Per Bülow

Psychosis and poverty : coping with poverty and severe mental illness in everyday life

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 difficulties. 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.

Long-term consequences of the reformation of psychiatric care : A 15-year follow-up study

Although there are a great many epidemiological studies of psychiatric diseases and the outcomes of controlled rehabilitation programmes, there is a shortage of studies of routine psychiatric care. This study is a retrospective cohort study of the total number ( n =138) of patients receiving inpatient care at a psychiatric rehabilitation clinic in Jönköping during 1984. The follow-up period is 15 years, 1984-98. The group had a considerable amount of inpatient care, but this decreased dramatically during the time of investigation. Positive indications were that there were no suicides during the last 5 years of the period and that the number of registered crimes showed a marked decrease from 1992. Negative indications were low levels of work and occupation and few social contacts.

The Stockholm Follow-up Study of Users Diagnosed with Psychosis (SUPP) : methodology, patient cohort and services

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.

After the Asylum? The New Institutional Landscape

AbstractDuring 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.

Structured risk assessment instruments : A systematic review of implementation determinants

Research-based structured risk assessment instruments (SRAIs) can improve violence risk assessment and clinical judgements in mental health and correctional services. Practical challenges of implementing SRAIs have led to calls for more research to understand the determinants influencing this process. Studies describing determinants for SRAI implementation in psychiatric, correctional, or community in-patient settings were systematically reviewed. Findings were analysed according to the Consolidated Framework for Implementation Research. A total of 11 studies were included. Four types of main implementation determinants were found: characteristics of the SRAI; users of the SRAI; inner setting; and process. Findings underscore the importance of applying a multifactorial approach to the implementation of SRAIs to address many different barriers and facilitators. More stringent research is needed to obtain more solid evidence of factors that impede or enable SRAI implementation, especially regarding patient perspectives and outer setting determinants. Constructing shared concepts of determinants across research fields could further aid information transferences.

Aloneness and loneliness – persons with severe mental illness and experiences of being alone

People with severe mental illness (SMI) are often described as lonely and socially incapable – an inability resulting from the mental illness. The aim of this article is to explore experiences of b ...

A time-geographic approach for visualizing the paths of intervention for persons with severe mental illness

ABSTRACT 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.

Stability of Diagnoses in a Cohort of Long-Term Mentally Ill Patients in Sweden

The aim of this study was to investigate diagnostic stability in a cohort of patients in Sweden over a 15-year follow-up period and to study the associations between diagnostic mobility and the patients’ utilization of care, their age, duration of their illness and factors related to the reorganization of psychiatric care. Information about psychiatric diagnoses was collected from medical records in all care settings utilized by the patients. There was a high level of instability. Fifty-five percent of the patients had a change of diagnosis. Age and duration of illness were the most important factors related to diagnostic stability/instability. Since the diagnosis constitutes the basis of prediction of course and outcome of the disease as well of choice of treatment, these results indicate that the current diagnostic system may have considerable limitations with regard to the clinical need for a holistic approach.

Institutional recovery: a 10-year follow-up of persons after their first psychosis diagnosis. A critical reflexive approach

ABSTRACT 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.

Staff Perceptions of Facilitators and Barriers to the Use of a Short- Term Risk Assessment Instrument in Forensic Psychiatry

ABSTRACT Prospective adverse events within forensic settings should be assessed using structured risk assessment instruments. Our aim was to identify the barriers and facilitators of a structured instrument for assessment of short-term risk within inpatient forensic psychiatric care. The instrument was piloted at a forensic psychiatric clinic. Three focus group interviews were conducted with staff. Content analysis revealed three main categories of barriers and facilitators for clinical use: implementation object, context, and users. Complexity of the instrument, insufficient continuous training and support, difficulties retrieving assessments on wards, and insecurity about translating assessments into actions were perceived barriers to clinical use. Routines for documentation improved communication and the inclusion of protective and short-term dynamic clinical factors were perceived as clinically relevant. Problem-solving ability, attitude, and motivation of staff were facilitating factors. Comprehensive risk assessment instruments require substantial support for staff to find them manageable. Systematic documentation is required to measure actual daily clinical use.