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The main aim of the thesis was to investigate the nature of as well as critically review the institutional care of young people who do not go to school.

The thesis consists of four studies. The first three studies are based on different empirical materials such as electronical journals and administrative patient databases, qualitative interviews with social workers at Child and Adolescent Psychiatry (CAP), and with managerial representatives in School, social services and CAP. The fourth study is mainly theoretical and problematizes the results from the first three studies.

The results show several problematic aspects in the institutional care of young truants. When young truants enters CAP, a quick, and sometimes without psychological investigation, categorization is made with psychiatric terminology in the form of a diagnosis, and medicines are prescribed as treatment. Further, social workers, who shall have a systemic approach on family and relationships, seem to embrace a psychiatric diagnostic understanding of the problems. At the same time, it appears that school only has extra resources to help the truants if they have a psychiatric diagnosis. Although the idea of collaboration between different professionals is that several different perspectives should be used, the results shows that CAP's psychiatric perspective dominates.

The results of what happens to young people who do not go to school is discussed as an example of a special form of medicalization, in which social difficulties and existential problems are referred to psychiatry. It appears that help for them is completely individualised, by focusing on symptoms and diagnosis. What is not visible in this unilateral individualisation, for example, are organisational and educational problems in school, system problems in the family or among friends or lack of social contacts outside the family. By referring the truant to CAP can therefore miss further social circumstances in their life situation, which can have great importance in whether they attend school or not. Therefore, it is important to problematise this process of referring everything to psychiatry and to ask questions about what situations and events have contributed to this cultural pattern, which means that people's difficulties in life are increasingly being solved with diagnosis and medications.

School non-attendence is often a sign of a complex combination of different kinds of problems, which means that these children and young people are often in need of composite help from several different types of professions within various authorities. The purpose of the study was to examine how school authorities, the Social Services and Child and Adolescent Psychiatry (BUP) collaborate in their work with young people who do not go to school. The study comprised a thematic analysis of qualitative interviews with managerial representatives of the respective authorities. The empirical material consisted of 12 qualitative interviews with heads of units at BUP (5 individuals), section managers from Social Services (3 individuals) and principals from compulsory schools (4 individuals) in three municipalities in western Sweden. According to the results, it seems problematic to manage the positions of power that may arise in collaboration between the parties. A position of power thus implies the right to make a desicion as a profession as well as activities that are related to each other. The right to make a desicion means the mandate to determine which measures should be put in place for the young people and their families. This study also shows that the parties should develop a common knowledge base that is a combination of educational, social and psychiatric perspectives. The common knowledge base can reduce the risk of power imbalance between the parties.

Utgangspunktet for denne teoretiske artikkelen er altså at forståelsen av menneskers eksistensielle lidelser og sosiale problemer, deres psykiske helse, domineres for mye av språkstilen og virkelighetsoppfatningen i psykiatrien. Hensikten med artikkelen er å presentere noen teoretiske resonnement, kunnskapsteoretiske utgangspunkter og forskningsspørsmål som kan anvendes ved sosiokulturelle studier av psykisk helse. Gjennom å analysere psykiatriens indre logikk og ytre berøringspunkter skapes kunnskap som kan anvendes for å finne en måte å forstå og hjelpe mennesker med dårlig psykisk helse bortenfor psykiatrienes kjappe løsninger med diagnoser og legemiddel. Den nye kunnskapen kan åpne muligheten for at forståelsen av menneskers eksistensielle lidelse og sosiale problemer kan føres tilbake til hverdagslivet hvor de leves ut.

The starting point for this theoretical article is that the understanding of peoples’ existential suffering and social difficulties and their mental health, are dominated too much by the language style of psychiatry. The purpose of this article is to present some theoretical reasoning, epistemological aspects and research issues that can be used for future socio-cultural studies on mental health. By analyzing psychiatry’s internal logic and external points of contact, knowledge is created that can be used to find ways to understand and help people with mental illness beyond psychiatry’s quick solutions with diagnoses and medication. The new knowledge could open up the possibility that the understanding of peoples’ existential suffering and social difficulties can be utilized in their everyday lives.

