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  • 1. Borg, Marit
    et al.
    Veseth, Marius
    Binder, Per-Einar
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    The role of work in recovery from bipolar disorders2013Ingår i: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 12, nr 3, s. 323-339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work - finding meaning and a focus; 2) helpful roles and contexts - to be much more than a person with an illness; 3) making work possible - the role of supportive relationships and supportive medications, and 4) the costs of working too much - finding a meaningful and healthy balance.

  • 2. Bülow, Per
    et al.
    Andersson, Gunnel
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Research and Development Unit, Psychiatry South Stockholm, Sweden.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Research and Development Unit, Psychiatry South Stockholm, Sweden; University of Agder, Norway.
    Experience of Psychotropic Medication - An Interview Study of Persons with Psychosis2016Ingår i: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, nr 11, s. 820-828Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 3. Davidson, Larry
    et al.
    Ridgway, Priscilla
    Kidd, Sean
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Borg, Marit
    Using qualitative research to inform mental health policy2008Ingår i: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 53, nr 3, s. 137-144Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    This article offers examples of the ways in which qualitative methods have informed, and may inform, mental health policy in Canada and beyond. Three initial uses of these methods are identified: to generate hypotheses to be tested by other means; to explore the subjective experiences and everyday lives of people with mental illnesses; and to investigate processes of recovery and the active role of the individual in recovery. Given the recent focus in mental health policy in Canada, the United States, and around the world on transforming mental health systems to promote recovery and the emphasis recovery places on the individual's own first-hand perspective, we argue that qualitative methods will become increasingly useful as psychiatry shifts away from symptom reduction to enabling people to live satisfying, hopeful, and meaningful lives in the community.

  • 4.
    Denhov, Anne
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    The components of helping relationships with professionals in psychiatry: User´s perspective2012Ingår i: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 58, nr 4, s. 417-424Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The quality of the relationship between professional and user is one of the important factors in the recovery process. However, more knowledge is needed concerning the components of helping relationships and characteristics of the helping professional. The aim of this study was to explore users’ experiences of helping relationships with professionals.

    Data and methods: This was a grounded theory analysis of 71 qualitative interviews to explore users’ experience of helping relationships and their components, in psychiatric care in Sweden.

    Discussion: Within the three main categories – interpersonal continuity, emotional climate and social interaction – two core themes were found that described vital components of helping relationships: a non-stigmatizing attitude on the part of the professionals and their willingness to do something beyond established routines.

    Conclusions: The focus in psychiatric treatment research needs to be broadened. In addition to research on the outcome of particular methods and interventions, the common factors also need to be investigated, above all, what is the effect of the quality of the relationship between user and professional. Greater attention needs to be paid, as well, to how helping respective obstructive relationships in psychiatric services arise, are maintained or are modified.

  • 5. Friesinger, Jan Georg
    et al.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Bøe, Tore Dag
    Larsen, Inger Beate
    Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review2019Ingår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 57, s. 44-53Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.

  • 6. Friesinger, Jan Georg
    et al.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Bøe, Tore Dag
    Larsen, Inger Beate
    The ambiguous influences of fire safety on people with mental health problems in supported housing2019Ingår i: Palgrave Communications, ISSN 2055-1045, Vol. 5, artikel-id 22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Over the last few decades, various housing types for people with mental health problems have been developed for use in the community. These housing types differ in their objectives, staff support and design. In this study, we focus on how fire safety influences the lives of tenants in supported housing. The qualitative study was designed with a multi-sited ethnography approach. Fieldwork was conducted in seven different Norwegian supported housing settings in 2017 with 105 participants (29 tenants, 70 staff, five managers, and one planner). The empirical data consist of field notes, recorded interviews and pictures, which were analyzed with grounded theory and situational analysis. The analysis reconstructed how fire safety was organized and tenants' experiences of it. These experiences could be positive (such as feeling protected) or negative (such as feeling annoyed or under surveillance). The tenants coped differently with these situations, and fire safety sets boundaries for tenants. Overall, fire safety was organized differently in the supported housing settings we looked at comparison to in most of the common housing units in Norway. The influences of fire safety on daily life can be understood as ambiguous and can be interpreted as a normalizing factor in a risk society. Thus, we emphasize the need for appropriate and well-considered fire safety as a public health intervention in supported housing.

