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  • 1.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Santosa, Ailiana
    School of Public Health and Community Medicine, University of Gothenburg, Medicinaregatan 18A, Gothenburg, Sweden.
    Zetterberg, Liv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Kawachi, Ichiro
    Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, MA, Boston, United States.
    Ng, Nawi
    School of Public Health and Community Medicine, University of Gothenburg, Medicinaregatan 18A, Gothenburg, Sweden.
    Social capital and sustainable social development - how are changes in neighbourhood social capital associated with neighbourhood sociodemographic and socioeconomic characteristics?2021In: Sustainability, E-ISSN 2071-1050, Vol. 13, no 23, article id 13161Article in journal (Refereed)
    Abstract [en]

    The development of social capital is acknowledged as key for sustainable social development. Little is known about how social capital changes over time and how it correlates with socio-demographic and socioeconomic factors. This study was conducted in 46 neighbourhoods in Umeå Municipality, northern Sweden. The aim was to examine neighbourhood-level characteristics associated with changes in neighbourhood social capital and to discuss implications for local policies for sustainable social development. We designed an ecological study linking survey data to registry data in 2006 and 2020. Over 14 years, social capital increased in 9 and decreased in 15 neighbour-hoods. Higher levels of social capital were associated with specific sociodemographic factors, but these differed in urban and rural areas. Urban neighbourhoods with a higher proportion of older pensioners (OR = 1.49, CI: 1.16–1.92), children under 12 (OR= 2.13, CI: 1.31–3.47), or a lower proportion of foreign-born members (OR= 0.32, CI: 0.19–0.55) had higher odds for higher social capital levels. In rural neighbourhoods, a higher proportion of single-parent households was associated with higher levels of social capital (OR = 1.44, 95% CI = 1.04–1.98). Neighbourhood socioeconomic factors such as income or educational level did not influence neighbourhood social capital. Using repeated measures of social capital, this study gives insights into how social capital changes over time in local areas and the factors influencing its development. Local policies to promote social capital for sustainable social development should strive to integrate diverse demographic groups within neighbourhoods and should increase opportunities for inter-ethnic interactions.

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  • 2. Santosa, Ailiana
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zetterberg, Liv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Study Protocol: Social capital as a resource for the planning and design of socially sustainable and health promoting neighbourhoods: A mixed method study2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 581078Article in journal (Refereed)
    Abstract [en]

    Introduction: Promoting inclusive, safe, resilient, and sustainable communities is one of the 17 Sustainable Development Goals ratified in 2015 by 193 UN member states, not least in Sweden. Social sustainability involves preserving particular societal values (e.g., local identity) as well as developing values (e.g., social cohesion) that are perceived as needed. Socially sustainable development also implies promoting integration and preventing segregation. Social capital is one important indicator to measure how socially sustainable an area is. This project aims to explore how social capital can be used as a conceptual tool in developing housing policy for social sustainability in Umeå Municipality.

    Methods: The three sub-studies in this project combine quantitative and qualitative methods. We will conduct a review of the municipality’s documents to understand how the ideas of social sustainability have influenced political declarations and implemented social and housing policies and interventions during the period 2006–2020. The quantitative study includes a longitudinal follow-up to the 2006 survey’s respondents to assess the longitudinal impacts of neighborhood social capital on health and well-being; as well as a new repeated cross-sectional survey to investigate how social capital has changed in local neighborhoods from 2006 to 2020. The qualitative study includes case studies in neighborhoods with different social capital dynamics to understand how different resident sub-groups perceive their neighborhoods and how implemented social and housing policies have influenced the social capital dynamics and responded to the needs of different sub-groups. The project is run in close collaboration with the Commission for a Socially Sustainable Umeå.

    Discussions: This project will create new and unique perspectives on long-term structural changes of relevance for a socially sustainable housing policy; knowledge that is highly valuable for continuous municipal planning; and will outline recommendations to guide local housing policies for social sustainable neighborhoods in Umeå Municipality.

