child’ are meant to prevail and disabilities are meant to be interpreted as barriers in society, children with disabilities seem to be reduced to individuals who are lacking in ability and competency and who are profoundly victimised by power structures that favour the adult perspective in social services.

Barn med funktionsnedsättning i svensk social barnavård – en särskiljande och funktionshindrande praktik

Forskning visar att barn med funktionsnedsättning drabbas av våld och övergrepp i högre omfattning än andra barn. Dessa barn är således i behov av stöd från socialtjänsten. I Sverige krävs samverkan mellan två olika enheter inom socialtjänsten för att stötta barn med funktionsnedsättning i socialt utsatta familjer eftersom stöd på grund av funktionsnedsättning handläggs av en enhet och våld och utsatthet av en annan. I denna studie har vi undersökt intersektionen mellan barn och funktionshinder i ett svenskt socialtjänstsammanhang utifrån ett childhood- och disabilitystudiesperspektiv. Genom fokusgruppsintervjuer utifrån två vinjetter granskas de två olika enheternas sätt att argumentera och hur barnperspektivet framträder. Resultaten visar att två olika rationaliteter skapas och upprättshålls vilket medför konsekvenser för barn med funktionsnedsättning. Trots en socialpolitik där barn ska betraktas som aktörer, ‘barnets bästa’ ska råda och funktionshinder ska tolkas som hinder i samhället tycks barn med funktionsnedsättning reduceras till passiva individer utan förmågor och färdigheter som drabbas hårt av maktordningar som gynnar vuxenperspektivet inom socialtjänsten.

Purpose

Persons with severe mental health problems (SMHP) point out financial strain as one of their main problems. De-institutionalisation in welfare countries has aimed at normalisation of their living conditions. The aim of the study was to follow the changes in income and source of income during a 10-year period for persons with a first-time psychosis diagnosis (FTPD).

Methods

Data were gathered from different registers. Data from persons with FTPD were compared to data on the general population. Two groups with different recovery paths were also compared: one group without contact with the mental health services during the last five consecutive years of the 10-year follow-up, and the other with contact with both 24/7 and community-based services during the same period.

Results

SMHP led to poverty, even if the financial effects of SMHP were attenuated by welfare interventions. Even a recovery path associated with work did not resolve the inequalities generated by SMHP.ConclusionsAttention should be paid to the risks of confusing the effects of poverty with symptoms of SMHP and thus pathologizing poverty and its impact on human beings. Adequate interventions should consider to improve the financial situation of persons with SMHP.

Background: Despite repeated attempts, it has not been possible to reach a consensus on the definition of recovery. In this paper, we use the term institutional recovery and focus on the persons' use of services. Aim: What type of services were used by men and women who were diagnosed for the first time with psychosis? How did different cut-offs of length of follow up influence the findings? Method: Interventions for 386 persons diagnosed for the first time with psychosis were followed up for 10 years. Data were collected from registers covering psychiatric and social work services and prisons. Results: Results varied according to cut-off. Nevertheless, even using the higher cut-off, fifty-five percent of the persons had no stay in 24/7 institutions during the follow-up's last 5 years. More than 40% had only community-based treatment and support. Fifteen percent had no interventions at all. A 2-year cut-off doubled the percentage of persons with no interventions. No statistically significant gender differences were found. Conclusions: Institutional recovery could be a useful recovery measure. However, the results from different studies are dictated by choices made by the research team, which should be clarified and discussed.

Living conditions for persons with severe mental illness (SMI) in Sweden have changed dramatically in recent decades, mainly due to the closure of mental hospitals in the 1990s and the subsequent development of community-based interventions. Thereby, people with SMI have experienced care interventions in various forms, which vary according to how the treatment is institutionally organised over the years. There is, however, a lack of knowledge concerning what care paths persons with SMI have undergone in this fragmented institutional landscape. In this article we present a time-geography-inspired visualisation method to address this. A set of 437 persons, first diagnosed with psychosis between 2000-2004, were studied over 10 years with regard to their contact with various care institutions. We constructed time-geographic paths of intervention for these individuals and visualised them at an aggregate level. The initial exploration conducted using the proposed visualisation method showed gender and age differences in some respects, but also that the initial periods after the psychosis diagnoses were similar in terms of in-patient care interventions among men and women. The proposed visualisation method is promising and should be further developed for deeper analysis of long-term individual paths of intervention.