  • 7. Larsen, Inger Beate
    et al.
    Topor, Alain
    University of Agder, Norway.
    A place for the heart: A journey in the post-asylum landscape. Metaphors and materiality2017Ingår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 45, s. 145-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The downsizing of psychiatric hospitals has created a new institutional landscape in the local community to support people with severe mental problems in their daily living. This study explores meeting places in Norway from the users’ perspectives. The users used four metaphors to describe these meeting places: “like a home”, “like a family”, “like a landing ground” and “like a trampoline”. The users have decorated the interiors of the meeting places with hearts made from various materials, and these could be considered as symbols of the places. The metaphors used: the hearts and the rooms and interiors, reflect old ideas about calmness and dignity rather than new ideas based on New Public Management.

  • 8. Ljungberg, Amanda
    et al.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden; University of Agder, Norway.
    A Balancing Act-How Mental Health Professionals Experience Being Personal in Their Relationships with Service Users2017Ingår i: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 38, nr 7, s. 578-583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 9. Ljungberg, Amanda
    et al.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Research and Development Unit, Psychiatry South Stockholm, Stockholm, Sweden.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Research and Development Unit, Psychiatry South Stockholm, Stockholm, Sweden; University of Agder, Norway.
    Non-helpful relationships with professionals: aliterature review of the perspective of persons with severe mental illness2016Ingår i: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 25, nr 3, s. 267-277Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    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.

  • 10. Ljungberg, Amanda
    et al.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden; University of Agder, Norway.
    The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness2015Ingår i: Psychiatric quarterly, ISSN 0033-2720, E-ISSN 1573-6709, Vol. 86, nr 4, s. 471-495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Relationships with professionals have been shown to be helpful to persons with severe mental illness (SMI) in relation to a variety of services. In this article, we aimed to synthesize the available qualitative research to acquire a deepened understanding of what helpful relationships with professionals consists of, from the perspective of persons with SMI. To do this, we created a meta-ethnography of 21 studies, through which ten themes and an overarching interpretation were created. The findings show that helpful relationships with professionals are relationships where the persons with SMI get to spend time with professionals that they know and trust, who gives them access to resources, support, collaboration and valued interpersonal processes, which are allowed to transgress the boundaries of the professional relationship. The overarching interpretation shows that the relationship that persons with SMI form with professionals is a professional relationship as well as an interpersonal relationship. Both these dimensions entail actions and processes that can be helpful to persons with SMI. Therefore, it is important to recognize and acknowledge both the functional roles of service user and service provider, as well as the roles of two persons interacting with each other, in a manner that may go beyond the purview of the traditional professionalism. Furthermore, the helpful components of this relationship are determined by the individual preferences, needs and wishes of persons with SMI.

  • 11. Ljungqvist, Ingemar
    et al.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Forssell, Henrik
    Svensson, Idor
    Davidson, Larry
    Money and Mental Illness: A Study of the Relationship Between Poverty and Serious Psychological Problems2016Ingår i: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 52, nr 7, s. 842-850Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several studies have indicated a co-occurrence between mental problems, a bad economy, and social isolation. Medical treatments focus on reducing the extent of psychiatric problems. Recent research, however, has highlighted the possible effects of social initiatives. The aim of this study was to examine the relation between severe mental illness, economic status, and social relations. Method: a financial contribution per month was granted to 100 individuals with severe mental illnesses for a 9-month period. Assessments of the subjects were made before the start of the intervention and after 7 months’ duration. A comparison group including treatment as usual only was followed using the same instruments. Significant improvements were found for depression and anxiety, social networks, and sense of self. No differences in functional level were found. Social initiatives may have treatment and other beneficial effects and should be integrated into working contextually with persons with severe mental illnesses.

