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  • 1.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Frames for choice and market characteristics - a Swedish case study of community mental health services in change2015In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 5, no 3, p. 227-243, article id 1059772Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and analyse structural frames for choice, as well as characteristics of a free-choice market, implemented in community mental health services in Sweden. Day centres were focused. A case study was conducted. Documents were collected and semi-structured interviews were conducted with twenty-eight agents involved in the implementation process. Content analysis of data showed that users’ freedom of choice was influenced by detailed regulation. Freedom of choice was extended, but it was also substantially reduced. The gain or loss of freedom of choice depended on which aspects of the system were emphasised. Features, which could be interpreted as paternalistic, were once again structurally embedded, despite a system addressing individual freedom of choice. Further, the market did not seem to be adjusted for the average user of community mental health services.

  • 2.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds universitet.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Freedom of choice or cost efficiency?: the implementation of a free-choice market system in community mental health services in Sweden2016In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 2, p. 129-141Article in journal (Refereed)
    Abstract [en]

    This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.

  • 3.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds Universitet.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The implementation of a Free-choice Market System in Swedish Community Mental Health Services by the Example of Day Centres2014In: Jubilee Congress 50 years WASP World Association of Social Psychiatry, London, November 13-15, 2014., 2014Conference paper (Refereed)
    Abstract [en]

    Marketization in community mental health services is a new phenomenon and might be the most comprehensive reform in the field since the deinstitutionalisation that occurred during the second half of the twentieth century. Historically, mental health services have been characterized by discipline and paternalistic practices.There has been an absence ofwhat is now, due to the new organizational model based on individual freedom of choice, is to be introduced.

     

    The aim of this study was to investigate the implementation of a free-choice market system in community mental health services, using the example of day centres for people with psychiatric disabilities. The study was conducted in a major city that was about to implement a free-choice market system due to a new legislation.

     

    Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top-down political process. The policy intentions of the new Act were in focus when studying the relation between policy and practice during the implementation process. A majority of the policy intentions of the new Act advocated individual autonomy as the market system’s main purpose, only one intention concerned organizational efficiency. Interview data reflected, however, that financial efficiency dominated the agents’ experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, when managers mainly focused on the market as a resource allocator.

  • 4. Bejerholm, Ulrika
    et al.
    Areberg, Cecilia
    Hofgren, Caisa
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Rinaldi, Miles
    Individual placement and support in Sweden: a randomized controlled trial2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    Background: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. Aims: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. Methods: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. Results: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. Conclusions: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.

  • 5. Bengtsson-Tops, Anita
    et al.
    Hansson, Lars
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bjarnason, Olafur
    Korkeila, Jyrki
    Merinder, Lars
    Nilsson, Liselotte
    Sørgaard, Knut Wollo
    Vinding, Hanne R
    Middelboe, Thomas
    Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: a Nordic multicentre study.2005In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 14, no 1, p. 221-9Article in journal (Refereed)
    Abstract [en]

    Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected.

  • 6. Björkman, Tommy
    et al.
    Hansson, Lars
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial.2002In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 37, no 4, p. 147-52Article in journal (Refereed)
    Abstract [en]

    SCM failed to improve clinical and social outcome compared to standard care, but was more successful in reducing days spent in hospital, and the clients were also more satisfied with the service compared to standard care.

  • 7.
    Dahlqvist-Jönsson, Patrik
    et al.
    Department of Research, Region of Halland.
    Schön, Ulla-Karin
    Dalarna University.
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Svedberg, Petra
    Halmstad University.
    Service users' experiences of participation in decision making in mental health services2015In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 22, no 9, p. 688-697Article in journal (Refereed)
    Abstract [en]

    Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.

  • 8. Diderichsen, F
    et al.
    Allebeck, P
    Bexell, A
    Hammarström, A
    Hansson, B S
    Hallqvist, J
    Janlert, U
    Lynöe, N
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Westerling, R
    [The challenges of social medicine: improved public health and effective health policy demand strong and unified social medicine].1990In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 87, no 1-2, p. 48-9Article in journal (Refereed)
  • 9.
    Edin, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Diskriminerad och psykiskt störd: självupplevd behandling bland psykiatrins patienter2013In: Psykisk hälsa, ISSN 0033-3212, Vol. 54, no 4, p. 57-64Article in journal (Refereed)
  • 10.
    Eklund, Mona
    et al.
    Lund, Sweden.
    Gunnarsson, A. Birgitta
    Lund, Sweden; Unit for Research and Development, Kronoberg County Council, Växjö, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Leufstadius, Christel
    Lund, Sweden.
    Effectiveness of an intervention to improve day centre services for people with psychiatric disabilities2014In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 61, no 4, p. 268-275Article in journal (Refereed)
    Abstract [en]

    Background/aim: Day centres for people with psychiatric disabilities need to be evaluated for effectiveness in order to provide the best possible support. This study aimed at investigating the effectiveness of a tailor-made intervention to improve day centre services for people with psychiatric disabilities.

