The deinstitutionalization of mental health institutions has enabled service users to live in the community and search for what Duff coins ‘enabling places.’ These places were explored through walking interviews, in which service-users led the way. This analysis revealed features which made places promote liveable lives: places help people explore, places help people stand out, places give people responsibilities, and places dare people. An adverse feature was also identified: places define people by their problems. Overall, we suggest that ‘living needs a landscape’ to capture how a diversity of places form an ‘enabling landscape’. This suggests a shift of focus in research and treatment, from internal to external landscapes.

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.

This article explores how professional relationships may be helpful from the perspective of residents in staffed supportive housing for individuals with severe mental health and/or drug problems. Using in-dept interviews, residents were individually asked to describe a helpful relationship with a self-chosen staff member, the content of the help provided by this staff member and how this help influenced their lives. Using thematic analysis, we found that the residents described mutual relationships that resembled friendships and helpful staff members who carried out a variety of doings. Four domains of doings were identified: small human gestures, filling the hours with 'friendship', enabling the residents to take care of their own needs and fighting on behalf of the residents to ensure rights and benefits. To some of the residents, these doings had life-changing impact. We propose that service management within relationship-based practices should be open for friendship resemblance when matching professionals and service users and make room for a diversity of doings rooted in the service users' perceived needs.

‘Det er ikke bare en masse ord’. En kvalitativ utforsking av beboeres beskrivelser av hjelpsomme relasjoner i bofellesskap

Denne artikkelen utforsker, fra tjenestebrukeres perspektiv, hvordan profesjonelle relasjoner kan være til hjelp i bofellesskap for mennesker med alvorlige psykiske problemer og/eller rusproblemer. Beboere ble intervjuet individuelt om sin relasjon til en selvvalgt ansatt, innholdet i hjelpen fra denne ansatte og hvordan denne hjelpen påvirket beboerens liv. Ved å bruke tematisk analyse fant vi at beboerne beskrev gjensidige relasjoner som lignet på vennskap og at hjelpsomme ansatte utførte en rekke handlinger. Vi fant fire ulike typer handlinger; små menneskelige gester, initiativ til og gjennomføring av sosiale aktiviteter, hjelp til selvhjelp og kamp på vegne av beboerne for å sikre rettighetene deres. For noen av beboerne hadde disse handlingene livsforvandlende effekt. Vi anbefaler at man ved fordeling av primærkontakter innen psykisk helsearbeid tilrettelegger for muligheter til å utvikle vennskapslignende relasjoner og at det gis rom for at ansatte kan utføre et mangfold av handlinger utfra tjenestebrukernes erfarte behov.

From being a concept questioning the core of psychiatric knowledge and practice, recovery has been adopted as a guiding vison for mental health policy and practice by different local, national, and international organizations. The aim of this article is to contextualize the different understandings of recovery and its psychiatrization through the emergence of an individualizing and de-contextualized definition which have gained a dominant position. It ends with an attempt to formulate a new definition of recovery which integrates people in their social context. Research results from various follow-up studies showing the possibility of recovery from severe mental distress have stressed the importance of societal, social and relational factors as well of the person's own agency when facing their distress and reactions from their environment. These researches were published in the 1970s and 80s; a period of struggle for liberation from colonialism, of struggle by women and black people for their civil rights, and a time of de-institutionalization of services directed toward the poor, elderly, handicapped, prisoners, and people with mental health problems. Recovery research pointed at the central role of individuals in their recovery journey and it was understood as a personal process in a social context. However, with neo-liberal political agenda, the personal role of individuals and their own responsibility for their well-being was stressed, and contextual understandings and the role of social, material and cultural changes to promote recovery faded away. Thus, during recent decades recovery has been mostly defined as an individualistic journey of changing the persons and their perception of their situation, but not of changing this situation. Contextual aspects are almost absent. The most quoted definition accepts the limits posed by an illness-based model. This kind of definition might be a reason for the wide acceptance of a phenomenon that was initially experienced as a break with the bio-medical paradigm. Recently, this dominant individualized understanding of recovery has been criticized by service users, clinicians and researchers, making possible a redefinition of recovery as a social process in material and cultural contexts.

 In conjunction with the dismantling of psychiatric hospitals, social workers have been commissioned to help service users in their daily living in their homes and in the community. The consequences of these changes for experience-based knowledge and practices in their contexts remain relatively unknown. In this study, eighteen service users and the social workers they described as helpful for them were interviewed. The interviews were recorded, transcribed, and analyzed using Thematic Analysis. The following themes emerged: “Here, there and everywhere”, “Doing, being, becoming”, “Talking” and “Order, planning and improvisation” concerning the contradictions service users and professionals mentioned about their practices and the conditions imposed by managerial methods connected to New Public Management. Finally, “Spontaneous planned complexity” was chosen as our overarching theme to characterize the new knowledge and practices which have been developed. The displacement of the place for the encounter and the introduction of non-medicalized professions have allowed community-based practices and thus the co-creation and emergence of new knowledge about the service users as persons and the professionals as qualified professionals. The challenge remains for managers to have trust in their colleagues and not impose rigid rules, schematized methods, and repeated controls. 

Introduction: In the aftermath of the deinstitutionalization in western countries, new community-based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community-based institutional supportive housing.

Aim: To explore how staff members describe their relationships with residents who have identified them as helpful.

Methods: Qualitative interviews with nine staff members were analysed using thematic analysis.

Results: Reciprocity was identified as the main theme, and two subthemes were developed: Something influential about the resident and Value for the staff member.

Discussion: The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested.

Implications for practice: To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity.

Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

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.

Background: The lack of social and material perspectives in descriptions of recovery processes is almost common in recovery research.

Aim: Consequently, we investigated recovery stories and how people with mental health and/or addiction challenges included social and material aspects in these stories.

Method: We conducted focus group and individual interviews. We investigated how the participants narrated their stories and how they assembled places and people in their recovery stories.

Results: We found that narratives of recovery became assemblages where humans and their environments co-exist and are interdependent.

Conclusion: As such, narratives about recovery are about everyday assemblages of well-being into which stories of insecurity are interwoven, without a start or stop point.

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.