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  • 1.
    Diesfeld, Kate
    et al.
    Auckland Univ Technol, Natl Ctr Hlth & Social Eth, Auckland 1020, New Zealand.
    Doctorate, Juris
    Auckland Univ Technol, Natl Ctr Hlth & Social Eth, Auckland 1020, New Zealand.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Auckland Univ Technol, Natl Ctr Hlth & Social Eth, Auckland 1020, New Zealand.
    Interpretive flexibility: Why doesn´t insight incite controversy in mental health law?2007In: Behavioral sciences & the law (Print), ISSN 0735-3936, E-ISSN 1099-0798, Vol. 25, no 1, p. 85-101Article in journal (Refereed)
    Abstract [en]

    This research investigates how the term ‘‘insight’’was employed in 25 decisions from mental health reviewproceedings in Victoria, Australia. The application ofinsight appears problematic in these decisions. First, thereis little clarification of its meaning. Second, the logicapplied when insight is related to compliance is oftenunclear. Third, there are frequent allusions to an implicitand undefined scale of insight, offering the appearance ofobjectivity. We have analysed insight as an ‘‘interpretiveresource’’, focusing on its various functions in the complexsocial context of commitment hearings and with aview to its therapeutic jurisprudence implications.The variable application of insight—its interpretive flexibility—appears useful in addressing complex problemsfaced by review boards. Hence, a key function of insight isto bridge between legal and clinical discourses. Insight isalso a convenient means to avoid complicated debatesregarding the person’s credibility. By analysing insightin Victoria, we hope to contribute to better theoreticalunderstanding of decision-making patterns in mentalhealth law in general.

  • 2.
    Enbom, Jesper
    et al.
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Öhman, Adam
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Institutionella villkor för mediehantering: en jämförande kartläggning mellan socialtjänst, skola och polis2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Institutional conditions for news management – a survey of social services, schools and the police

    In recent years, organizations within the public sector have become increasingly attentive to how they are perceived by the public. Professional news management is primarily associated with the private sector, where the rationale has been to maximize profit and market value. For organizations under democratic authority, the ultimate goals are different. The aim of this paper is to describe and compare news management in three types of public sector organizations: school, police and social services. The three types of organizations are chosen because they appear different in some respects that might potentially affect news management.

    The paper draws on data from a national survey of all 21 Swedish regional police authorities and a representative sample of municipal school (n=90) and social service administrations (n=91) (attrition rate < 10%). Data are analyzed in terms of policies, personnel and activities.

    With the exception of a couple of small municipalities, all organizations have a systematic and professional organization for media relations. The police authorities stand out in having implemented more developed strategies. The school administrations tend to be somewhat more active in their media relations than social services.

    Differences between the types of organizations are discussed in terms of variation in institutional conditions for news management. The reason why the police stand out can be attributed to a higher newsworthiness, higher public visibility and less strict secrecy rules. We conclude that conditions relating to public interests have the most impact on the formation of news management. 

  • 3.
    Hollander, Anna
    et al.
    Department of Social Work, Stockholm University.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Defender, spokesperson, therapist: representing the true interest of the client in therapeutic law2007In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 16, no 4, p. 373-381Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to analyse the role of the legal representative in therapeutic law, specifically in Swedish administrative court hearings relating to compulsory care. Data are collected from three types of cases where a health or social welfare authority argues that it is necessary to apply coercion to a citizen: the Care of Young Persons (Special Provisions) Act, the Care of Alcohol and Drug Abusers (Special Provisions) Act and the Compulsory Psychiatric Care Act. The data consist of audio-recordings from 39 hearings, supplemented by 28 interviews with participants in these hearings, and court documents. Three primary roles of the legal representatives are identified: defender, spokesperson and therapist. We show how the primary role of the attorney becomes that of the spokesperson, but also that the role of the therapist takes precedence over that of the defender.

  • 4.
    Hollander, Anna
    et al.
    Stockholms universitet.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Röster i rätten2000In: Kulturella perspektiv - Svensk etnologisk tidskrift, ISSN 1102-7908, no 2, p. 35-40Article in journal (Other academic)
    Abstract [en]

    Voices in CourtIn the ongoing project: Therapist and adverse party- cour! hearings about coercive intervention, weanalyze the communication process in court hearingsconcerning cases where citizens are subjectedto coercive measures (compulsory care for psychiatricpatients and drug abusers, social authorities'interventions to separate children from theirparents). The primary purpose is to analyze thedilemma ofbalancing two seemingly incompatibleroles for chief psychiatrists and social workers: tobe "on the client's side" in clinical and social worksettings, while acting as a formal adverse party tothe client in the courtroom.

  • 5.
    Ineland, Jens
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Normalisering, autenticitet och reflexivitet: om iscensättande av det vanliga livet i handikappomsorg2007In: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 14, no 4, p. 266-279Article in journal (Refereed)
    Abstract [sv]

    This article attempts to elaborate on the scholarly discourse about normalisation in disability care. More specifically, the problem of imitation is addressed. The aim is to cast light on the tension between artificially created, “authentic” reality in activities that try to achieve nor-malisation for people with disability. The discussion is carried out by using examples from theatre for people with mental disability and home care for people with long-term mental ill-ness.