    Methods: The intervention was devised to bridge identified gaps in the services and lasted for 14 months. Eight centres were allotted to the intervention (55 attendees) or comparison condition (51 attendees). Fidelity to the intervention and major events in the day centres were assessed. The outcomes were degree of meaningfulness found in the day centre occupations, satisfaction with the rehabilitation received, satisfaction with everyday occupations and quality of life.

    Results: The fidelity to the intervention was good, but more positive events, such as new occupational opportunities, had taken place in the comparison units. No differences were identified between the intervention and the comparison group regarding changes from baseline to the 14-month follow-up in perceived meaningfulness among day centre occupations, satisfaction with everyday occupations or quality of life.

    Conclusions: The intervention seemed ineffective, but the positive events in the comparison group resembled the measures included in the tailor-made interventions. This first intervention study in the day centre context has hopefully helped to generate hypotheses and methods for future research.

  • 11. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Predictors of valued everyday occupations, empowerment and satisfaction in day centres: implications for services for persons with psychiatric disabilities2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 582-590Article in journal (Refereed)
    Abstract [en]

    This study addresses predictors of occupational value, empowerment and satisfaction with the rehabilitation received in day centres for people with psychiatric disabilities. These outcomes represent varying aspects of relevance for the day centre context and together create a manifold outcome picture. This was a longitudinal study with approval from the regional research vetting board. Self-report instruments were used, and the investigated predictors motivation for going to the day centre, occupational engagement, socio-demographic factors and self-reported diagnosis. Attendees (N = 108) at 8 day centres participated and filled in self-report questionnaires regarding the predictor and outcome variables. A baseline measurement and a 14-month follow-up composed the data. Occupational engagement at baseline could predict all three outcomes at the follow-up. Motivation for the day centre activities and not preferring work before attending the day centre were positive for satisfaction with the day centre. A low participation rate, although comparable with previous studies on the target group, was a limitation of this study. To conclude, both occupational engagement and motivation are factors that can be stimulated by the staff in day centres. Actions for how to accomplish that, and thereby also more positive outcomes of the day centre services, are proposed, such as a system of freedom of choice among day centres, and between day centres and supported employment.

  • 12. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The life situation of people with persistent mental illness visiting day centers: a comparative study2012In: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 48, no 5, p. 592-597Article in journal (Refereed)
    Abstract [en]

    This study compared the life situation of visitors of day centers (DC) for people with mental illness (N = 93) with a comparison group (N = 82) in respect of sociodemographic and clinical characteristics, care consumption, well-being and everyday activities. The response rate was 49%, and those who declined are believed to be those with the most severe psychiatric disabilities. Most individuals were single (81%/78%) and few had children (12%/18%). The DC group had less education than the comparison group but had a friend more often. Although having their need for daily activities met, the DC group had greater unmet needs in respect of daily living in general. They less frequently reported having a psychosis and had fewer negative and more depressive symptoms. They got more housing support and general outpatient care, while the comparison group used specialized psychiatric care more frequently. The samples were equally satisfied with their care, health and well-being and found their everyday activities equally meaningful. The DC visitors formed a vulnerable group, by living single, having a low level of education and having unmet needs, and were at risk of not getting specialized psychiatric care.

  • 13. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Work experiences among attendees of day centres for people with psychiatric disabilities2016In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 53, no 2, p. 377-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is possible that people with psychiatric disabilities who visit day centres have previous work experiences that may be seen as resources for their current engagement in day centre activities. Research in this respect seems to lack, however.

    OBJECTIVE: To investigate work experiences among attendees at day centres for people with psychiatric disabilities and relationships with current type of day centre (work-oriented, meeting place-oriented or mixed), engagement in day centre activities, motivation and socio-demographic and health-related factors.

    METHODS: Seventy-seven attendees responded to questionnaires. Global Assessment of Functioning, GAF, was also used. Work was categorised into Group I (professionals, semi-professionals), Group II (clerical support, services workers) and Group III (e.g. craft workers, elementary occupations).

    RESULTS: Almost everyone had previously had open-market employment; more than half for ≥10 years. Group I was more common in mixed centres, Group II in meeting place-oriented ones and Group III in work-oriented ones. Group I more frequently had college degree and was rated high on GAF functioning. Women were over-represented in Group II, and men in Group III and in meeting place-oriented centres. Attending mixed centres was more likely when having a college degree, scoring high on GAF functioning and being highly engaged in activities. Attendees at work-oriented day centres were characterised by being motivated for spending time alone and reporting a diagnosis of psychosis.

