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Implementation of choice from participants' perspectives: a study of community mental healthcare reform in Sweden
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0001-9836-6446
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-6330-5640
2016 (English)In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, no 2, 116-133 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016. Vol. 15, no 2, 116-133 p.
Keyword [en]
Choice, community mental health, community mental health reform, day center, free-choice system, implementation, participants' perspectives, qualitative research
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-119917DOI: 10.1080/1536710X.2016.1162121ISI: 000387348100003PubMedID: 26959298OAI: oai:DiVA.org:umu-119917DiVA: diva2:925560
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2010-0142
Available from: 2016-05-02 Created: 2016-05-02 Last updated: 2017-05-18Bibliographically approved
In thesis
1. Choice as governance in community mental health services
Open this publication in new window or tab >>Choice as governance in community mental health services
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 2009, the Act on Freedom of Choice Systems (SFS 2008:962) wasestablished in Sweden, and this enabled municipalities to organise services aschoice models. This thesis describes and analyses the implementation of afreedom of choice system within community mental health services. Daycentre services were in focus, and a case study was conducted of a majormunicipality that sought to be a “world-class city” in regard to citizens’ choice.The experiences of policy makers, managers, professionals, and participantswere explored in interviews, and documents on a national, municipal, and citydistrict level, as well as homepages of providers of community mental healthservices, were all part of the study and were analysed using content-analysismethods.

The results showed that the freedom of choice system aimed for two objectives– improvements at the individual level and financial efficiency. In practice,financial efficiency was experienced as the main objective. Increased varietyof services was aimed for by the competitive model, but such variety was notobserved. Instead, services tended to be more similar than specialised.Concerning new providers, they were characterised as committedprofessionals running companies with strained economies. Participantsaffected by the reform expressed anxiety and worries due to theunpredictability and uncertainty embedded in the competitive choice model.Choice within the system concerned where to go, whereas participantsemphasised a wish to be able to influence the choice aspects of who carriedout the service and how much time to attend the services.

The conclusion was that the freedom of choice system was implemented as atechnology of governance to increase financial efficiency of services.Individual choice was not experienced as increased in any aspect except forthe choice of where to go. Instead, freedom of choice actually appeared todecrease due to standardisation and hierarchical structures. Aspects that werefound to be relevant when designing freedom of choice systems aiming toincrease individual freedom of choice were to address predictability andcontinuity, to address sustainable financial premises, to analyse the predictedimpact of administrative systems that are to be used, and to avoid the use of“hidden goals” in the policy-making process.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 93 p.
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 85
Keyword
freedom of choice systems, community mental health services
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-135018 (URN)978-91-7601-718-0 (ISBN)
Public defence
2017-06-09, Hörsal D, Samhällsvetarhuset, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2017-05-19 Created: 2017-05-16 Last updated: 2017-05-18Bibliographically approved

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Citation style
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