    Disability care in Swedish municipalities is described in terms of institutional logic. The logic of care is characterised by three sets of elements: regulative elements are made up of legislation, policy guidelines and organisational framework; normative elements like integra-tion and participation are grounded in national disability policy; cognitive elements are taken-for-granted values held by actors on the disability field, e.g. the value of work, not staying up all night, etc.

    When professionals undertake normalising activities, the logic of care is welded with a logic of everyday life. The underlying assumption appears to be that users benefit from lead-ing a life as similar to what is considered as normal as possible. The article probes deeper into two such logics, the logic of theatre and the logic of home. The logic of theatre stresses the artistic and creative elements of the work with disabled clients, which creates the opportunity to achieve alternative identities for users. The logic of home involves values such as a sense of control, the home as conveyor of identity, and providing a setting for important relations.

    Both theatre and home care involve institutional ambiguities. When welfare institutions attempt to imitate authentic everyday life, the assumption is that this would bring about posi-tive effects for clients. However, it is difficult to create this kind of authenticity within the therapeutic context of disability care – clients and outsiders are likely to see through the artifi-cial design of the situation. Occasionally, though, magic moments may occur when clients and staff engage in genuine activities that transcend the therapeutic purpose.

    However, given Giddens’ conception of late modernity, the problem of imitation may ap-pear less problematic. The design of normal-appearing environments in disability care seems to be similar to and no-less artificial than what is the case with normal people, in an age where individuals increasingly tend to reflexively create their identities.

  • 6.
    Isaksson, Cristine
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Looking for 'social work' in school social work2017In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 20, no 2, p. 191-202Article in journal (Refereed)
    Abstract [en]

    School social workers can be seen as a professional group operating on the margin of an educational logic that dominates schools as institutions. This conditions what tasks they are assigned and what aspects of social work knowledge they will find relevant. On the other hand, the role as a sole professional and relative outsider in the organization provides a potential for school social workers to transcend established theories of social work practice. This article aims to investigate how social work theory is applied in school social work. Twelve semi-structured interviews with school social workers were analysed in terms of how they relate to four knowledge approaches derived from the literature: task-centred, systems theory, strengths and anti-oppressive. Contrary to claims within the sociology of professions that social work practice is formed largely by organizational context rather than a discipline-specific knowledge base, the interviewees seemed to lean on a robust professional foundation within social work theory. Interviewees strongly emphasised their role as working for the individual pupil and positioned themselves as somewhat in opposition to a somewhat oppressive school environment.

  • 7.
    Jacobsson, Maritha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Believing and blamning the victim: Comparing rape victims with male assault victims2012In: The Normative Anatomy of Society. Relations between norms and law in the 21st century: Book of abstracts, 2012Conference paper (Other academic)
  • 8.
    Jacobsson, Maritha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Offer, minne, och utsatthet: diskurser om alkohol i våldtäkts- och misshandelsmål2016In: Tidskrift för Genusvetenskap, ISSN 1654-5443, E-ISSN 2001-1377, Vol. 37, no 4, p. 102-124Article in journal (Refereed)
    Abstract [en]

    The alcohol consumption of female rape victims is often discussed during rape trials. This has been regarded as an emblematic example of victim blaming and the failures of the legal system in relation to rape. From a feminist perspective it can be seen as an expression of the structural subordination of women in society in general.

    This article investigates the meanings attached to alcohol in written court decisions in Swedish rape trials (2008-2012). Rape trials are contrasted with assault trials, where the complainants are men. Thirty court decisions from each type of trial are compared, with the same number of guilty and not-guilty verdicts.

    Quantitative analysis reveals that alcohol consumption is mentioned more often in rape trials, where it also appears more relevant to decision-making. The complainants' consumption is mentioned four times more often than the defendants' consumption. In assault decisions, the mentioning of alcohol consumption is distributed roughly equally between the parties.  

    The analysis shows how a large proportion of the alcohol references in both rape trials and assault trials can be regarded as largely irrelevant noise. The remaining alcohol references are understood in terms of five interpretative repertoires: 1) the accuracy of memory on part of witnesses; 2) explanations of seemingly irrational behaviors; 3) vulnerability, 4) getting the victim drunk, and 5) moral character. The latter three interpretive repertoires are more common in rape decisions. As a conclusion, part of the preoccupation with rape victims’ alcohol consumption can be attributed to protectionary strategies, and should thus not be regarded as victim-blaming. However, some assessments appear to build on assumptions that information about alcohol consumption is indicative to moral character that is relevant to court decisions. 

  • 9.
    Jacobsson, Maritha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Trovärdighet i våldtäktsmål: Metodproblem i jämförelser med manliga brottsoffer2010In: Nordic Police Seminar: book of abstracts, 2010Conference paper (Other academic)
    Abstract [sv]

     

    Under senare år har rättssystemets hantering av våldtäktsmål varit föremål för kritik. Forskning har visat att få anmälda brott klaras upp och att brottsoffer ofta upplever sig ifrågasatta under polisutredning och domstolsförhandlingar. En invändning mot denna kritik är att bevisläget ofta är svårt i våldtäktsfall, särskilt om det saknas tydliga vittnesuppgifter.