    CONCLUSIONS: The participants had unused working capacity. No clear-cut relationships were found between work experiences and the investigated correlates.

  • 14. Eklund, Mona
    et al.
    Tjörnstrand, Carina
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Argentzell, Elisabeth
    Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness - a cluster RCT study2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 363Article in journal (Refereed)
    Abstract [en]

    Background: Many with a mental illness have an impoverished everyday life with few meaningful activities and a sedentary lifestyle. The study aim was to evaluate the effectiveness of the 16-week Balancing Everyday Life (BEL) program, compared to care as usual (CAU), for people with mental illness in specialized and community-based psychiatric services. The main outcomes concerned different aspects of subjectively evaluated everyday activities, in terms of the engagement and satisfaction they bring, balance among activities, and activity level. Secondary outcomes pertained to various facets of well-being and functioning. It was hypothesized that those who received the BEL intervention would improve more than the comparison group regarding activity, well-being and functioning outcomes.

    Methods: BEL is a group and activity-based lifestyle intervention. CAU entailed active support, mainly standard occupational therapy. The BEL group included 133 participants and the CAU group 93. They completed self-report questionnaires targeting activity and well-being on three occasions – at baseline, after completed intervention (at 16 weeks) and at a six-month follow-up. A research assistant rated the participants’ level of functioning and symptom severity on the same occasions. Non-parametric statistics were used since these instruments produced ordinal data.

    Results: The BEL group improved more than the CAU group from baseline to 16 weeks on primary outcomes in terms of activity engagement (p < 0.001), activity level (p = 0.036) and activity balance (p < 0.042). The BEL group also improved more on the secondary outcomes of symptom severity (p < 0.018) and level of functioning (p < 0.046) from baseline to 16 weeks, but not on well-being. High intra-class correlations (0.12–0.22) indicated clustering effects for symptom severity and level of functioning. The group differences on activity engagement (p = 0.001) and activity level (p = 0.007) remained at the follow-up. The BEL group also improved their well-being (quality of life) more than the CAU group from baseline to the follow-up (p = 0.049). No differences were found at that time for activity balance, level of functioning and symptom severity.

    Conclusion: The BEL program was effective compared to CAU in terms of activity engagement. Their improvements were not, however, greater concerning other subjective perceptions, such as satisfaction with daily activities and self-rated health, and clustering effects lowered the dependability regarding findings of improvements on symptoms and functioning. Although the CAU group had “caught up” at the follow-up, the BEL group had improved more on general quality of life. BEL appeared to be important in shortening the time required for participants to develop their engagement in activity and in attaining improved quality of life in a follow-up perspective.

  • 15.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Zingmark, Karin
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions2016In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 28, no 4, p. 321-338Article in journal (Refereed)
    Abstract [en]

    Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.

  • 16.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Towards a method for clinical ethics support to promote inter-professional communication about ethically difficult care situations: observations of an interventionManuscript (preprint) (Other academic)
    Abstract [en]

    Background Studies show that healthcare professionals need inter-professional clinical ethics support (CES) to communicate and reflect on ethically difficult care situations. Internationally, various CES-interventions have been performed, but the communication process and the organisation of CES are sparsely described in the literature. The CES intervention observed in this study was inspired by Habermas’ theory of communicative action and involved healthcare professionals meeting inter-professionally to discuss value conflicts to achieve a common understanding and arrive in agreement about how to act and relate. The communication of value conflicts during a series of sessions in this CES - intervention has been described in a previous study. To further develop a clearly described theory-based CES-method it is important to increase knowledge about the conditions that can promote communication of value conflicts. The aim of this study was therefore to explore the organisational and communicative conditions of a CES intervention with the intention to promote interprofessional communication about ethically difficult care situations.

    Methods Eight audio- and video-recorded CES sessions were conducted over a period of eight months. The observations were transcribed and sorted by using the video analysis tool Transana and analyzed with concept and data-driven content analysis methods.

    Results The findings show the CES organization as an integrated framework, providing both a given structure and openness for variation, as conditions for facilitating the communication of value conflicts. The structure consisted of both constancy and flexibility. The given structure provided constancy while the openness for variation provided flexibility. The combination of constancy and flexibility generated bot safety, and stability for a free and dynamic dialogue, and opened up for responsiveness and creativity to find proposals for actions. As courses of actions to reach communicative agreement were the approaches of a permissive communication, extended views and mutual understanding found.

    Conclusion The results showed CES as an integrated framework with a given structure and openness for variations as conditions to reach a communicative agreement. The findings constitute a step towards a clearly described CES method based on Habermas theory of communicative action. Extended intervention studies with different kinds of data needs to be conducted in order to fully develop the method and get increased knowledge about how to promote a dialogue about ethically difficulties.