  • 12. Mattsson, M.
    et al.
    Forsell, Y.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Cullberg, J.
    Association between financial strain, social network and five-year recovery from first episode psychosis2008Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 43, nr 12, s. 947-952Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite much effort to positively affect long-term outcome in psychosis and schizophrenia many patients are still facing a poor outcome with persistent psychotic symptoms and decline in social functioning. The aim of this study was to examine the relationship between financial strain and social network and five-year outcome of first episode psychosis (FEP). FEP patients were divided into recovered (n = 52) and non-recovered (n = 19). Each person was matched according to age and gender with four persons (n = 284) from a longitudinal population-based study. All persons had answered an extensive questionnaire including social network, quantitative and qualitative, financial strain and mental health. Linear regression analysis showed that both financial strain and social network were associated, and had a unique contribution, to outcome. The results indicate that FEP patients might benefit from interventions that reduce financial strain thus facilitating daily life and cultural and social activities.

  • 13. Ness, Ottar
    et al.
    Borg, Marit
    Semb, Randi
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Negotiating partnerships: parents' experiences of collaboration in community mental health and substance use services2016Ingår i: Advances in Dual Diagnosis, ISSN 1757-0972, E-ISSN 2042-8324, Vol. 9, nr 4, s. 130-138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose - The importance of collaboration in the mental health field is a well established theoretical principle, but there has so far been less attention to its practical implications from a parents' perspective. The purpose of this paper is to describe parents' experiences of collaboration with mental health practitioners. Design/methodology/approach - This was a qualitative study based on thematic analysis of multi-stage focus group discussions with ten parents of young adults with co-occurring mental health and substance use problems. Findings - The authors identified three major themes related to family member's experiences of collaborative practices: negotiating partnerships, incomprehensible services and being the young adult's advocate. Research limitations/implications - A potential limitation of this study is that the parents who agreed to take part in this study were all part of the population who really want to be involved in their relative's care; other family members who did not take part may have different feelings. It would be interesting to interview the siblings and partners of young adults with mental health and substance abuse problems. A last limitation is that only family parents participated in these focus group discussions; it would be interesting to invite service users and practitioners to elicit information about similarities and differences in their experiences of collaborative practices. Practical implications - This study emphasises that parents should be seen as unique individuals as well as families. Parents are persons in different contexts. This creates different needs in their collaboration with the professionals. Parents want to be invited to contribute with their experiences and knowledge, being a collaborative partner in the service provision, and not a burden for their young adults, or to the professionals. Social implications - This study emphasises that it may be important to understand the complex situations of each family parent, supporting their loved ones and at the same time living lives of their own. Families are in demanding and stressful situations often over many years. They want to be invited to contribute with their experiences and knowledge, being a collaborative partner in the service provision, and not a burden for their young adults, or to the professionals. Originality/value - The importance of collaboration is well established in in the mental health field. However, there has been less attention to what collaboration with parents might involve in practice. This paper describes the collaborative experiences of parents of young adults (18-28 years) with co-occurring mental health and substance use problems.

  • 14.
    Piuva, Katarina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Bergroth, Marian
    Åberg, Martin
    Sysselsättning för personer med psykisk funktionsnedsättning: Utvärdering av statsbidrag under åren 2009-20112012Rapport (Övrigt vetenskapligt)
  • 15.
    Schön, Ulla-Karin
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Social relationships as a decisive factor in recovering from severe mental illness2009Ingår i: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 4, nr 55, s. 336-347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Recovery research often describes recovery from mental illness as a complex individual process. In this article a social perspective on recovery is developed.

    Aims: To ascertain which factors people regard as decisive to their own recovery and what makes them beneficial.

    Methods: In-depth interviews were conducted with 58 persons in Sweden who had recovered from severe mental illness. Interviews were qualitatively analyzed using grounded theory.

    Results: Three dimensions of contributing recovery factors were identified. Social relationships emerged as the core category throughout these dimensions.

    Conclusions: The results show that recovery processes are social processes in which social relationships play a key role.

  • 16.
    Skogens, Lisa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    von Greiff, Ninive
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Initiating and maintaining a recovery process - experiences of persons with dual diagnosis2018Ingår i: Advances in Dual Diagnosis, ISSN 1757-0972, E-ISSN 2042-8324, Vol. 11, nr 3, s. 101-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose - The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.