     

    Vi påbörjar nu ett treårigt forskningsprojekt med det övergripande syftet att undersöka om och i så fall hur kvinnor som utsätts för våldtäkt med känd gärningsman diskrimineras i mötet med rättsapparaten. Detta syfte undersöks genom att jämföra våldtäktsmål med fall där en man utsatts för våldsbrott och frågan om offrets trovärdighet är central för bevisningen.

     

    Rättssystemets hantering av målen kommer att studeras dels i polisutredningar (förhörsprotokoll och andra utredningsdokument), dels i domstolsförhandlingar (protokoll, domar och videoupptagningar av vittnesförhör). Totalt studeras 12 våldtäktsmål och 12 med manliga brottsoffer i sin helhet, både polisutredning och domstolsförhandling och ytterligare 12 vardera av polisutredningar som inte resulterat i att åtal väckts. Därutöver genomförs intervjuer med samtliga målsäganden och ett urval av professionella.

     

    Syftet med denna presentation är att diskutera hur man bäst kan hitta mål som blir relevanta att jämföra. Det bör vara sådana där det finns en identifierad gärningsman men tydliga vittnesuppgifter och teknisk bevisning saknas – där ord står mot ord. De mål med manliga offer som vi primärt tänker oss rör sig om våldtäkt, misshandel, rån som bygger på hot, olaga hot eller övergrepp i rättssak. Problem kan finnas på flera nivåer: i validitet, dvs. om målen analytiskt är jämförbara; i frekvens, dvs. om jämförbara mål förekommer i tillräcklig utsträckning; i tillgänglighet; dvs. om det är administrativt och praktiskt möjligt att få tillgång till jämförbara mål; samt i etik, dvs. om det är etiskt försvarbart och möjligt att samla in data som är jämförbara.

  • 10.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Home bittersweet home: the significance of home for occupational transformations2011In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 57, no 3, p. 284-299Article in journal (Refereed)
    Abstract [en]

    Background: The study illuminated how persons with psychiatric disabilities experienced the processes of change in a residential context.

    Material: Qualitative interviews with residents living in supported housing were conducted and analyzed using constant comparative analysis.

    Discussion: Residential conditions appear to provide a complex structure that facilitates rehabilitative interactions, in which ‘progressive tensions’ arise between opposing values, such as authentic versus artificial, and independence versus dependence, both of which are important in the process of change.

    Conclusions: A client-centred approach could be taken further if clients are engaged in productive discussions about challenging these ‘progressive tensions’. Awareness of the meaning of home also emerged as central.

  • 11.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Responsiveness or resistance: views of community care workers encountering a new rehabilitation modelManuscript (preprint) (Other academic)
    Abstract [en]

    The importance of engagement in meaningful occupations and participation in life situations of people with psychiatric disabilities is well known. Therefore, community care workers (CCWs) in sheltered or supported housing are a key resource in the facility context. Yet, the role and views of CCWs, in facilitating or inhibiting rehabilitative opportunities for residents, is only beginning to be understood. We offered an intervention project using the Everyday Life Rehabilitation (ELR), to integrate recovery- and occupation-oriented interventions, including collaboration between occupational therapists (OT) and CCWs, into supported or sheltered housing. As one part of the intervention project, focus group interviews were conducted with 21 CCWs involved in the intervention project. The aim was to illuminate the views of CCWs working with residents partaking the Everyday Life Rehabilitation. Qualitative content analysis revealed seven categories, with associated subcategories. These categories relate to two different disability ideologies: a stabilisation oriented, and a recovery oriented approach to rehabilitation. Related to organisational aspects, we have also identified two different tensions to change: resistance, and responsiveness to the intervention. The findings have implications for the forthcoming development of housing facilities, personnel development, and rehabilitative efforts for people with severe psychiatric disability.

  • 12.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Stories of rediscovering agency: home-based occupational therapy for people with severe psychiatric disability2013In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, no 6, p. 728-740Article in journal (Other academic)
    Abstract [en]

    As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim of this article was to understand how participants make sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of ‘rediscovering agency’, referring to occupational and identity transformations. A parallel outcome article has shown positive results for participants, and by narrative inquiry we contribute with a deeper understanding of the meaning-making of their transformations and mechanisms of the intervention; i.e. hope, extended value of reaching goals, re-entering the majority world, and transparency of process and attunement to the individual. The findings support the use of the ELR-intervention.