  • 17.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Nursing, Ersta Sköndal University College, Stockholm, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Zingmark, Karin
    Communicative and organizational aspects of clinical ethics support2019In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, no 16, p. 724-733Article in journal (Refereed)
    Abstract [en]

    Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

  • 18.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    County Council of BD, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlqvist, Vera
    Ethically difficult situations in hemodialysis care: nurses' narratives2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 6, p. 711-722Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.

    RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.

    RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.

    PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.

    ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.

    RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.

    DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.

    CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

  • 19.
    Fjellfeldt, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementation of choice from participants' perspectives: a study of community mental healthcare reform in Sweden2016In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, no 2, p. 116-133Article in journal (Refereed)
    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.

  • 20.
    Forsberg, Karl A
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11-12, p. 1519-1528Article in journal (Refereed)
    Abstract [en]

    Improving physical health with lifestyle programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

  • 21.
    Forsberg, Karl Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. The Vårdal Institute, the Swedish Institute for Health Sciences, Lund.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Influence of a life style intervention among persons with a psychiatric disability: a cluster randomised controlled trial on symptoms, quality of life and sense of coherence2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11-12, p. 1519-1528Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim of this study was to investigate how a life style intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities.

     Background: Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at life style interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities.

    Design: a cluster randomised controlled trail.

    Methods: Forty one persons with a DSM- ІV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12 month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance.

    Results: A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up.

    Conclusions: Structured activities in the form of life style intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence.

    Relevance to clinical practice: Improving physical health with life style programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

  • 22.
    Forsberg, Karl Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Physical health: a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6, p. 486-495Article in journal (Refereed)
    Abstract [en]

    The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities, and their caregivers. Their satisfaction with the intervention was also assessed. Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known. Few randomized controlled trials have been aimed specifically at lifestyle issues among persons with a psychiatric disability. This trial includes clients with psychiatric disabilities living in supported housing and their staff. Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005-2006 in Sweden. The supported housing facilities with residents and staff were randomly assigned to either a health intervention programme or a control programme with an aesthetic content. The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c, P-glucose, P-insulin, lipids, blood pressure, physical working capacity, body mass index, Heart Score were investigated and participants' satisfaction assessed. There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up. The participants expressed satisfaction with the programme. The results indicate that health interventions on lifestyle issues when involving carers are appreciated, feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities.

  • 23. Forsberg, Karl-Anton
    et al.
    Johansson, M
    Åhman, K
    Borgstedt, M
    Karlsson, EC
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hälsa och ett liv i balans för personer med psykisk funktionsnedsättning: en arbetsbok för dig som coachar2012 (ed. 1)Book (Refereed)
  • 24.
    Forsberg, Karl-Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy Nils
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 357-364Article in journal (Refereed)
    Abstract [en]

    Lifestyle changes that affect physical and psychological health are described in research literature; however, the meaning of participating in a lifestyle intervention programme together with the staff has not been described. This study illuminates meanings of participating in a lifestyle programme as experienced by persons with psychiatric disabilities. The first author interviewed five women and six men with schizophrenia and depressive syndrome, aged 26-53, participating in a lifestyle programme. The transcribed interviews were analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. Meanings of participating in a lifestyle programme include my health can be improved as both the physical effects and the obstacles are considered and the daily life is partially given a changed content in new experiences and by participating in something to take pride in. The meanings of participating together with the staff mean an increased sense of closeness and equality with the staff expressed in changes in relationships and the difference between the two groups being revealed and also in becoming aware of the life situation, an insight into the loss of a healthy life but also hope for the future is expressed. The conclusions that could be drawn from this study are that a lifestyle intervention affects health and other important life areas such as the content of daily life and the relationship with the carers, which appears to affect the sense of hope and the ability to see new possibilities. Carers should find situations and activities where the residents and carers participate under equal conditions giving the residents the opportunity to leave the sick roll, experience equality and develop good relationships.

  • 25. Grunewald, Karl
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    [The child or the bathing water? - The psychiatry reform again]2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 6, p. 496-8Article in journal (Refereed)
  • 26. Grunewald, Karl
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    [The psychiatric reform was necessary! Normalized life conditions for tens of thousands of persons].2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 4, p. 307-8Article in journal (Refereed)
  • 27.
    Gustafsson, Carina
    et al.
    Institute for Evidence-Based Social Work Practice, Sweden .
    Öjehagen, Agneta
    Lund University, Sweden.
    Hansson, Lars
    Lund University, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyström, Marie
    Institute for Evidence-Based Social Work Practice, Sweden.
    Glad, Johan
    Institute for Evidence-Based Social Work Practice, Sweden.
    Cruce, Gunilla
    Lund University, Sweden.
    Jonsson, Ann-Kristin
    National Board of Health and Welfare, Sweden.
    Fredriksson, Maja
    National Board of Health and Welfare, Sweden.
    Effects of psychosocial interventions for people with intellectual disabilities and mental health problems: A survey of systematic reviews2009In: Research on social work practice, ISSN 1049-7315, E-ISSN 1552-7581, Vol. 19, no 3, p. 281-290Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to provide a survey of systematic reviews that have evaluated the effects of psychosocial interventions for adult people with intellectual disabilities and/or an autistic syndrome with concurrent mental health problems. Reviews for inclusion were identified through searches of 10 electronic databases. The authors found that 3 out of 126 published reviews met the inclusion criteria for interventions, population, and being considered a systematic review. The results imply a weak scientific support for behavioral therapy, cognitive-behavioral therapy, and some forms of integrated care and support. However, the primary studies included in the reviews have several methodological shortcomings. The results suggest future research initiatives in the direction of more effectiveness studies of good quality and reproduction of high-quality systematic reviews.

