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Näslund, H., Sjöström, S. & Markström, U. (2019). Delivering experiential knowledge: repertoires of contention among Swedish mental health service user organisations. Nordic Social Work Research
Open this publication in new window or tab >>Delivering experiential knowledge: repertoires of contention among Swedish mental health service user organisations
2019 (English)In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588Article in journal (Refereed) Epub ahead of print
Abstract [en]

The aim of this article is to map the field of Swedish mental health service user organisations (MHSUOs) with a focus on organisational characteristics, positions and relationships. This mapping enables us to discuss these organisations’ repertoires of contention and their connections to governmental actors. Annual reports, organisational by-laws, and financial reports were collected for each of the 12 MHSUOs and the two network organisations that were included in the study. The empirical material was analysed according to the organisations’ size, activities, target groups, relationships and main knowledge base. Developments towards professionalization and hybridisation are evident within the field, and repertoires of contention are focused on advocacy and educational activities, with organisations providing experiential knowledge as a service to external actors. We further discuss how close ties to governmental actors and a consensus-oriented approach is related to risks of failure in recognising the conflicts that social mobilisation presupposes. It is crucial to strengthen MHSUOs independence, financial and otherwise, in order for these organisations to remain responsive to demands from the collective of service users.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Mental health, service user organisation, hybridisation, experiential knowledge
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-156997 (URN)10.1080/2156857X.2019.1583599 (DOI)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-03-15
Fjellfeldt, M. & Markström, U. (2019). Development of a Swedish community mental health service market. Nordic Social Work Research (1), 72-84
Open this publication in new window or tab >>Development of a Swedish community mental health service market
2019 (English)In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, no 1, p. 72-84Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine changes in an organizational field over time when implementing a freedom of choice model. Main focus was on the range and characteristics of providers and services. Our findings suggest that the expected effects of the reform in terms of variety of providers and services within the organizational field did not materialise due to a lack of market competition. Providers complemented each other rather than competed with each other, and the logics of care, choice, and advocacy challenged each other within the quasi-market. All informants described financial conditions in the market as extremely strained. Strong personal commitment characterized providers entering and exiting the market. A gap was found between policy goals and experiences among stakeholders, and efficiency was found to be the policy goal achieved most often in practice. This raises the questions of how the Swedish community mental health service market will develop in the future and what the implications are for the participants.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
mental health, social policy, choice model
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-150580 (URN)10.1080/2156857X.2018.1491011 (DOI)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-02-27Bibliographically approved
Johansson, S., Markström, U. & Bejerholm, U. (2019). Enabling the return-to-work process among people with affective disorders: a multiple-case study. Scandinavian Journal of Occupational Therapy, 26(3), 205-218
Open this publication in new window or tab >>Enabling the return-to-work process among people with affective disorders: a multiple-case study
2019 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 26, no 3, p. 205-218Article in journal (Refereed) Published
Abstract [en]

Background: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.

Methods: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.

Results: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.

Conclusion: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Return to work, sick leave, affective disorders, supported employment, case study
National Category
Psychiatry Social Work
Identifiers
urn:nbn:se:umu:diva-141615 (URN)10.1080/11038128.2017.1396356 (DOI)000463112800005 ()29078724 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-05-23Bibliographically approved
Nouf-Latif, F., Andersson, K. & Markström, U. (2019). Encouraging real or make-believe citizen-workers?: Narratives of self-realization versus disabling support-to-work contexts by individuals with High Functioning Autism. Alter;European Journal of Disability Research ;Journal Europeen de Recherche Sur le Handicap, 13(2), 126-140
Open this publication in new window or tab >>Encouraging real or make-believe citizen-workers?: Narratives of self-realization versus disabling support-to-work contexts by individuals with High Functioning Autism
2019 (English)In: Alter;European Journal of Disability Research ;Journal Europeen de Recherche Sur le Handicap, ISSN 1875-0672, E-ISSN 1875-0680, Vol. 13, no 2, p. 126-140Article in journal (Refereed) Published
Abstract [en]

Sweden, like other Western countries, has a disability legislation that coexists with the Active Labour Market Policies. ALMP address a discourse emphasizing the importance of the able and productive ‘citizen-worker’, who is expected to crafthis/her own success through meaningful personal goals and ambitions. This discourse also impacts disability groups who are actualized for support-to-work interventions, such as people with high-functioning autism (HFA). The objective of this paper is to analyse how narratives targeting ambitions and self-realisation in work life are expressed by individuals with HFA in relation to the citizen-worker discourse. This ethnographic study comprises 26 qualitative interview narratives by 11 participants with HFA. Findings indicate that the participants have developed a strong citizen-worker identity. The will is an essential point of gravity, expressed through notions of individual meaningfulness and ambitions of being perceived as resources in any vocational context. Barriers to these ambitions are experienced as personally counteractive support-to-work practices. These results suggest that disability legislation and policies are caught in a mantra of stagnating normalisation, resulting in disability-worker interventions that are incompatible with meanings emphasized in the citizen-worker discourse, which is the new ‘normal’ of today.