  • 13.
    Markström, Carina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ljuslinder, Karin
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Konsensus och personifierade konflikter: problembeskrivningar av äldreomsorg i svensk dagspress2011In: Sociologisk forskning, ISSN 0038-0342, Vol. 48, no 1, p. 5-23Article in journal (Refereed)
    Abstract [en]

    Consensus and personified conflicts: Representations of elderly care issues in Swedish newspapers Elderly care issues are commonly framed in public discourse. In mass media the representations of such issues are influenced by media logic. The purpose of this paper is to describe and analyse how elderly care issues were represented in three Swedish newspapers during the first half of 2007. How were the problems characterized? How were different actors characterized and which roles were they assigned? How are conflicts of interests described? Finally, we aim to discuss how media contribute to an understanding of the complexity of elderly care as a whole. Taken together, the articles do not provide a coherent picture. However, costs, quality of care and demographic issues were common themes. The elderly were commonly represented in personal narratives about. problems that occurred when they needed elderly care. The elderly in the future are projected as more active and demanding than the elderly today. The care workers were active voices in discussions about working conditions, but absent in discussions about their education and professional identity, which was an issue commonly advocated by politicians. Many issues were represented as conflicts between the individual elderly and the care system or between care workers and their employers. More elaborated discussions about how to prioritize between different needs and demands were rare. This can be seen as examples of how the media tends to use personification, simplification and polarization as means to tell interesting stories.

  • 14.
    Näslund, Hilda
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Participatory spaces of mental health service user organizations in the post-deinstitutional era: mapping roles and challenges2018In: VOLUNTAS - International Journal of Voluntary and Nonprofit Organizations, ISSN 0957-8765, E-ISSN 1573-7888, Vol. 29, no 1, p. 190-200Article in journal (Refereed)
    Abstract [en]

    By applying the concept of participatory spaces, this article maps and analyzes current research on mental health service user organizations (MHSUOs). We have analyzed research literature from 2006 to 2016 to examine how the role of and challenges facing MHSUOs are formulated in the post-deinstitutional era. The current situation is marked by MHSUOs parallel presence in invited, claimed and popular spaces for participation. The post-deinstitutional era is characterized by a shift in focus from gaining access to such participatory spaces, to critically examining the political opportunities available in these. We further argue that the dominance of psychiatry-specific spaces could prevent MHSUOs from fully exploring their potential for participation in broader social issues. 

  • 15.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ceorcion contexts: how compliance is acheived in interaction2016In: Coercion in community mental health care: international perspectives / [ed] Andrew Molodynski, Jorun Rugkåsa, and Tom Burns, Oxford: Oxford University Press, 2016, p. 131-142Chapter in book (Other academic)
    Abstract [en]

    Until the last 50 years or so, psychiatric patients mostly interacted with clinical staff within closed institutions permeated with a paternalistic culture. The transition from hospital-based to community care marked a radical shift in treatment ideologies and the general approach to service users with mental illness. In the community we expect services to have values of participation and respect for autonomy. Staff whom patients meet in the community often have different knowledge and value systems from those primarily trained to function within institutions. Community staff may find the idea of coercing service users into complying with a treatment regime quite troubling. Accordingly, when community treatment orders (CTOs) were to be introduced in Sweden in 2008, representatives of municipal social services expressed concern that their staff would have to start using coercion. Relatively little is known about the everyday enactment of coercion in community settings. Emerging research suggests that problematic features observed in inpatient settings occur here as well: patients are not always aware of their formal status and may be subject to various kinds of informal coercion (Lambert et al. 2009; Newton-Howes and Mullen 2011; Sjöström 2012; Canvin et al. 2013). A particularly salient phenomenon is how different kinds of ‘leverages’ (Monahan et al. 2005) or ‘influencing behaviors’ (Rugkåsa et al. 2014) are brought into play to make patients under a CTO comply with things they would not otherwise have chosen (Szmukler and Appelbaum 2008). This chapter will draw upon my experience gained from a number of studies regarding coercion within Swedish mental health care over the past 20 years, both in hospital and community settings (Sjöström 1997, 2000, 2012; Zetterberg et al. 2014). The Swedish arrangements for community compulsion are similar to those in the USA, Australia, New Zealand, England and Wales, as well as other European countries such as Norway and Finland. For the purpose of discussing the practice of coercion in community settings, they are thus likely to be transferable. This chapter proposes a theoretical understanding of the micro-level interaction by which community coercion is enacted. A crucial element in analysing human interaction is the context in which it takes place. I will argue that it is meaningful to think about how staff exercise coercion in terms of how they invoke a certain kind of coercion context when interacting with people under compulsion in the community.

  • 16.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Det diffusa tvånget: patienters upplevelser av öppen tvångsvård2012Conference paper (Other academic)
  • 17.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Det diffusa tvånget: patienters upplevelser av öppen tvångsvård2012Report (Other academic)
    Abstract [sv]

    Rapporten är genomförd på uppdrag av Socialstyrelsen i samband medmyndighetens uppföljning av införandet av öppen psykiatrisk tvångsvård(ÖPT) och öppen rättspsykiatrisk vård (ÖRV). Dessa nya former av tvångsvårdinfördes den 1 september 2008 och syftar bland annat till att underlättautslussningen av patienter som vårdats med sluten tvångsvård som inte längreär behov av slutenvård.Syftet har varit att undersöka patienters upplevelser av öppen tvångsvårdutifrån tre frågeställningar:1. Vilken är patientens vardagliga upplevelse av öppen psykiatrisk tvångsvård?2. Vilken skillnad gör öppen psykiatrisk tvångsvård jämfört med andravårdformer?3. Vad gör patienter följsamma mot de särskilda villkor som ställs upp förvården?Totalt har 21 kvalitativa intervjuer genomförts, vara nio patienter överfördaenligt öppen psykiatrisk tvångsvård och tolv patienter överförda enligt öppenrättspsykiatrisk vård.