  • 28. Hansson, L
    et al.
    Christiansen, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Göstas, G
    Zandrén, T
    Lindhardt, A
    Saarento, O
    Oiesvold, T
    The Nordic Comparative Study on Sectorized Psychiatry. Part V. Contact rates, contact patterns and care level at index contact.1997In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 32, no 1, p. 12-8Article in journal (Refereed)
    Abstract [en]

    As part of a Nordic comparative study on sectorized psychiatry in seven Nordic catchment areas, a prospective investigation of contact rates of new patients and pathways to the psychiatric services was performed. The results showed that there was more than a twofold difference between the services in the total contact rates. Regarding diagnostic groups, contact rates for neurosis were predominant in three of the services, while adjustment disorders, dependencies and personality disorders were predominant in other the services. The contact rate of functional psychosis, as well as the ratio of psychotic patients to the total contact rate were highest in two catchment areas serving inner parts of big cities. The most common way of getting into contact with the services was by self-referral, 39.4% of total referrals, followed by primary care referrals, although there were large differences between the services. Psychotic patients made contact with the services to a significantly less extent by self-referral. The majority of patients were treated in outpatient care at entry to the services, with a large variation between the services. It was also found that inpatient care at index contact was predicted by clinical characteristics-a diagnosis of psychosis and a history of former inpatient care-as well as by social characteristics-male, widowed or divorced, sick pension/old age pension.

  • 29. Hansson, L
    et al.
    Middelboe, T
    Merinder, L
    Bjarnason, O
    Bengtsson-Tops, A
    Nilsson, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sourander, A
    Sørgaard, K W
    Vinding, H
    Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study.1999In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 45, no 4, p. 247-58Article in journal (Refereed)
    Abstract [en]

    As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.

  • 30. Hansson, L
    et al.
    Middelboe, T
    Sørgaard, K W
    Bengtsson-Tops, A
    Bjarnason, O
    Merinder, L
    Nilsson, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Korkeila, J
    Vinding, H R
    Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings.2002In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 106, no 5, p. 343-50Article in journal (Refereed)
    Abstract [en]

    People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not.

  • 31. Hansson, L
    et al.
    Muus, S
    Saarento, O
    Vinding, H R
    Göstas, G
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Zandrén, T
    Oiesvold, T
    The Nordic comparative study on sectorized psychiatry: rates of compulsory care and use of compulsory admissions during a 1-year follow-up.1999In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 34, no 2, p. 99-104Article in journal (Refereed)
    Abstract [en]

    There was a great variation in rates of compulsory care. No consistent rural-urban pattern in rates of commitment was found. It is discussed whether a formal referral procedure to the psychiatric service is associated with higher rates of compulsory care.

  • 32. Hansson, L
    et al.
    Muus, S
    Vinding, H R
    Göstas, G
    Saarento, O
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lönnerberg, O
    Oiesvold, T
    The Nordic Comparative Study on Sectorized Psychiatry: contact rates and use of services for patients with a functional psychosis.1998In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 97, no 5, p. 315-20Article in journal (Refereed)
    Abstract [en]

    As part of a Nordic comparative study on contact rates of new patients and use of services in seven catchment areas, contact rates and use of services for patients with a functional psychosis during a 1-year follow-up period were investigated. The highest contact rates were found in two large city catchment areas in Stockholm and Copenhagen. Compared to other patients in the cohorts, patients with a functional psychosis were more often found to be unemployed and living alone. They also showed more extensive service use in terms of both voluntary and compulsory admissions, and in the use of day-care facilities. In addition, they were more often multiple users of in-patient care (> or =3 admissions during the follow-up period). Large differences in service use among patients with a functional psychosis were discovered between the catchment areas, with the most extensive use of voluntary in-patient care and day-care facilities in Frederiksberg. Patients most frequently had compulsory admissions in Bodö and least frequently had them in Frederiksberg. Out-patient services were most frequently used in Stockholm. Correlations between levels of resources and use of services for patients with a functional psychosis were in general low, except for the rates of short-term beds, which showed a strong and significant correlation with the number of days in voluntary in-patient care (r=0.89).