    Design/methodology/approach - In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.

    Findings - There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.

    Research limitations/implications - The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having double trouble.

    Practical implications - The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.

    Social implications - Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.

    Originality/value - By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.

  • 17.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Boendestödjarnas erfarenhetskunskap : Boendestöd - beslut och praktik. Erfarenheter från Lidingö stads socialpsykiatri2014Rapport (Övrigt vetenskapligt)
  • 18.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Fra asosial til sosial psykiatri?2015Ingår i: Psykisk helse: Nye arenaer, aktører og tilnærminger / [ed] D. Ulland, A.B. Thorod & E. Ulland, Oslo: Universitetsforlaget, 2015, s. 240-248Kapitel i bok, del av antologi (Refereegranskat)
  • 19.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Kan psykiatrin bli återhämtningsinriktad?:  Psykiatrins praktik och kunskap kontra brukarpraktik och kunskap2011Ingår i: Tidskrift för Psykisk Helsearbeid, Vol. 8, nr 4, s. 303-313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An increasing number of policy documents are recommending that the recovery perspective be used as a guiding principle in the development of psychiatric care. The recovery perspective also implies a formalized user involvement in the planning and managing of treatment interventions. The present article questions whether it is possible to integrate this perspective in psychiatry’s current practice and body of knowledge. Three aspects are investigated: What are mental disorders? Who are the users? What factors contribute to the recovery process? Psychiatry’s belief in chronic illnesses that follow a given course of development is contrasted with the view of mental problems as being related to life events and that recovery is a likely course of development. The dominant view in psychiatry is that the patient is irrational and incapable of interpersonal relationships. Results in recovery research place the user in his or her social context and show that managing of symptoms and stigma is possible. Where psychiatry focuses on specific treatment interventions, the users themselves point at a variety of helping factors where interpersonal relationships play a central role. An integration of users’ experience-based knowledge in the arena of psychiatry would deeply transform its current knowledge and practice.

  • 20.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Managing the contradictions: Recovery from severe mental disorders2001Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [en]

    One of the assumptions made when mental problems are defined as a medical problem is that certain problems, certain diagnoses, are chronic. Nevertheless, a substantial number of follow-up studies have shown that the course of development in patients with these diagnoses is neither uniform nor chronic. The aim of this dissertation is to summarise the state of the art in the knowledge about recovery from severe mental disorders and to examine in depth which factors people who have recovered regard as having helped them in their recovery, and in which ways. These two aims have resulted in two separate but complementary presentations of results. The review of the state of the art, which focuses on the diagnosis schizophrenia, shows that some two-thirds of the patients who received this diagnosis have recovered, either totally or socially. The variation in the percentage of persons who have recovered is explained in the study by such factors as fluctuations in national and local unemployment rates, in definitions of the diagnoses and in access to psychiatric care. On the other hand, the introduction of various treatment interventions seems to have had no noticeable effect on the recovery rate, although it has affected the relapse frequency. There is still a long way to go towards understanding the recovery process and how it can be facilitated. The interview study with persons who have been treated for severe mental disorders and recovered show the patients themselves to be a crucial factor in their own recovery. Throughout the whole course of the disorder, they struggle to find ways to manage both their symptoms and the factors that cause them. What appears to others as symptoms might instead be theperson’s unsuccessful attempts to manage existential problems. Entering into and maintaining relationships with other people is another crucial factor in recovery work. Professionals from a variety of backgrounds as well as family members and other laypersons can contribute to recovery, first and foremost in that they represent continuity between diverse facets of the person’s life; they engage with the person in his/her full complexity, not as someone reduced to a diagnosis and a given patient role, nor by denying the fact of the person’s suffering. Still another factor in recovery work is material conditions which impact on the person’s possibility to regain an identity as a full member of the community. Lastly, the descriptions that the respondents give of their recovery practice have certain constructed meanings in common. These meanings can be categorised as medical, therapeutic, spiritual and interactional. In many of the life stories collected in this study, several of these categories of meaning appear in unison, co-existing in one and the same life story. There is a recurrent theme running through these practice stories of recovery: that people in their everyday lives are not reducible to their problems, but at the same time these problems must not be denied. That people have both weaknesses and strengths, sometimes existing within the same spheres of life and occurring simultaneously; but that in relationships with other people they are given scope to manage and live with these contradictions is of central importance for recovery practice.