  • 18.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grindvakter och den kritiska forskningen2012In: Etiska dilemman: forskningsdeltagande, samtycke och utsatthet / [ed] Hildur Kalman och Veronica Lövgren, Malmö: Gleerups Utbildning AB, 2012, p. 146-159Chapter in book (Other academic)
  • 19.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Invocation of coercion context in compliance communication: power dynamics in psychiatric care2006In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 29, no 1, p. 36-47Article in journal (Refereed)
    Abstract [en]

    This article draws on observations from ethnographic fieldwork to develop a theoretical understanding of the power dynamics in psychiatric care. The aim is to analyze how psychiatric clinicians solve compliance problems by invoking "coercion context".

    It is suggested that clinicians take a rather instrumental approach to laws regulating coercive intervention. Clinicians may invoke a coercion context even with voluntary patients. For example, they may use wordings that connote coercion, or they may make use of how treatment wards are set up to accommodate involuntary patients, thus stalling voluntary patients who cannot exit through locked doors. A coercion context can also be invoked to solve mundane practical problems, e.g. when clinicians talk about "coerced showers". The management of information and maintaining a suitable "awareness context"with regards to coercion is an essential feature in clinical attempts to achieve compliance from patients.

    In conclusion, the notion of coercion context helps explain the confusing findings from previous research about patients' apparent misconceptions of their formal legal status. Furthermore, it is argued that research that rely on decontextualised, objectifications of "coercion" risk to miss the meaning coercion is assigned in everyday clinical practice.

  • 20.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Labelling theory2018In: Routledge International Handbook of Critical Mental Health / [ed] Cohen, Bruce M Z, Abingdon: Routledge , 2018, p. 15-23Chapter in book (Other academic)
  • 21.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Omsorgshemmet och innebörder av begreppet hem2008In: Boende och sociala sammanhang: för människor med funktionshinder / [ed] Jan Paulsson och Bibbi Ringsby Jansson, Studentlitteratur , 2008, p. 61-80Chapter in book (Other academic)
  • 22.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Patient experiences of forensic community care2011Conference paper (Other academic)
    Abstract [en]

    The paper presents findings from an ongoing project concerning compulsory community care (CCC) in Sweden. CCC was introduced for both civil and forensic patients in 2008, following a series of incidents of assault involving people with mental illness that were widely reported in mass media. The stated purpose of CCC, however, is to facilitate the transfer of inpatients to community care.

     

    Throughout the world, CCC has been controversial because it involves new ethical questions. For example, coercive measures may be invoked over longer time periods and they infringe into new and more private spheres of citizens. On an organizational level, it requires improved cooperation between health and social service providers.

     

    The objective of this paper is to investigate the experiences of forensic patients subjected to CCC. Three aspects of experiences are focused: 1) what is the everyday life experience of being under CCC? 2) How is being under CCC different from other forms of voluntary and involuntary care? 3) How is CCC affecting the ways in which compliance is achieved? The objective is reached by analysis of 12 qualitative interviews with patients.

     

    The paper notes that it is difficult for patients to separate the experience of CCC from the overall experience of psychiatric care and other forms of coercive interventions. Furthermore, it discusses the implications of some main findings: patients evaluate CCC as positive in comparison to inpatient care; patients have a poor understanding of regulations surrounding CCC; despite the label “community care”, some housing arrangements are very similar to confined institutions; patient compliance seems to be based on a culture of “sticks and carrots”.

  • 23.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Patients experiencing compulsory community care2011In: Psychiatrische Praxis, ISSN 0303-4259, E-ISSN 1439-0876, Vol. 38, no Suppl. 1Article in journal (Refereed)
    Abstract [en]

    Title:

    Patients experiencing compulsory community care

     

    Background/Objectives

     

    The paper presents findings from an ongoing project concerning compulsory community care (CCC) in Sweden. CCC was introduced in 2008 following a series of incidents of assault involving people with mental illness that were widely reported in mass media. The stated purpose of CCC, however, is to facilitate the transfer of inpatients to community care. CCC can only be initiated following compulsory inpatient care after an application to an administrative court from the treating psychiatrist. CCC typically involves coordination between psychiatry and social services, where the latter often are responsible for the day-to-day engagement with the patient.

     

    Throughout the world, CCC has been controversial because it involves new ethical questions. For example, coercive measures may be invoked over longer time periods and they infringe into new and more private spheres of citizens. On an organizational level, it requires improved cooperation between health and social service providers.

     

    The objective of this paper is to investigate the experiences of patients subjected to CCC. Three aspects of experiences are focused: 1) what is the everyday life experience of being under CCC? 2) How is being under CCC different from other forms of voluntary and involuntary care? 3) How is CCC affecting the ways in which compliance is achieved?

     

    Methods

    20 qualitative interviews are carried out with patients with prior or current experience of CCC (10 forensic, 10 civil). Interviewees are selected with the ambition to achieve variation in gender, ethnicity, diagnosis, age and type of housing. In addition, two group interviews with relatives to patients are carried out.