  • 33. Hansson, L
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Utilization and patterns of care in comprehensive psychiatric care organizations. A review of studies and some methodological considerations.1992In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 86, no 4, p. 255-61Article in journal (Refereed)
    Abstract [en]

    This article reviews and analyzes studies on the utilization of care and patterns of care in psychiatric care organizations with a defined catchment area responsibility. Eight studies fulfilled the inclusion criteria. The main results of the studies were reviewed with regard to distribution of utilization, typical patterns of care, sociodemographic characteristics, clinical characteristics and, when appropriate, organizational characteristics related to utilization. The results show that a small proportion of patients use a large proportion of resources. Sociodemographic factors such as living alone or having no occupation in some of the studies predicted a higher utilization. Only one study reported sex differences, men being more common among heavy users. In most of the studies a psychosis diagnosis predicted a higher utilization. A history of prior contacts with psychiatric care predicted a higher utilization in 2 studies. It is concluded that future studies should make efforts to develop standardized models of classification of patterns of care to enhance possibilities of comparisons. Cost, as a common unit for summarizing and comparing resource utilization, has not been used, but is viewed as a highly relevant measure. Furthermore, measures of utilization should be separated from evaluations of outcome or quality of care. However, the latter is a neglected area that should also be promoted in studies of utilization of psychiatric care to create knowledge of the relationship of utilization to outcome.

  • 34. Hansson, L
    et al.
    Vinding, H R
    Mackeprang, T
    Sourander, A
    Werdelin, G
    Bengtsson-Tops, A
    Bjarnason, O
    Dybbro, J
    Nilsson, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sørgaard, K
    Middelboe, T
    Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.2001In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 103, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

  • 35. Hansson, Lars
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bengtsson-Tops, Anita
    Bjarnason, Olafur
    Karlsson, Hasse
    Mackeprang, Torben
    Merinder, Lars
    Nilsson, Liselotte
    Sørgaard, Knut
    Vinding, Hanne
    Middelboe, Thomas
    The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study.2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 1, p. 5-11Article in journal (Refereed)
    Abstract [en]

    The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.

  • 36.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lynöe, Niels
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [The ethics of clinical training - must patients cooperate?]1990In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 87, p. 1168-1170Article in journal (Refereed)
  • 37. Kjellin, Lars
    et al.
    Andersson, Kristina
    Bartholdson, Erik
    Candefjord, Inga-Lill
    Holmstrom, Helge
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Wallsten, Tuula
    Östman, Margareta
    Coercion in psychiatric care: patients' and relatives' experiences from four Swedish psychiatric services2004In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 58, no 2, p. 153-159Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore possible regional differences in the use of coercion in psychiatric care as experienced by patients and relatives. At four psychiatric care settings in different parts of Sweden, 138 committed and 144 voluntarily admitted patients were interviewed at admission using the Nordic Admission Interview. At discharge or, if the care episode was still ongoing, after 3 weeks of care, a follow-up patient interview and an interview with 162 relatives of these patients took place. In one of the centers, where involuntarily admitted patients were treated without locking the doors of the wards, the patients reported less coercion at admission than in the other three centers. Regarding the patients' reports of the use of coercive measures, personal treatment and outcome of care, and concerning the relatives' experiences, few differences were found between centers among committed and voluntarily admitted patients, respectively. Coercion in psychiatric care, as reported by patients and relatives, was not always legally based, and many of the patients reported they felt violated during the admission process. Only a minority of patients and relatives reported participation in treatment and care planning, as regulated by law. Still, a majority of both committed and voluntarily admitted patients reported they had been well treated by the personnel at admission as well as during the stay at the ward, and that they had been improved in their mental health after the psychiatric care episode.

  • 38. Larsson, Gerhard
    et al.
    Wiklund, HansSandlund, MikaelUmeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Missbruket, kunskapen och vården: missbruksutredningens forskningsbilaga : delbetänkande2011Collection (editor) (Refereed)
  • 39.
    Larsson, Johannes
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stigma vid psykisk sjukdom: vad betyder svaren på attitydfrågor?2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 2, p. 293-302Article in journal (Refereed)
    Abstract [sv]

    Stereotypier, fördomar och diskriminering är grundpelare i den moderna stigmadefinitionen. Studier har visat att det sker en stigmatisering av personer med psykisk sjukdom. Vår studie syftade till att utforska relationen mellan de attitydbilder som postenkäter ger och den som ges vid intervjuer. En slumpvis utvald grupp fick svara på enkäter och sedan intervjuas. I enkäterna besvarades de positivt betonade påståendena runt kunskapsfrågor och generositet instämmande, och de negativt betonade avståndstagande. Intervjuerna gav liknande svar, men med betoning på orsaker till dessa attityder. De svarande hade egen erfarenhet av personer med psykisk sjukdom. Resultatet visar att attitydbilden överensstämmer mellan metoderna. Intervjuer ger möjliga förklaringar till attityderna. En positiv relation likt vänskap uppväger de negativa förställningarna förenade med psykisk sjukdom.

