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.

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.

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.

Background: Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries. Aims: This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users. Method: Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis. Results: Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their experience-based knowledge to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users. Conclusions: Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible.

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.

During the last decades services to people with severe mental health problems have gone through important changes. Terms as de-, trans-, reinstitutionalisation and dehospitalisation has been used. The objective of the study was to collected data about the changes in a welfare society about the new institutional landscape after the mental hospital area. Data about interventions from social welfare agencies, psychiatric care, and prisons were collected from local and national register as well as data about cause of death and socio-economic status for 1355 persons treated with a diagnosis of psychosis in a Stockholm area 2004–2008. Psychiatric in-patient care and prisons are marginalized. Different interventions in open care touched a very large number of persons. Social welfare agencies play an increasing role in this context. The total institutions have been replaced by a network of micro-institutions sometimes offering help but also control.

Psychotropic drugs, particularly antipsychotic types, are a cornerstone of the treatment of people with psychosis. Despite numerous studies showing that drug treatment with psychotropic drugs initially alleviates psychiatric symptoms, the proportion of people with mental health problems and symptoms that do not follow doctors' prescriptions, thus exhibiting so-called non-adherence, is considerable. Non-adherence is predominantly seen as a clinical feature and as a patient characteristic that is especially due to patients' poor understanding that they are ill. There is also a widespread notion that non-adherence is of great disadvantage to the patient. This article is based on interviews with 19 persons diagnosed with psychosis. It challenges the notion of patients being either adherent or non-adherent to the doctor's orders. The findings show that persons with psychosis are active agents when it comes to adjusting medication. The interviewees created their own strategies to gain power over treatment with psychotropic drugs. The most common strategies were to adjust the doses or take breaks of varying lengths from the medication. These deviations from prescriptions were important to conceal, not only from their own psychiatrists, but from all psychiatric staff.

Background: The relationship with professionals has proved to be important with regard to outcome for persons with severe mental illness (SMI). The understanding of non-helpful relationships is important complementary knowledge to that regarding helpful relationships.

Aim: To review the available qualitative research providing knowledge of non-helpful relationships from the perspective of persons with SMI.

Method: A review of qualitative studies, based on an earlier systematic search, analyzed through thematic analysis.

Results: The main themes were non-helpful professionals, organization versus relation and the consequences of non-helpful relationships with professionals. Examples of professionals described as non-helpful were pessimistic and uncaring professionals who were paternalistic and disrespectful. Discontinuity, insufficient time and coercion were some of the contextual factors described as non-helpful. These sorts of relationships were non-helpful because they hindered helpful relationships from developing and contributed to further suffering, instilling hopelessness and hindering personal growth.

Conclusions: Non-helpful relationships with professionals can be understood as impersonal relationships that contain no space for negotiation of the relationship nor of the support and treatment provided through it. It is important that organizations provide professionals with favorable conditions to negotiate the organizational framework and to treat persons with SMI as whole human beings.