  • 21.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Universitetet i Agder.
    Om pengar och psykisk hälsa: ensamhetens sociala grund2014Ingår i: Tidskrift for Psykisk Helsearbeid, ISSN 1503-6707, Vol. 11, nr 1, s. 75-85Artikel i tidskrift (Refereegranskat)
  • 22.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Om penge og psykisk sundhet: ensamhetedens sociale fundament2015Ingår i: Det sociales betydning för mennesker med sindslidelse / [ed] B. Lihme, Köpenhamn: Akademisk Forlag, 2015Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 23.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    På mitt eget sätt2013Ingår i: Hjälpande möten i vård och omvärld: brukare, praktiker och forskare reflekterar / [ed] Ingemar Ljungqvist, Håkan Jenner, Stockholm: Liber, 2013, s. 68-91Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 24.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Socialpsykiatrin – i gränstrakten mellan medicin och socialt arbete2014Ingår i: Tre decennier med socialtjänstlagen : utopi, vision, verklighet / [ed] Ulla Pettersson, Malmö:: Gleerups Utbildning AB, 2014, 1Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 25.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Återhämtning Ett nytt begrepp för en ny verklighet2009Ingår i: Psykiatri för baspersonal: Kunskap för en evidensbaserad praktik / [ed] Ingemar Ljungqvist, Håkan Jenner, Stockholm: Gothia Förlag AB, 2009, 1:1Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 26.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Återhämtning.:  Vad är det? Vad hjälper? Hur kan professionella bidra?2011Ingår i: Psykiatri som socialt arbete / [ed] Sundgren, M. & Topor, A., Stockholm: Bonnier Utbildning , 2011, s. 1-18Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 27.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden; University of Agder, Norway.
    Andersson, Gunnel
    Bülow, Per
    Stefansson, Claes-Göran
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden.
    After the Asylum? The New Institutional Landscape2016Ingår i: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 52, nr 6, s. 731-737Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 28.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Andersson, Gunnel
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Holmqvist, Sara
    Mattson, Maria
    Stefansson, Claes-Göran
    Bülow, Per
    Psychosis and poverty: coping with poverty and severe mental illness in everyday life2014Ingår i: Psychosis, ISSN 1752-2439, E-ISSN 1752-2447, Vol. 6, nr 2, s. 117-127Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In psychiatry, it is assumed that the social conditions of everyday life do not in themselves affect the severity of an individual’s mental ill health. Rather, the illness is the cause of problems that the individual meets in daily life. However, recent studies indicate that social factors can explain behavior that has ordinarily been regarded as symptoms of mental illness. The aim of the present study is to investigate how people with a psychosis diagnosis manage their economic diffi- culties. Nineteen persons with a psychosis diagnosis were interviewed on several occasions in the course of a follow-up study. The interviews were analyzed according to Grounded Theory. The present study shows that the persons had developed different rational ways of coping with economic strain: reducing their expenses, increasing their incomes or borrowing money and acquiring debts. Living under poverty negatively affects their possibility to acquire and maintain a social network and their sense of the self. The study contributes to our knowledge of the nature of psychosis and its relationship to the social context.

  • 29.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Borg, Marit
    Di Girolamo, Simonetta
    Davidson, Larry
    Not just an individual journey: Social aspects of recovery2011Ingår i: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 57, nr 1, s. 90-99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Recent literature on recovery describes the process as deeply personal and unique to each individual. While there are aspects of recovery that are unique to each individual, this article argues that focusing solely on these overlooks the fact that recovery unfolds within a social and interpersonal context.

    Materials: Drawing from qualitative data, this article describes aspects of recovery that involve the contributions of others, the social environment and society.

    Discussion: These aspects of recovery include relationships, adequate material conditions and responsive services and supports.