  • 40.
    Lieber, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit, Luleå, Sweden.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Öhlund, Louise
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundqvist, Robert
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Sunderby Research Unit, Luleå, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit, Luleå, Sweden.
    Lithium-associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study2019In: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, article id UNSP 0269881119882858Article in journal (Refereed)
    Abstract [en]

    Background: The association between lithium and thyroid dysfunction has long been known. However, it remains unknown if lithium-associated hypothyroidism is reversible once lithium treatment has been stopped.

    Aims: To determine whether lithium-associated hypothyroidism was reversible in patients who subsequently discontinued lithium.

    Methods: A retrospective cohort study in the Swedish region of Norrbotten into the effects and side- effects of lithium treatment and other drugs for relapse prevention (Lithium – Study into Effects and Side Effects). For this particular study, we reviewed medical records between 1997 and 2015 of patients with lithium-associated hypothyroidism who had discontinued lithium.

    Results: Of 1340 patients screened, 90 were included. Of these, 27% had overt hypothyroidism at the start of thyroid replacement therapy. The mean delay from starting lithium to starting thyroid replacement therapy was 2.3 years (SD 4.7). In total, 50% of patients received thyroid replacement therapy within 10 months of starting lithium. Of 85 patients available for follow-up, 41% stopped thyroid replacement therapy after lithium discontinuation. Only six patients reinstated thyroid replacement therapy subsequently. Of these, only one had overt hypothyroidism.

    Conclusions: Lithium-associated hypothyroidism seems reversible in most patients once lithium has been discontinued. In such cases, thyroid replacement therapy discontinuation could be attempted much more often than currently done. Based on the limited evidence of our study, we can expect hypothyroidism to recur early after thyroid replacement therapy discontinuation, if at all.

  • 41. Lindgren, Stefan
    et al.
    Petersson, Göran
    Bergenbrant Glas, Susanne
    Sandlund, Mikael
    Läkaresällskapet svarar Åke Thörn och medförfattare: E-hälsa kan vara bra ibland, men löser inte alla problem i vården2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id EU3FArticle in journal (Other academic)
  • 42.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Lucero, Nancy M.
    Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Blom-Nilsson, Marcus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nyström, Siv
    National Board of Health and Welfare, Stockholm, Sweden.
    Carver-Roberts, Tabitha
    Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Immigration Status and Substance Use Disorder-related Mortality in Sweden2019In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227Article in journal (Refereed)
    Abstract [en]

    Objectives: First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

    Methods: A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

    Results: Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

    Discussion: Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.

  • 43.
    Lundgren, Lena
    et al.
    Boston University School of Social Work Center for Addictions Research and Services.
    Wilkey, Catriona
    Boston University School of Social Work Center for Addictions Research and Services.
    Chassler, Deborah
    Boston University School of Social Work Center for Addictions Research and Services.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Kerstin
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Brännström, Jan
    Integrating addiction and mental health treatment within a national addiction treatment system: Using multiple statistical methods to analyze client and interviewer assessment of co-occurring mental health problems2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 1, p. 59-79Article in journal (Refereed)
    Abstract [en]

    AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data from the ASI Interviewer Severity Rating (ISR) score were used to develop a K-means cluster analysis with three client cluster profiles: Narcotics (n=4795); Alcohol (n=4380); and Alcohol and Psychiatric Problems (n=3658). Chi-square and one-way ANOVA analyses identified self-reported mental health problems for these clusters. RESULTS - 44% of clients had a history of using outpatient mental health treatment, 45% reported current mental health symptoms, and 19% reported significant mental health problems. Women were 1.6 times more likely to report significant mental health problems than men. Staff assessed that 74.8% of clients had current mental health problems and that 13.9% had significant mental health problems. Client and staff results were congruent in identifying that clients in the Alcohol profile were less likely (5%) to report having significant mental health problems compared to the other two profiles (30% each). CONCLUSIONS - About 19% of clients with SUDs reported significant mental health problems, need integrated addiction and mental health treatment, and these clients are clustered in two population groups. An additional 25% of the addiction treatment population report current mental health symptoms and have at some point used mental health treatment. This national level assessment of the extent and severity of co-occurring disorders can inform decisions made regarding policy shifts towards an integrated system and the needs of clients with co-occurring disorders.