     

    Results

    Interviews will revolve around topics such as previous experience of formal and informal coercion, court proceedings, information from service providers, relations to professionals, perceptions of being coerced and a general evaluation of CCC. At this stage, data indicate that patients have little knowledge and understanding of the formal rules surrounding CCC. They appear to comply with medication and other provisions because of a misconception that they otherwise would be recalled to hospital

     

    Discussion/Conclusion

    The paper will explore whether the everyday perception of coercion is different with the new legislation compared to the use of long-term leave from hospital care that was applied prior to 2008. The rules about recall to inpatient care for patients under CCC have been criticized for being toothless: even if patients refrain from abiding to the special provisions set up by the court, it might be difficult to recall. From quantitative data we already know that very few patients are recalled. Nevertheless, preliminary data indicate that clinicians believe that CCC works while patients feel that they are under an obligation to abide to special provisions. The paper to explores the mechanism which induce compliance despite the relatively weak powers to enforce the treatment proposed by the treating psychiatrist.

     

    Funding:

    The project is funded by the Swedish Research Council for Working Life and Social Research.

     

  • 24.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Personliga röster om öppen tvångsvård2012Conference paper (Other academic)
  • 25.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Post-samhället, dess zombier och nya sociala problem2006In: Nordisk sosialt arbeid, Vol. 26, no 4, p. 282-292Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    This theme issue was inspired by a Nordic conference for social workers in Lillestrøm, Norway, in the spring of 2006. Different forms of societies give rise to their particular social problems and their interpretation. Hence, it is relevant to ask what general societal trends we can observe in the future and how these may cause changes in social work of the future. Some such trends are globalisation, an increase in the proportion of elderly, marketisation and limitations in the Nordic countries’ discretion to pursue traditional welfare policies. Drawing from the six articles in this issue, four overarching issues can be identified: approaches to knowledge, the social worker caught in the system, solidarity and orientation towards users.

  • 26.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Science and Social Control in Socio-Political Discourse about Outpatient Coercion2009Conference paper (Other academic)
    Abstract [en]

    In 2008, a form of outpatient coercion was introduced through a legal reform in Sweden. This paper aims to analyze the socio-political discourse leading to the change in legislation. Data are analyzed in terms of two polarities that have been recurring in discourse about mental health policy: 1) ideology-science and 2) autonomy-control.

    Regarding the ideology-science dimension, the paper asks to what extent scientific knowledge is mobilized in the debate. In the light of the long-time discussion of the nature of mental illness, one analytic theme is the relative importance of medico-biological arguments and psycho-dynamic or social psychiatric approaches.

    The autonomy-control dimension will be analyzed in the light of social theory about risk society. One particular question concerns how notions about dangerousness and certain crime incidents with high mass media coverage may have influenced the socio-political discourse.

    The paper analyses the period between 1980 and 2008. Swedish data consist of public documents such as reports from parliamentary commissions, expert hearings and legal documents, but also debate in mass media and professional journals. Swedish data are contrasted with data from three international scenes: Norway, UK and New York. Data from the other countries are drawn from legislative documents and expert interviews.

  • 27.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    TUD internasjonalt2012Conference paper (Other academic)
  • 28.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Tvång är svårt - hur ska vi då tänka och göra?2012Conference paper (Other (popular science, discussion, etc.))
  • 29.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Öppen tvångsvård - mildare eller mer ingripande?2012In: Moderna läkare, no 4, p. 16-17Article in journal (Other academic)
  • 30.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Öppen tvångsvård - vetenskap, ideologi och rättssäkerhet2012Conference paper (Other academic)
  • 31.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Enbom, Jesper
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Öhman, Adam
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Towards a Theory of News Management in Public Sector Organizations2015In: Proceedings of the 3rd International Conference on Management Leadership and Governance (ICMLG 2015) / [ed] Ingley, C, Lockhart, J, Reading: Academic Conferences Limited, 2015, p. 233-239Conference paper (Refereed)
    Abstract [en]

    This paper introduces a theoretical model for analyzing institutional conditions for news management in public sector organizations. In the wide body of empirical research covering public relations and news management, the distinction between private and public sector organization is seldom made. There is little theory development that explicitly takes account of the quite different contexts in public vs. private sector organizations. What are the specific circumstances that define news management practice in the public sector? How may such conditions vary between different types of public organizations?

    In a first part, the paper traces the history of public relations in the public sector, acknowledging that public relations research has some of its deepest roots in political communication but that there has been less interest in the organizations that provide actual services or exercise authority. The paper continues to delineate major themes and approaches within traditional public relations theory, where researchers take the perspective of the agent who wants to promote its own interests.  We argue that there is need to discuss this topic in terms of a fundamental contradiction between two rationales: serving the public’s interest to learn about all sides of organizational activities (good and bad) on the one hand, and protecting the interest of the organization itself on the other. We propose a typology of three types of institutional conditions that are particularly vital for news management in public sector organizations:

    • Governance
    • Public interest
    • Transparency

    Governance conditions relate to the involvement of politicians in executive decision-making; the role played by professionals; the degree of external competition and how organizational activities are monitored and audited. Transparency conditions relate to how clear the mission and activities appear; how visible organizational activities are to the public and the formal possibilities for management to control information. Public interest conditions relate to the general newsworthiness of organizational activities; how broadly organizational activities affect the public; the involvement of interest groups. The impact of these conditions will be illustrated by contrasting different types of public sector organizations in Sweden.