    Conclusion: The authors consider the implications of these social factors for transforming psychiatric research and theory as well as for recovery-orientated practice

  • 30.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Bøe, Tore Dag
    Larsen, Inger Beate
    Small Things, Micro-Affirmations and Helpful Professionals Everyday Recovery-Orientated Practices According to Persons with Mental Health Problems2018Ingår i: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 54, nr 8, s. 1212-1220Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study is to present concrete descriptions of the content in the construction of helpful relationships with staff, according to users. Starting with the re-occurring concept of the meaning of little things in recovery studies, a literature review was done. A thematic analysis shows that small things play an important role in improving a person's sense of self. Small things seem to be an invisible but effective parts of a recovery-orientated practice, but they might be defined as unprofessional and their efficacy negated.

  • 31.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Evidensbaserade insatser: Vilken och vems evidens?2011Ingår i: PSykiatri som socialt arbete / [ed] Sundgren, M. & Topor, A., Stockholm: Bonnier Utbildning , 2011, 1, s. 138-155Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 32.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway; Psychiatry South Stockholm, Sweden.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Psychiatry South Stockholm, Sweden.
    Going beyond: Users’ experiences of helping professionals2015Ingår i: Psychosis, ISSN 1752-2439, E-ISSN 1752-2447, Vol. 7, nr 3, s. 228-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Establishing a working alliance has been found to be of great importance for the outcome of professional interventions for people diagnosed with severe mental illnesses. Aim: The aim of the present study was to analyse the concrete actions of helpful professionals in establishing a working alliance. Method: Interviews with 58 persons diagnosed with severe mental illness who were in a recovery process or had recovered were analysed using Grounded Theory. Results: The core category that emerged from the analysis was termed ‘going beyond’. It was constituted on three subcategories: challenging the rationality of the institutions, restoring the professional as a person and restoring the user as a person. Conclusion: Users’ experience-based knowledge about helpful professionals calls into question the traditional view of professional roles.

  • 33.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Helping Relationships and Time: Inside the Black Box of the Working Alliance2012Ingår i: American Journal of Psychiatric Rehabilitation, ISSN 1548-7768, E-ISSN 1548-7776, Vol. 15, nr 3, s. 239-254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research has shown the importance of the relationship between professionals and users for the outcome of interventions in psychiatry. The aim of this study is to analyze time as one factor in the development of working alliances. Fifty-eight persons in recovery from diagnosis of severe mental illness were interviewed about helping factors in their recovery process. Two aspects of time were considered to be of importance for the construction of working alliances: the quantity of time, that is, getting more time than expected during, between, and after the sessions; and the quality of time, that is, having undisturbed and focused time, the experience of being in the professional thoughts between the sessions and timing in one’s life. Those experiences give the person a sense of being a real-life person and not an abstract patient, and this lays the groundwork for establishing a working alliance. The management of time is an important factor in the creation of a working alliance and should be given greater attention in the development of experienceand evidence-based practice.

  • 34.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Di Girolamo, S
    Erfarenhetens kunskap: Erfarenheter från ett samforskningsprojekt2009Ingår i: Medforskning: å forske sammen for kunnskap om psykisk helse / [ed] Borg, M. & Kristiansen, K., Oslo: Universitetsforlaget, 2009Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 35.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Di Girolamo, Simonetta
    La recherche sur le recovery2008Ingår i: Psychiatrie française, ISSN 0755-9755, Vol. 39, nr 4, s. 108-113Artikel i tidskrift (Refereegranskat)
  • 36.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Di Girolamo, Simonetta
    Sortir de la schizophrénie: L’état actuel des savoirs2009Ingår i: Psychiatrie française, ISSN 0755-9755, Vol. 40, nr 4, s. 99-107Artikel i tidskrift (Refereegranskat)
  • 37.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Di Girolamo, Simonetta
    "You have to be careful who you talk to and what you say...": on psychosis and making rational choices2010Ingår i: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 19, nr 6, s. 553-561Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: People who have been diagnosed with schizophrenia are regarded as being no longer capable of making rational choices.