Artikeln handlar om 20 ungdomar som inte går till skolan med fokus på deras väg genom den Barn- och ungdomspsykiatriska vården. Ungdomarna i studien var mellan 13 och 17 år gamla och den omfattades av 12 flickor och åtta pojkar. Resultatet visar olika professioner inom BUP ger ungdomarna många olika diagnoser och många olika behandlingsåtgärder under en och samma vårdperiod. Vilka konsekvenser kan då detta få för ungdomarna? Det kan leda till för långa vårdperioder som ger psykisk lidande för ungdomarna, samtidigt som det påverkar deras möjligheter att fullfölja sin skolgång negativt.

The article addresses 20 adolescents who do not go to school, with a focus on their path through the Child and Youth Mental Health services (BUP). The adolescents in the study were between 13 and 17-years-old and included 12 girls and eight boys. The results show that various professions within BUP give adolescents many different diagnoses and many different treatment measures during a single treatment period. What implication does this have for the adolescents? It can lead to extremely long treatment periods that result in protracted psychological distress for adolescents, at the same time as it affects their possibilities to succeed in school negatively.

Trots den tydliga begreppsliga avgränsningen av vad stödjande samtal är och inte är, kvarstår det faktum att stödjande samtal som klinisk praxis inom Barn- och ungdomspsykiatrin (BUP) rymmer en mängd olika handlingar och förhållningssätt. Syftet med studien var att undersöka vad kuratorer inom BUP beskriver att de gör i praktiken när de har stödjande samtal med patienter och anhöriga. I denna studie intervjuades 11 yrkesverksamma kuratorer från Barn- och ungdomspsykiatrin (BUP) i västra Sverige. Fyra centrala teman beskrivs i resultatet: 1) Det värdefulla lyssnandet, 2) Arbetsallians, 3) Integrerad arbetsform, 4) Hopp. Det stödjande samtalet kan beskrivas som en behandlingsåtgärd med hög komplexitet. I åtgärden integreras grundläggande samtalsmetodik med aspekter från olika psykologiska teorier och metoder. I åtgärden integreras också kuratorns arbets- och livserfarenheter. Kuratorer inom BUP gör följande när det har stödjande samtal med patienter och anhöriga: De skapar förtroende och tillit mellan behandlare, patient och anhörig. De synliggör och bekräftar patientens psykiska lidande och de vardagsproblem som är knutna till deras svåra situation. De integrerar sina arbets- och livserfarenheter i mötet med patient och anhörig. De har en pragmatisk hållning till psykologisk teori. De inger hopp om förbättring av patientens psykiska lidande och vardagsproblem.

Supportive conversation as a clinical practice within the Child and Adolescent Psychiatric Services (CAP) accommodates a variety of actions and attitudes. The aim of this study was to examine what counsellors within CAP do when they have supportive conversations with patients and families. Eleven professional counsellors from the CAP were interviewed. Thematic analysis was chosen as the processing method of data. Four key themes were described in the results: 1) The valuable listening, 2) Work alliance, 3) Integrated working method and 4) Hope. The supportive conversations can be described as a treatment measure with high complexity. The measure integrates basic conversational methods with aspects from various psychological theories and methods. The measure also integrates the counsellor’s work and life experiences. This study introduces the concept of integrative counselling to summarise the counsellor’s work using supportive conversations within the CAP.

Begreppet kompetens har visat sig vara svårfångat i kognitiv terapi (Kazantizis 2003). Ändå är det något som vi terapeuter försöker utveckla och uppnå. Ett specifikt försök, som författarna till denna artikel har antagit är "den korrekta och skickliga användningen av en empiriskt validerad modell av terapi på ett sådant sätt att de är sannolikt att resultera i en mera klinisk signifikant förändring för patienten" (James, Blackburn, Milne & Reichelt, 2001, förf. översättning). Flera studier tyder på att både erfarenhet, utbildningsnivå och expertskattad kompetens gör skillnad i behandlingsutfall. (DeRubeis, Hollon, Amsterdam mfl., 2005; Frank, Kupfer, Wgner mfl., 1991; Trepka, Rees, Shapiro mfl., 2004).