  • 32.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Hollander, Anna
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Rättssäkerheten kränks i tvångsvårdsärenden2006Other (Other (popular science, discussion, etc.))
  • 33.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hollander, Anna
    Collegiality, therapy and mediation: the contribution of experts in Swedish mental health law2017In: Laws, ISSN 0458-7251, E-ISSN 2268-1167, Vol. 6, no 1, article id 2Article in journal (Refereed)
    Abstract [en]

    Independent experts serve a vital role in how the human rights of patients are protected in mental health law. This article investigates the contribution of court-appointed psychiatrists (APs) in civil commitment court hearings. Analysis is based on 12 court hearings that were audiotaped. Supplementary informal interviews with participants were also conducted. Data were analysed through a combination of rhetoric analysis and discourse analysis. Analysis of the hearings reveals that APs do not fulfil their function to critically investigate treating psychiatrists’ (CPs) recommendations that patients meet commitment criteria. They typically do not ask any questions from CPs, and the few questions that are asked do not cast light on the legal issues at stake. To further understand the role of APs, their communication has been analyzed in terms of four interpretative repertoires: collegial, disclosing, therapeutic and mediating. In conclusion, the human rights of patients subjected to involuntary commitment might be at risk when therapeutic concerns are built into the process. The specific Swedish model where APs deliver their own assessment about whether commitment criteria are met may be counterproductive. This argument possibly extends to the role of medical members in mental health tribunals in the United Kingdom, Australia and New Zealand.

  • 34.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hollander, Anna
    Institutionen för socialt arbete, Stockholms universitet.
    Kollegialitet, terapi och medling: experters tolkningsrepertoarer i psykiatrimål2002In: Sociologisk forskning, ISSN 0038-0342, Vol. 39, no 3-4, p. 86-115Article in journal (Refereed)
    Abstract [sv]

    This article investigates the role of court appointed psychiatrist’s (AP) in Swedish court hearings relating to compulsory psychiatric care. Data consist of taperecordings and documents from twelve court hearings together with informal interviews with actors in court.

    The discourse in court is analysed in terms of interpretative repertoires. The possibility for APs to examine each case is limited by shortage of time and resources. Furthermore, APs may have to take into account an out-of-court, professional relationship to the treating psychiatrist (CP). We find that conversation between APs and CPs frequently are carried out in a collegiate repertoire. These circumstances inhibit a detailed critical examination of the CP’s application for compulsory care, which in turn helps explaining why APs seldom assess cases different from CPs.

    This raises the question of how APs’ status as experts is reproduced in courtroom conversation. This is accomplished by using a disclosing repertoire, which invites the patient to produce incoherent talk. Expert status is also reproduced when APs give medical advise to patients in a therapeutic repertoire. Applying a mediating repertoire, APs attempt to resolve clinical conflicts between CPs and patients. As a result, the legal conflict at stake is downplayed.

  • 35.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Jacobsson, Maritha
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hollander, Anna
    Kollegialitet, terapi och medling: expertgranskning i psykiatrimål2003In: Sociologisk forskning, ISSN 0038-0342, no 3-4, p. 86-115Article in journal (Refereed)
  • 36.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Zetterberg, Liv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Why community compulsion became the solution: reforming mental health law in Sweden2011In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 34, no 6, p. 419-428Article in journal (Refereed)
    Abstract [en]

    The aimof this article is to understand how compulsory community care (CCC) has become a solution in mental health policy in so many different legal and social contexts during the last 20 years. The recent introduction of CCC in Sweden is used as a case in point, which is then contrasted against the processes in Norway, England/Wales and New York State. In Sweden, the issue of CCC was initiated following high-profile acts of violence. Contrary to several other states, therewas agreement about the (lack of) evidence about its  effectiveness. Rather than focusing on dangerousness, the government proposal about CCC was framedwithin an ideology of integrating the disabled. The new legislation allowed for a broad range ofmeasures to control patients at the same time as itwas presented as a means to protect positive rights for patients. Compared to previous legislation in Sweden, the scope of social control has remained largely the same, although the rationale has changed — from medical treatment via community treatment and rehabilitation, to reducing the risk of violence, and then shifting back to rehabilitation in the community. The Swedish approach to CCC is similar to Norway, while New York and England/Wales have followed different routes. Differences in ideology, social control and rights orientations can be understood with reference to the general welfare and care regimes that characterize the four states.

     

  • 37.
    Sjöström, Stefan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Öhman, Adam
    What if an investigative journalist calls? Media relations in social workIn: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263XArticle in journal (Refereed)
    Abstract [en]

    This article aims to investigate to what extent social service organizations (SSOs) conceive news management as a means to promote organizational self-interest as opposed to achieving democratic openness.

     

    The study is based on a nationally representative telephone survey with persons responsible for communication or public relations in Swedish SSOs (n=91). Against the background of descriptive statistics, the aim is pursued by qualitative analysis of four open-ended questions.