Abstract [fr]

À l’instar d’autres pays occidentaux, la Suède a une législation sur le handicap qui coexiste avec les politiques d’activation sur le marché du travail. Le discours de ces dernières met l’accent sur le « citoyen-travailleur », compétent et productif, dont on attend qu’il réussisse en réalisant ses ambitions et des objectifs qui leurs soient personnels et auxquels ils attachent du sens. Ce discours touche aussi les groupes de personnes handicapées qui bénéficient d’aide à l’emploi, par exemple les personnes atteintes d’autisme de haut niveau de fonctionnement. En lien avec ce discours sur le citoyen-travailleur, l’article propose d’analyser comment ces personnes expriment leurs ambitions et rendent compte de la réalisation d’elles-mêmes dans la vie professionnelle. Cette étude ethnographique est constituée de 26 entretiens qualitatifs, menés avec 11 participants atteints d’autisme de haut niveau de fonctionnement. Les résultats montrent que les participants se sont approprié une forte identité de citoyen-travailleurs. La volonté joue un rôle central, elle s’exprime via les notions de sens personnel et d’ambition à être considéré comme une ressource, quel que soit le contexte professionnel. Les pratiques qui s’opposent aux mesures d’aide au travail sont perçues comme des obstacles à la réalisation de ces ambitions. Nos résultats suggèrent que la législation et les politiques du handicap restent prises dans l’éternel mantra de la normalisation, ce qui aboutit à des interventions auprès des travailleurs handicapés difficilement compatibles avec le sens valorisé par le discours du citoyen-travailleur, nouveau standard contemporain du « normal ».

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Citizen-worker, High functioning autism, Inclusion, Self-realisation, Vocational rehabilitation, Work
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-157714 (URN)10.1016/j.alter.2019.03.001 (DOI)000467422900005 ()
Note

French title: Encourager des citoyens-travailleurs réels ou imaginaires ? Accomplissement de soi et aide à l’emploi dans les récits de personnes atteintes d’autisme de haut niveau de fonctionnement

Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-06-18Bibliographically approved
diva2:1331797
Open this publication in new window or tab >>Hälsa, jobb och gemenskap: om hur välfärdssystemet bäst stöttar personer med psykisk funktionsnedsättning
2019 (Swedish)In: Funktionsnedsättning i arbetsliv och välfärd: rapport från forskarseminariet i Umeå 16-17 januari 2019, Stockholm: Försäkringskassan , 2019, p. 49-58Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Försäkringskassan, 2019
Series
Socialförsäkringsrapport, ISSN 1654-8574 ; 2019:1
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-161098 (URN)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-07-01Bibliographically approved
Bergmark, M., Bejerholm, U. & Markström, U. (2019). Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services. Social Work in Mental Health, 17(2), 129-148
Open this publication in new window or tab >>Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services
2019 (English)In: Social Work in Mental Health, ISSN 1533-2985, E-ISSN 1533-2993, Vol. 17, no 2, p. 129-148Article in journal (Refereed) Published
Abstract [en]

This study analyses the implementation and sustainability of evidence-based community mental health services in the form of publicly financed Individual Placement and Support programs. Critical implementation components and program fidelity were assessed after one year. After two years, program fidelity was assessed once again. After three years, the programs’ sustainability was assessed and semi-structured interviews performed, in order to deepen the understanding of implementation. Interviews and documents provided the quantitative and qualitative data, which were analyzed by the use of the Supported Employment Fidelity Scale, the Sustainable Implementation Scale (which was developed in a connecting study), and qualitative content analysis. Despite promising fidelity results after one year, eight out of 14 programs were terminated within three years. Implementation of integrated evidence-based programs in community-based settings is a delicate undertaking. Implementing agencies can benefit from rigorous preparation before program start, especially concerning the circumstances at the organizational level, such as making plans for collaboration, financing and assessments of program fidelity.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Community mental health, evidence-based, implementation, IPS, practice, Psychosocial
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-143118 (URN)10.1080/15332985.2018.1511500 (DOI)000469988700001 ()2-s2.0-85053301348 (Scopus ID)
Funder
Swedish National Board of Health and Welfare, 33716/2011
Note

Originally included in thesis in manuscript form.

Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2019-06-20Bibliographically approved
Fjellfeldt, M. & Markström, U. (2019). Nationell styrning och lokal respons: en implementeringsstudie av länsgemensamt arbete för psykisk hälsa. Umeå: Institutionen för socialt arbete, Umeå universitet
Open this publication in new window or tab >>Nationell styrning och lokal respons: en implementeringsstudie av länsgemensamt arbete för psykisk hälsa
2019 (Swedish)Report (Other academic)
Abstract [sv]

Utifrån statens och SKLs Överenskommelse "Stöd till riktade insatser inom området psykisk hälsa" har Sveriges län under 2016 och 2017 formulerat länsgemensamma strategier och handlingsplaner. I denna rapport presenteras en studie av hur tre kommuner arbetat med handlingsplanerna i sina lokala sammanhang. Kommunerna har valts ut utifrån de länsgemensamma handlingsplanernas karaktär, kommunens geografiska placering och invånarantal. En så stor variation som möjligt eftersträvades. 18 nyckelpersoner intervjuades. I den lilla kommunen karaktäriserades arbetet av att anpassas till ett lokalt behov av att arbeta med psykisk hälsa i relation till integration av nyanlända personer. Ett starkt engagemang hos personer på chefsposition inom detta område beskrevs som av vikt, såväl som möjligheten att kunna söka och få del av externa medel för arbete med psykisk hälsa inom just detta område. Den lilla kommunens små ekonomiska resurser utifrån fördelningsprincipen i Överenskommelsen innebar att alternativa ekonomiska lösningar aktualiserades för att kunna arbeta i linje med handlingsplanens mål. Förutsättningen att externa medel finansierade verksamheten påverkade inriktningen på det arbete som var möjligt att genomföra.I den mellanstora kommunen pågick sedan länge ett folkhälsoarbete till vilket den nya satsningen som rörde befolkningens psykiska hälsa kunde knytas. Det fanns sedan tidigare folkhälsostrateger som kunde ta sig an uppgiften, och uppbyggda nätverk inom vilka satsningen kunde materialiseras. Detta innebar att implementeringsprocessen i denna kommun fick en tydlig folkhälsoprägel.I den stora kommunen fanns sedan tidigare ett väletablerat nätverksarbete uppbyggt mellan brukarorganisationer, kommun och landsting beträffande arbete med personer med komplex eller svår psykisk problematik. I denna kommun landade därför satsningen i en lokal kontext där det fanns drivande aktörer som förespråkade att arbetet skulle inriktas på den målgrupp som upplever störst konsekvenser av psykisk ohälsa. Den ambition som fanns i kommunen beträffande arbete med denna målgrupp bedömdes inte vara uppnådd, och arbetet utifrån handlingsplanen fokuserade därför företrädesvis på att fortsätta att arbeta med denna målgrupp, även om ytterligare initiativ lokalt också togs inom ramen för satsningen.Studien visade att implementeringsprocessen i de tre kommunerna hade en starkt lokal prägel. De slutsatser som kan dras utifrån studiens resultat är att den nationella styrningen med en låg grad av konflikt beträffande vad som skulle göras – främja befolkningens psykiska hälsa - kombinerat med en hög grad av otydlighet beträffande hur detta mål ska nås innebar att kontextuella förutsättningar var av avgörande betydelse för implementeringsprocessen. Kommunens historia och traditioner, vilka aktörer som engagerade sig på lokal nivå, vilka resurser som ställdes till förfogande, vilka lokala projekt som sedan tidigare var påbörjade och som föll inom ramen för handlingsplanens mål, samt vilka nätverk och samverkansstrukturer som tidigare byggts upp, var av avgörande betydelse för den lokala implementeringsprocessens utveckling.

