Despite the ideological direction described in Swedish legislation, which emphasizes rehabilitation and the right to participation in community life “as all others”, the development of recovery oriented services has been sluggish. The authors question whether the comprehensive welfare system, which includes many potential supports to the recovery process, might begin to redefine the service structures and professional cultures which frame the experience of individuals seeking support. Methods
A recently completed national research project included a series of surveys of community-based need related to serious psychiatric impairment, interviews with municipal service providers and documentation studies. The surveys included non-traditional, generic services and supports, in order to collect data from a broader population than those exclusively in contact with formal mental health services. The overall aim of the study was to investigate the meeting between individuals experiencing serious psychiatric impairments and welfare system structures, including but not limited to, community- based mental health services.
Up to 50% of those identified in the surveys avoided contact with formal mental health services. They instead, in many cases, utilized generic community services in order to satisfy their self-defined need for support to participate more actively in community life. Jobs, studies, social contacts and other natural community involvements were not seen as being supported by the mental health system, which tended to categorize need based on a medically-based care paradigm. A lack of rehabilitation and recovery-oriented services was also experienced by the majority of active clients.
Knowledge of recovery may be utilized to analyze and explain the manner in which individuals negotiate their contact with traditional mental health services. The research studies presented here describe areas of need related to participation in community life and possibilities for recovery that service systems working from a care paradigm are not currently prepared to address.