     

    The literature on the relations between social work and media has largely painted a negative picture. This study suggests a different image. The statistical analysis of survey data revealed that respondents were largely satisfied with their relations to journalists.

     

    It is concluded that increasingly professionalized news management in SSOs has largely served the function of protecting organizational self-interest, at the expense of democratic openness. This is expressed in how respondents talked in terms of promoting the positive aspects of organizational performance, how they applied a marketing perspective and how the goal of addressing criticism was to deflect it rather than embrace the potential it had for improving performance. This approach is problematic and scholars and practitioners alike need to be more detached from the interests of the social work profession and its organizations.

  • 38.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markstom, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjostrom, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Risk management or improving the life for the patient?: Court rulings concerning compulsory community care in Sweden2011In: Psychiatrische Praxis, ISSN 0303-4259, E-ISSN 1439-0876, Vol. 38Article in journal (Refereed)
  • 39.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Translating coercion policy into inter-organisational collaboration: the implementation of compulsory community care for people with mental illness2016In: Journal of Social Policy, ISSN 0047-2794, E-ISSN 1469-7823, Vol. 45, no 4, p. 655-671Article in journal (Refereed)
    Abstract [en]

    In 2008, compulsory community care (CCC) for people with severe mental illness was introduced in Sweden. CCC requires co-operation between psychiatric and social services, thus further complicating the longstanding difficulties with service coordination in the mental health field.

    This article investigates what happens when a new policy is introduced that assumes complex co-operation of two organisations bestowed with high degrees of discretion. The process of institutionalisation will be analysed in terms of how an idea is translated and materialised on local levels. This has been investigated by interviewing key informants within psychiatric and social services at three different locations.

    The implementation was perceived as relatively successful and occurred without major conflict. The main effect of the new legislation was improvement in the coordination of services, where designing a template form for a coordinated care plan was central. The inter-organisational discussions about service coordination that arose had a spill-over effect on services for other patient groups.

    In essence, respondents describe CCC as a pedagogical reform to promote the coordination of services, rather than a reform to increase coercive powers over patients. This raises concerns about the legitimacy of the reform.

  • 40.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The compliant court: procedural fairness and social control in compulsory community care2014In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 37, no 6, p. 543-550Article in journal (Refereed)
    Abstract [en]

    Compulsory community care (CCC) was introduced in Sweden in 2008. This article investigates all written court decisions regarding CCC over a 6 month period in 2009 (N = 541). The purpose is to examine how the legal rights of patients are protected and what forms of social control patients are subjected to. 51% of CCC patients are women and 84% are being treated for a psychosis-related disorder. In the court decisions, only 9% of patients are described as dangerous to themselves, while 18% are regarded a danger to others. The most common special provisions that patients are subjected to are medication (79%) and a requirement that they must maintain contact with either community mental health services (51%) or social services (27%). In the decisions, both the courts and court-appointed psychiatrists agree with treating psychiatrists in 99% of cases. Decisions lack transparency and clarity, and it is often impossible to understand the conclusions of the courts. There is considerable variation between regional courts as regards the provisions to which patients are subjected and the delegation of decision-making to psychiatrists. This means that decisions fail to demonstrate clarity, transparency, consistency and impartiality, and thus fail to meet established standards of procedural fairness. Surveillance techniques of social control are more common than techniques based on therapy or sanctions. Because of the unique role of medication, social control is primarily imposed on a physical dimension, as opposed to temporal and spatial forms. The article concludes that patients are at risk of being subjected to new forms of social control of an unclear nature without proper legal protection.

  • 41.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bengtsson, Nils-Olof
    Lobotomins okända historia: kvinnor, barn och idioter opererades2000In: Läkartidningen, Vol. 97, no 30-31, p. 3395-3398Article in journal (Other academic)
  • 42.
    Öhman, Adam
    et al.
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Enbom, Jesper
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The development of news management in the public sector: A survey of social services, schools and the police2015Conference paper (Refereed)
    Abstract [en]

    In recent years, organizations within the public sector have become increasingly attentive to how they are perceived by the public. Professional news management is primarily associated with the private sector, where the rationale has been to maximize profit and market value. For organizations under democratic authority, the ultimate goals are different. The aim of this paper is to describe and compare news management in three types of public sector organizations: schools, the police and social services. The three types of organizations are chosen because of differences in that might potentially affect news management. The paper draws on data from a national survey of all 21 Swedish county police authorities and a stratified randomized sample of municipal school and social service administrations, which represents all 290 Swedish municipalities. Data are analyzed in terms of personnel and activities. With the exception of a couple of small municipalities, all organizations do have a an organizational foundation for media relations, often as a distinct organizational unit with specialized staff. The police authorities stand out in having implemented more developed strategies. The school administrations tend to be somewhat more active in their media relations than social services. Differences between the types of organizations are discussed in terms of variation in organizational conditions for news management. The reason why the police stands out as more strategic can be attributed to a higher newsworthiness, higher public visibility, less strict secrecy rules and a more distinct mission that is easier to asses. We conclude that conditions relating to public interests have the most impact on the formation of news management.

1 - 42 of 42
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