Place, publisher, year, edition, pages
Umeå: Institutionen för socialt arbete, Umeå universitet, 2019. p. 43
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-159721 (URN)
Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2019-06-12Bibliographically approved
diva2:1292239
Open this publication in new window or tab >>Service user entrepreneurs and claims to authority: a case study in the mental health area
2019 (English)In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664Article in journal (Refereed) Epub ahead of print
Abstract [en]

Mental health service user movements have historically to a large extent employed collective forms of mobilisation, where people with service user experience have joined in formal organisations or informal groups. Currently, expressions of service user engagement are changing, and we can now observe the growth of more individualised expressions, often enacted online. This article introduces the concept ‘service user entrepreneur’ (SUE), that relates to this development. SUEs are individuals with service user experience who have made a career of their engagement in mental health issues. Based on their individual narratives of mental ill-health, SUEs often express themselves in participatory media, hold lectures and write books on the subject. The aim of this article is to examine how SUEs in their communication establish authority. Applying case study methodology, we follow four Swedish SUEs involved in mental health issues and analyse their communication primarily in digital arenas. Intimate personal narratives, mobilisation of collectives and institutional perspectives constitute authority sources for SUEs. Balancing individual and collective narratives as well as maintaining a desirable level of vulnerability is a continuous effort. How SUEs manage these issues is further discussed.

Keywords
Mental health, service user entrepreneur, authority, participatory media
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-156799 (URN)10.1080/13691457.2019.1580249 (DOI)
Available from: 2019-02-27 Created: 2019-02-27 Last updated: 2019-02-28
Bergmark, M., Bejerholm, U., Svensson, B. & Markström, U. (2018). Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment. International Journal of Integrated Care, 18(4), 1-11
Open this publication in new window or tab >>Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment
2018 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 18, no 4, p. 1-11Article in journal (Other academic) Published
Abstract [en]

Introduction: There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative.

Methods: Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The “Sustainable Implementation Scale” helped to identify critical implementation components, and these were further explored using the qualitative interview data. The “Tool for Measuring Assertive Community Treatment” addressed programme fidelity, and the initiative’s sustainability was assessed.

Results: High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members’ characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model’s characteristics and existing organisational traditions and regulations.

Discussion and Conclusions: Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.

Place, publisher, year, edition, pages
Ubiquity Press, 2018
Keywords
Integrated Care, Mental Health Services, Evidence-based Practice, Assertive Community Treatment, Implementation, Case Management
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-143121 (URN)10.5334/ijic.3547 (DOI)
Funder
Swedish National Board of Health and Welfare, 33716/2011
Note

Originally included in thesis in manuscript form 

Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2019-01-14Bibliographically approved
Bergmark, M., Bejerholm, U. & Markström, U. (2018). Critical Components in Implementing Evidence-based Practice: A Multiple Case Study of Individual Placement and Support for People with Psychiatric Disabilities. Social Policy & Administration, 52(3), 790-808
Open this publication in new window or tab >>Critical Components in Implementing Evidence-based Practice: A Multiple Case Study of Individual Placement and Support for People with Psychiatric Disabilities
2018 (English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 52, no 3, p. 790-808Article in journal (Refereed) Published
Abstract [en]

When developing Community Mental Health Services to support people with psychiatric disabilities, European countries are advocating evidence-based practice (EBP). Individual Placement and Support (IPS) is an evidence-based model designed to support people in acquiring and maintaining competitive employment. Implementation science is a growing research field, with a focus on components that impact the process of implementing EBP programmes. In this multiple case study, we have followed three IPS demonstration sites for two years, in order to describe and analyze barriers and facilitators for implementation, according to constructs described in the Consolidated Framework for Implementation Research (Damschroder et al. 2009). The results highlight the importance of strategic networking, as well as the need for planning and preparations carried out before the start of an EBP programme, since deficiencies related to these constructs are difficult to compensate for.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Community mental health, Implementation, Evidence-based practice, Individual placement and support, Severe mental illness, Organizational settings
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-124616 (URN)10.1111/spol.12243 (DOI)000430084700014 ()2-s2.0-84994574735 (Scopus ID)
Available from: 2016-08-17 Created: 2016-08-17 Last updated: 2018-09-28Bibliographically approved
Projects
Mental health service user movements post de-institutionalization ? forms of organization and attitudes to services [2015-00414_Forte]; Umeå UniversityHousing and living environments for people with psychiatric disabilities. Aligning social services and housing planning through experimental collaborative practices. [2018-01325_Forte]; Umeå UniversityResearch communication aimed at nursing and caring staff in the field of elderly and disability care and their managers [KOM18-1359:1_RJ]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6330-5640

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