    Method: Fifteen users with psychosis diagnosis participated to 10 focus group sessions about different aspects of everyday life. The discussions were tape recorded and the transcript analyzed using a grounded theory inspired methodology. A core category that emerged was making choices in crises situations.

    Results: Users have to choose whether or not they want help, to whom to turn for help, and how to describe their problems so as to get the kind of help they seek. The choices were based on past experiences in connection with the choices available. They were constantly making quality judgements of the care workers they came into contact with. Experiencing a sense of comradeship emerged as a vital criterion.

    Conclusions: The ability to make rational choices often existed parallel with hallucinations and delusions. This ability could form the basis for a true collaboration between users and professionals. The findings of this study indicate that such collaboration is possible, but that it requires a reassessment of our traditional knowledge base.

  • 38.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Ljungberg, Amanda
    "Everything is so relaxed and personal" - The construction of helpful relationships in individual placement and support2016Ingår i: American Journal of Psychiatric Rehabilitation, ISSN 1548-7768, E-ISSN 1548-7776, Vol. 19, nr 4, s. 275-293Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The relationship with professionals is an important factor in relation to the outcome of interventions directed to persons with severe mental problems. However, the current knowledge regarding the development of helpful relationships within Individual Placement and Support (IPS) services is limited. The aim of the study was to investigate how participants in IPS services described their relationship with their IPS coach. The article is based on interviews from a Swedish government evaluation of IPS services, thematically analyzed. The results showed that the relationship with the coach is central for the participants' success in the service. The main theme, something different - as a human being highlighted that the conditions for the relationship are different within IPS as compared to traditional services. The other themes were here and now action, closer to wish-fulfilment - impact on the self, and from role to person. The principles of IPS parallel the results from research about helpful relationships and offers good preconditions for the occurrence of such relationships. This can represent a bridge between evidence based methods and research on helpful relationships, and should be possible to implement in the development of evidence based methods as well as of treatment as usual.

  • 39.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Ljungqvist, Ingemar
    Money, Social Relationships and the Sense of Self: The Consequences of an Improved Financial Situation for Persons Suffering from Serious Mental Illness2017Ingår i: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 53, nr 7, s. 823-831Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During a 9-month period, 100 persons with SMI were given approx. 73 USD per month above their normal income. Sixteen of the subjects were interviewed. The interviews were analysed according to the methods of thematic analysis. The money was used for personal pleasure and to re-establish reciprocal relations to others. The ways in which different individuals used the money at their disposal impacted their sense of self through experiences of mastery, agency, reciprocity, recognition and security. The findings underline the importance of including social circumstances in our understanding of mental health problems, their trajectories and the recovery process.

  • 40.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Ljungqvist, Ingemar
    Strandberg, Eva-Lena
    The costs of friendship: severe mental illness, poverty and social isolation2016Ingår i: Psychosis, ISSN 1752-2439, E-ISSN 1752-2447, Vol. 8, nr 4, s. 336-345Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The relationship between severe mental illness, poverty and social isolation has been explored in a number of studies.Aim: The purpose of the study was to explore the relationship between financial strain and social isolation.Methods: Sixteen persons with severe mental illness were interviewed about their experience of having a severe mental illness, living in poverty and the effect these circumstances had on their social relationships. The interviews were analysed according to thematic analysis.Results: The overarching theme was the cost of having friends; it consisted of five categories: the loss of friends; making do without friends; dependence on friends and family; supported socialisation; and money as an aid to recovery. The participants experienced a connection between their financial circumstances, their social relationships and their lack of initiative in maintaining and developing a social network.Conclusions: The results underline the importance of considering the person in his/her social context in order to avoid the risk of interpreting rational strategies for coping as psychiatric symptoms.

  • 41.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Mattsson, Maria
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Bulow, Per
    Holmqvist, Sara
    Davidson, Larry
    The Stockholm Follow-up Study of Users Diagnosed with Psychosis (SUPP): methodology, patient cohort and services2012Ingår i: Psychosis, ISSN 1752-2439, E-ISSN 1752-2447, Vol. 4, nr 3, s. 246-257Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The de-, re- and trans-institutionalization of psychiatric care has resulted in a number of changes in the interventions available to persons with severe mental disorders. Aims: This article describes the design of a naturalistic follow-up study of persons with a psychosis diagnosis, the characteristics of the study population, and the interventions they received prior to study participation from various agencies in and outside of mental healthcare. Method: data from various registers, such as psychiatric and social services case registers, criminal records, and the cause of death register have been collected and analyzed. Results: Under the period 1997-2004, 42% were in contact only with out-patient care, 58% were in contact with the social services, and 2% had served prison sentences. Conclusions: Studies need to include interventions that are provided beyond the scope of psychiatric services in order to assess the extent of the existing support network and the long-term outcomes for persons with a psychosis diagnosis. The lack of a gender perspective in psychiatric research also needs to be addressed.

  • 42.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Skogens, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    von Greiff, Ninive
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Building trust and recovery capital: the professionals' helpful practice2018Ingår i: Advances in Dual Diagnosis, ISSN 1757-0972, E-ISSN 2042-8324, Vol. 11, nr 2, s. 76-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose - The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals' perceptions of their contribution to improvement.

    Design/methodology/approach - In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.

    Findings - Recovery processes were dependent of the persons' access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one's self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person's life. Trusting a professional might be a basis for trusting one's self as an agent in one's recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).

    Practical implications - Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.

    Originality/value - Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

  • 43.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Stefansson, Claes-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Bulow, Per
    Andersson, Gunnel
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. Research and Development Unit, FoU Södertörn, Sweden.
    Recovery and economy; salary and allowances: a 10-year follow-up of income for persons diagnosed with first-time psychosis2019Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 54, nr 8, s. 919-926Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 44.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Stefansson, Claes-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Bülow, Per
    Andersson, Gunnel
    Institutional recovery: a 10-year follow-up of persons after their first psychosis diagnosis. A critical reflexive approach2018Ingår i: Psychosis, ISSN 1752-2439, E-ISSN 1752-2447, Vol. 10, nr 4, s. 263-274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 45.
    Topor, Alain
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    von Greiff, Ninive
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Skogens, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Micro-affirmations and Recovery for Persons with Mental Health and Alcohol and Drug Problems: User and Professional Experience-Based Practice and Knowledge2019Ingår i: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 46.
    von Greiff, Ninive
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Skogens, Lisa
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Supporting recovery in social work with persons having co-occurring problems – clients’ and professionals’ perceptions2018Ingår i: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study focus on how clients with co-occurring problems describe the importance of treatment factors for the recovery process and how these descriptions relates to professional descriptions. 40 client interviews and 15 interviews with professionals were conducted. Three major themes emerge in the results: medication, methods and the professionals.

    The amount of contact with psychiatry and social services that these clients often have through the years can lead to a ‘learned passivity’ towards their own recovery process. Thus, an important task for the professionals is to break through passivity and isolation. This can be done by treating the client like an ‘ordinary fellow human’. Besides the actual professional tasks, small things seem to be important; greeting the person, paying respect when entering some one’s home, etc.

    When a social network is missing, the professional can sometime fill this gap, but if this is to promote recovery, it seem important that the professional social network is used as a bridge to other social networks.

    The professionals as a group, including the environment, emerge as important. Accordingly, to be supportive as a group, and be able to act like ‘social role models’, the professionals need to have working alliances also between themselves. The environment can also offer tools that can be used for socialization that interfere with the ‘learned passivity’ and instead includes and respects the client. This, together with the results highlighting the importance of creating safe milieus, confident and secure professionals, puts focus on how the professional work is organized.

  • 47. Vrotsou, Katerina
    et al.
    Andersson, Gunnel
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. FoU Södertörn, Sweden.
    Ellegård, Kajsa
    Stefansson, Claes-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Topor, Alain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan. University of Agder, Norway.
    Denhov, Anne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete - Socialhögskolan.
    Bülow, Per
    A time-geographic approach for visualizing the paths of intervention for persons with severe mental illness2017Ingår i: Geografiska Annaler. Series B, Human Geography, ISSN 0435-3684, E-ISSN 1468-0467, Vol. 99, nr 4, s. 341-359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

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