  • 44. Lundvik Gyllensten, Amanda
    et al.
    Svensson, Bengt
    Björkman, Tommy
    Hansson, Lars
    Leufstadius, Christel
    Bejerholm, Ulrika
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Östman, Margareta
    Eklund, Mona
    Brunt, David
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Attitudes in healthcare students towards mental illness: a pre- and post multicenter university program study2011In: The Internet Journal of Allied Health Sciences & Practice, ISSN 1540-580X, E-ISSN 1540-580X, Vol. 9, no 3Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to investigate the effects of naturalistic educational interventions on attitudes towards persons with mental illness. Methods: In a pre-post test design, 456 students in vocational University programmes to become nurses, social workers, occupational therapists, physiotherapists, psychologists, and public health workers were studied after a course in mental illness, using questionnaires focusing on familiarity with mental illness and attitudes towards the mentally ill in general and towards schizophrenia in particular. Results: The results revealed a significant improvement for the total group in their being afraid of people with mental illness in general and being more positive towards having mentally ill people living in their neighbourhood. Differences between the student groups were found. Some educational features positively influencing stigmatizing attitudes were identified. Conclusion: Education has some effect on attitudes towards patients with mental illness, mostly on fear. To understand the effective educational ingredients for change, further research is needed.

  • 45. Lynöe, N
    et al.
    Mattsson, B
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The attitudes of patients and physicians towards placebo treatment--a comparative study.1993In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 36, no 6, p. 767-74Article in journal (Refereed)
    Abstract [en]

    Placebo treatment in clinical practice can be given either in order to comply with the wishes of the patient, or with the purpose of doing good and not causing harm. In the former instance, the procedure may be in accordance with the interests of the patient, yet be in conflict with the interests of the medical profession. In the latter instance, the procedure presupposes that in most cases the patient has not been informed of the nature of the treatment; this type of procedure may jeopardize a trusting patient-doctor relationship. Therefore, it is of interest to investigate both the extent to which patients and physicians feel they can accept placebo treatment and a paternalistic attitude, and in which particular situations. In order to shed some light on this matter, we compiled a questionnaire built around three case histories which problematize placebo treatment and paternalistic acts. The questionnaire was distributed to 100 patients and 100 physicians. 83 patients and 94 physicians responded. The results show that patients and physicians do not automatically follow specific group interests. Physicians are more inclined to respect the patient's option to refuse medical treatment than the patients are inclined to respect a physician's professional autonomy. Patients appear more to be paternalistic in their judgements than physicians, but one cannot rule out the possibility that the answers of the physicians reflect the fact that placebo treatment represent a socially undesirable behaviour. We conclude that theoretical and normative analyses of the perspective of the actors ought to be supplemented by empirical research.(ABSTRACT TRUNCATED AT 250 WORDS)

  • 46. Lynöe, N
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [An inquiry shows that guidelines on patient participation in clinical training are necessary].1992In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 89, no 50, p. 4407-9Article in journal (Refereed)
  • 47. Lynöe, N
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ethical and educational aspects of clinical training. A study in the experience and attitudes of medical students.1995In: Scandinavian journal of social medicine, ISSN 0300-8037, Vol. 23, no 3, p. 216-9Article in journal (Refereed)
  • 48. Lynöe, N
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [Research ethics in practice. Research ethics committees do not guarantee the right to informed consent].1992In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 89, no 25, p. 2292-4Article in journal (Refereed)
  • 49. Lynöe, N
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Westberg, K
    Duchek, M
    Informed consent in clinical training--patient experiences and motives for participating.1998In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 32, no 5, p. 465-71Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to assess patients' attitudes to and experiences of participating in the clinical training of medical students. Samples of patients (n = 582) selected at random from six different departments (gynaecology, psychiatry, internal medicine, paediatrics, urology and a health care centre with general practitioners) were interviewed by means of a questionnaire. The patients were selected from those who had consulted the actual departments in the last six months of 1995. Four hundred and forty-one patients (76%) answered the questionnaire. Seventy-one per cent of all patients had experience of participating; of these 41% had estimated that they had once or several times participated without being informed. Eighty per cent felt aggrieved if they were not informed. On average 88% were, in principle, positive to participating. Of those who were, in principle, negative a majority had negative experiences of participating. Elderly patients tended to accept participating more often without being informed. Almost all patients seemed to be positive to participating in the education of medical students, although a silent precondition might be that patients should be informed and given the opportunity to abstain.

  • 50.
    Lynöe, Niels
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Boman, Karin
    Andersson, Håkan
    Sandlund, Mikael
    Informed consent and participants' inclination to delegate decision-making to the doctor.2004In: Acta Oncol, ISSN 0284-186X, Vol. 43, no 8, p. 769-Article in journal (Refereed)
123 1 - 50 of 108
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