Arild Granerud

Preserving Integrity: experiences of people with mental health problems living in their own home in a new neighbourhood

For patients with mental health problems, de-institutionalization has meant a shift from institutional care to living in the community. However, several studies show that problems of stigmatization, loneliness and negative attitudes devalue the dignity and autonomy of these patients. The aim of this study was to gain a deeper understanding of how people with mental health problems experience living in an apartment of their own. The data collection method was focus group interviews. The constant comparative method revealed the main category ‘preserving integrity’. The subcategories were: the need for control over information, similar relationships with both friends and neighbours (symmetrical contact), and ‘My home is my castle’. Participants who lived in a group home had little or no contact with their neighbours. The participants experienced lack of acceptance and loss of autonomy when meeting people. Integrity was a necessary condition in order for them to become equal citizens, experience autonomy and dignity, and have the opportunity to develop social contacts.

“Life on Hold”: A Qualitative Study of Patient Experiences with Outpatient Commitment in Two Norwegian Counties

In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients’ experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients’ daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.

‘Responsible, but Still not a Real Treatment Partner’: A Qualitative Study of the Experiences of Relatives of Patients on Outpatient Commitment Orders

The aim of this study was to explore relatives’ experiences when their family member is under an outpatient commitment order. A descriptive and exploratory approach was used based on qualitative interviews with 11 relatives. The relatives felt they had responsibility for the patient, but experienced a lack of recognition for their contribution to the treatment. Relatives paid little attention to coercion, but were more concerned about whether the follow-up care improved the patients social functioning. They further reported an unmet need for information and guidance from healthcare staff to improve cooperation in the patients care and treatment.

Opioid dependency rehabilitation with the opioid maintenance treatment programme - a qualitative study from the clients’ perspective

BackgroundOpioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence. The opioid maintenance treatment (OMT) programme represents an opportunity for people who are opioid users to minimize the many negative health and societal outcomes associated with opioid use through meeting the physiological need of their bodies for opioids. The purpose of this study is to shed some light on how clients in the Norwegian OMT programme see their level of influence on their own treatment.MethodIt is a qualitative enquiry using semi-structured interviews of seven OMT clients living in various locations in Norway. The analysis of the material utilized a grounded theory-inspired approach.ResultsThis study show that the clients who were part of the OMT programme had better lives than people with untreated addictions did. However, the participants experienced having to play by the rules of the OMT programme if they wanted to have successful treatment. This resulted in varying degrees of dissatisfaction with the treatment.ConclusionsThe results indicated that the clients felt objectified and disenfranchised in the OMT programme, and points out the low level of influence on their own treatment felt by the OMT clients.

“Care or control?”: a qualitative study of staff experiences with outpatient commitment orders

PurposeOutpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals’ experiences with the scheme. The purpose of this study was to examine health professionals’ experiences with patients subject to outpatient commitment.MethodsThis was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis.ResultsThe study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients’ lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient.ConclusionHealth professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients’ need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients’ autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.

Prevalence and management of patients with outpatient commitment in the mental health services

Background People with mental health problems are mostly treated within the community. The law allows for the use of compulsory mental health care both in hospital and in the community. Various forms of outpatient commitment (OC) have been adopted in much European legislation. To be subjected to OC is a serious intervention in a person’s life. Aim The purpose of this study is to gain knowledge about patients who undergo OC. The study explores the incidence and prevalence of OC in a geographical area, the central characteristics of the sample, and how the framework for follow-up treatment for patients to resolve OC works. Methods The data were collected from a review of electronic patient records. The statistical methods used in this study were descriptive analysis, with frequency analysis and cross-tabulation analysis. Results The main finding in the present study is that the use of OC has increased. An important finding is that most of the patients have a decision made for OC that is justified by the treatment criterion. The present study shows that there is insufficient documentation on statutory responsibilities for follow-up treatment of patients with an OC. Conclusions This study shows that the use of OC has increased. It should be considered whether implemented measures to reduce the use of coercion have the desired effect.

Teoretiske og ideologiske innflytelser på utviklingen av psykiatrisk sykepleie etter 1960 ? en litteraturgjennomgang

The purpose of this article is to give an overview of theoretical and ideological impacts on the development of psychiatric nursing. The chosen method for this review is the resumé format. This has been carried out by outlining the contents of theoretical and research articles in psychiatric nursing journals in the period 1960–2008. Three theoretical influences are prominent in this resumé: The human science influence (humanistic-existential approach; psychodynamic approach), natural science influence (biomedical approach; generalised, decontextualised facts of knowledge) and social science influence (anti psychiatry; psychosocial impacts; holism and pluralism; user perspective). In conclusion, a main concern in the reviewed articles is to present the contribution of psychiatric nursing as complementary to other professions work in order to meet the challenges in the field of mental health services. Consequently, a strong emphasis on multidisciplinary collaboration and cooperation with users are present. The importance of making ideological perspectives explicit is pointed out as having impacts on the modes of care, nursing and treatment of persons with mental health disabilities. The reviewed articles show that the social science perspective has gradually influenced psychiatric nursing both ideologically and practically. Finally, it seems that psychiatric nursing philosophy presents counter-arguments to the emphasis on biomedical research and practice in contemporary mental health care.

Mental Health Nurses and Responding to Suffering in the Twenty-first Century Occidental World: Accompanying People on Their Search for Meaning

Much of contemporary health and mental health practice pays little attention to suffering, and when it does, invariably suffering is conflated with pain. Within such views, the health care practitioner ought to be concerned with removing or stopping the suffering as, for many parts of the occidental world at least, suffering is regarded as antagonistic to the pursuit of happiness. However, it has been recognized since ancient times that the experience of suffering can give rise to growth. This view sees suffering as an inevitable aspect of the human condition and experience; as something that might need to be endured, minimized, relieved, explored for meaning and maybe even learned from. The former conceptualization of suffering leaves little, if any, room for the sufferer to be proud of his suffering and to consider it ennobling rather than degrading, and such views are highly congruent with the increased pathologizing of “everyday life” and with that, the inexorable proliferation of pharmacological “treatment.” Accordingly, we assert that there is a clear need for Psychiatric/Mental Health nurses to re-think their views of suffering and consider how they might help the person discover meaning in the experience; how they might accompany the individual on his/her suffering journey. We therefore identify a range of approaches and interventions that Psychiatric/Mental Health nurses can use when attempting to help those experiencing mental health-related suffering.

Psychiatric/Mental Health Nursing Care of the Older Adult: Mental Health in Old Age

It is well documented that Europe and the Occidental world face pressing mental health-care challenges that are linked to their ageing populations. Moreover, in addition to the current and projected alarming rise in diagnosis of dementia, this population also often simultaneously face multiple pathological, psychological and experiential health challenges. Accordingly, this chapter focuses on providing psychiatric/mental health nursing care to and for older adults, from a humanistic and holistic perspective. The chapter outlines developments in Europe’s demography and examines different gerontological theories and theoretical approaches to ageing and mental health, with an emphasis on psychosocial views and theory, resting on the conviction that both mental well-being and mental ill health are closely related to and dependent on one’s social environment and personal story. Commonly occurring mental health problems among older people are considered, including those that are related to particular lived experiences such as social losses, crises and transitions of old. The chapter then concentrates on psychiatric/mental health nursing and how theories of gerontological mental health care can be operationalized for this population, focusing on ecological and local community perspectives.

Nursing students’ attitudes towards people with diagnosed with mental illness and mental health nursing: an international project from Europe and Australia

Abstract The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students’ attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim.