Monica Nordström

The discretion and power of street-level bureaucrats: an example from Swedish municipal eldercare

This paper focuses on discretion in the frontline practice of social work with elderly people in Sweden. The aim is to describe and analyse how care managers in municipal eldercare use discretion and power in needs assessment and decision-making. Emanating from Lipskys concept of discretion, we identify the conditions of decision-making, which along with the concepts of structural power and intentional power constitute the theoretical framework of our analysis. Eight care managers from four Swedish municipalities were observed and interviewed. The researchers carried out 38 observations and nine in-depth interviews. The analysis led to the identification of four techniques in the decision-making process of care managers: reject, execute, transform needs and control. The consequences of these practices are discussed at the end of the paper. Denna artikel handlar om beslutsprocessen inom socialt arbete med äldre i Sverige. Syftet är att beskriva och analysera hur några biståndsbedömare inom kommunal äldreomsorg, som exempel på frontlinjebyråkrater, använder sitt handlingsutrymme och sin makt. Utifrån Lipskys begrepp handlingsutrymme, beskriver vi de villkor för beslutsfattandet som tillsammans med begreppen strukturell och intentionell makt, utgör ramen för analysen av det empiriska materialet. Åtta biståndsbedömare, från fyra svenska kommuner, har observerats och intervjuats. Sammanlagt har 38 observationer och nio djupintervjuer genomförts. I analysen framträder fyra handlingssätt i biståndsbedömarnas beslutsprocess: avvisa, expediera, omvandla behov och kontrollera. Konsekvenserna av dessa handlingssätt diskuteras avslutningsvis i artikeln. Handlingsutrymme Strukturell Och Intentionell Makt Frontlinjebyråkrater Beslutsfattande Äldreomsorg Biståndsbedömare

The roles and functions of the informal support networks of older people who receive formal support: a Swedish qualitative study

Several studies of frail older people have focused on the relationship between formal and informal care, while others have examined the character of inter-generational relationships. Yet knowledge of the significance of the informal-support networks of older people who receive formal care is still scarce. The aim of this paper was to explore how older Swedes who receive formal elder-care experienced their informal support networks. The findings presented emanate from a qualitative case study. The structural, interaction and functional dimensions of the support networks were the main analytical tools. In the study population, the size of the formal support network varied from one to 12 people (or categories of people), and the size of the informal support network varied from one to six people (or categories of people). The main results demonstrate the importance of informal support with reciprocal relationships, and the value of confidants and emotional support, both of which contribute to feelings of belonging, security and wellbeing. A well-functioning formal and informal support network allows individuals to maintain autonomy in old age, even when they have to depend on help from others.

The life circumstances of persons with a psychiatric disability: a survey in a region in southern Sweden

Accessible summary •  This article describes the life circumstances of persons with a psychiatric disability living in a region in southern Sweden. The respondents themselves describe their life circumstances in terms of their living conditions, occupation and activities, health, and formal and informal support. •  The results show that 77.5% are unmarried, which differ considerably from corresponding figures for the Swedish population in general, of whom only 34% are single. Approximately 23% reported some sort of regular work, while only 8.7% declared that they earned a salary. Nine of 10 participants reported that their income came from sickness benefits and disability pensions, which can be compared with 10% (approximately) of the general Swedish population. Ninety per cent of participants reported receiving two or three different types of support – e.g. practical, social and medical – and having extensive contacts with municipal services to help them cope with their daily lives. •  People with psychiatric disability need both formal and informal support in coping with their everyday lives. The family plays an important role and it is essential to establish cooperation between the formal and informal support systems. •  The socio-political goal of fostering access to work and gainful employment is far from having been attained. Abstract This article describes the life circumstances of persons with a psychiatric disability living in one urban and six rural areas in a single region in Sweden. Furthermore, the life circumstances of persons with a psychiatric disability are discussed in relation to the aims of social policies in Sweden. Data were collected by means of a survey study exploring the formal support provided by local authorities to its citizens and the informal support given by family members and volunteers. The results reveal how the respondents themselves describe their life circumstances in terms of their living conditions, occupation and activities, health, and formal and informal support. The results indicate that persons with a psychiatric disability, regardless of where they live, need both formal and informal support in order to cope with their everyday lives. The family plays an important role in this, and it is essential for the formal and informal support systems to cooperate with each other. The lack of activities and opportunities for work experienced by persons with a psychiatric disability indicates that the sociopolitical goal of fostering access to employment and work and to earning a living for this group is far from having been attained.This article describes the life circumstances of persons with a psychiatric disability living in one urban and six rural areas in a single region in Sweden. Furthermore, the life circumstances of persons with a psychiatric disability are discussed in relation to the aims of social policies in Sweden. Data were collected by means of a survey study exploring the formal support provided by local authorities to its citizens and the informal support given by family members and volunteers. The results reveal how the respondents themselves describe their life circumstances in terms of their living conditions, occupation and activities, health, and formal and informal support. The results indicate that persons with a psychiatric disability, regardless of where they live, need both formal and informal support in order to cope with their everyday lives. The family plays an important role in this, and it is essential for the formal and informal support systems to cooperate with each other. The lack of activities and opportunities for work experienced by persons with a psychiatric disability indicates that the sociopolitical goal of fostering access to employment and work and to earning a living for this group is far from having been attained.

Recovery-promoting Care as Experienced by Persons with Severe Mental Illness and Substance Misuse

This paper explores recovery-promoting care as experienced by persons with concomitant severe mental illness and substance misuse. Sixteen in-depth interviews, based on an interview guide concerning their experiences of health, life situation and care, were held with eight participants in an outpatient treatment programme. The analysis aimed to identify themes reflecting the diversity and complexity of the phenomenon recovery-promoting care. Six themes emerged: “entirety”, “participation and reciprocal relations”, “stability”, “symptom control”, “mindfulness”, and “dignity and autonomy”. The participants reported that care conveying experiences of meaningfulness and providing empowerment increased their motivation and their capacity to take an active part in the recovery process. The findings of the study underscore the importance of incorporating the patients’ perspectives on what promotes recovery when offering mental health services.

Support networks and social support for persons with psychiatric disabilities—a Swedish mixed-methods study

The aim of this study was to explore the structure, interaction, and function of the support networks of women and men with psychiatric disabilities. The study took a mixed-methods approach, using quantitative (n=181) and qualitative (n=42) data from a region in southern Sweden. The quantitative results showed that the respondents received widespread support of different types and from many different sources. However, the qualitative interviews revealed that many of the interviewees did not perceive the received support as supportive. The respondents’ internal resources influenced both their ability to receive support and their perception of the support. The informal and formal support sources formed the external resources of the respondents. Our interviewees often experienced formal support as conditional support, while informal support from the family was experienced as unconditional. There was thus a gap between the structure and function of the social support. This article contributes important knowledge from the perspective of persons with psychiatric disabilities.

Investigating poor insight in Alzheimer’s disease A survey of research approaches

Persons with Alzheimer’s disease (AD) often seem to have a poor insight into the functional deficits brought about by the dementing process. There are many indications that preserved insight into deficits in dementia is of advantage to a person with AD. Various research approaches have been adopted to investigate poor insight related to AD. The purpose of this article was to present various research approaches for investigating poor insight into deficits in AD. The study is based on a literature survey. The findings show that concept of poor insight has been investigated in detail from different perspectives. Each one of the perspectives found, the neuropsychological, the psychological and the socio-psychological, has its merits, but none of them has yet led to study results that make us fully understand what poor insight implies and involves. We need integrated knowledge from the different perspectives, and in multidisciplinary research settings we believe that such knowledge could be developed.

Privacy, meetings and rejections – a qualitative study of everyday life among young persons with psychiatric disabilities

Abstract This study explores how young persons with psychiatric disabilities experience everyday life according to places, social relationships and activities, using semi-structured, in-depth interviews and site-maps. Qualitative content analysis was chosen for analyzing the interviews in comparison with information from the site-maps. Respondents spent most of their time in the private arena, in their own homes, and the homes of their parents. Many also spent time in the semi-private arena, in places such as day centres and care settings. Some also spent time in the public arena, especially the neighbourhood. They experienced all three arenas both positively and negatively and associated each one with self-determination and community, as well as with demands and solitude. Young peoples activities and experiences were formed by the various arenas and by their social relationships, as well as by specific strategies for handling different situations.