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  • 3.
    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.

     

  • 4.
    Zetterberg, Liv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Tvingad till autonomi: en teoretisk analys av öppen psykiatrisk tvångsvård i Sverige2020In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, Vol. 27, no 2, p. 177-196Article in journal (Other academic)
    Abstract [en]

    In earlier research about compulsory community care, two contradictions related to the legislation have been identified: First, compulsory community care (CCC) means both more and less autonomy for the patient. Second, it means that autonomous individuals are being coerced to autonomy. The aim of the article is to clarify the normative underpinning of the law in light of four perspectives of autonomy to that help understand the two contradictions.

    The first contradiction can be explained by the fact that the legislator operates with two different definitions of autonomy: liberalistic and bioethical. In a liberalistic perspective, CCC restricts the right to autonomy. From a bioethical perspective, CCC potentially increases autonomy since it may enhance or protect the future autonomy of the patient. According to this perspective, other values, like health and quality of life, can also motivate restriction of autonomy.

    The second contradiction can be explained by how the legislator confuses procedural with substantial conceptions of autonomy. Since the patient is not assumed to be incompetent, the patient is assumed to have procedural autonomy. At the same time, whether or not the patient’s will is accepted depends on the eventual outcome of the patient’s choice. If the patient refuses care, her opinion is not presumed authentic, which is an expression of a substantive conception of autonomy. The coercive care provided is supposed to re-install the patient’s substantive autonomy. When it comes to the practice of CCC, the patient is assumed to voluntarily accept the coercive elements. This means that the patient is also autonomous according to a substantive conception of autonomy. Since the objective of compulsory care is to enable the patient to accept care voluntarily and thus restoring her/his authentic opinion, the legal requisites for allowing and discharging from CCC are met at the same time.

    If compulsory community care is to be acceptable from a bioethical perspective, it must provide the patient with actual benefits or more autonomy. There is no research evidence that compulsory community works. Accordingly, it is hard to identify what benefits CCC provide that can trump the autonomy of the patient.

  • 5.
    Zetterberg, Liv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Tvångsvård i frihet: tillkomst, implementering och rättstillämpning av öppen psykiatrisk tvångsvård2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis aims to analyze compulsory community care (CCC) as a social and normative practice in different contexts in the Swedish welfare system. The research questions are:

    - How can the motives to introduce CCC in Sweden and other Western countries be understood?

    - What happens in and between psychiatric and social service organizations when CCC is implemented?

    - How are the legal rights of patients protected and what forms of social control of patients is discernible in written court decisions regarding CCC?

    - What normative positions regarding autonomy is the CCC legislation based on?

    - How can CCC be understood from steering, historic and power perspectives?

    The four first research questions corresponds to the four research studies included in the thesis and the fifth question relates to the material as a whole.

    The empirical material for the first study mainly consists of documents from the parliamentary process. For the second study, 15 interviews with employees in psychiatric and social services were conducted. For the third study, all written court decisions over a 6 month period (N=541) were investigated. In the fourth study, the analysis is primarily based on the current legislation and its history.

    Community care has already taken over most tasks of the old institutions. With the adoption of CCC, even the coercive measures are now formally found in community settings. CCC was adopted despite lack of evidence supporting its effectiveness. Although the policy process started in the aftermath of high-profile crimes, the government bill was focused on integration and rehabilitation with the stated intention to reduce coercive powers. While CCC entails an actual expansion of coercive powers, those coercive elements are downplayed in the bill. CCC allows for preventative restrictions on non-violent civilly committed patients. The CCC example shows that political steering is not something that automatically restricts discretion over the medical profession. Earlier political steering strategies had failed to reduce the excessive clinical use of use of temporary leave. The introduction of CCC meant that politicians adapted legislation to previously undesired practices.

    In psychiatric and social services, CCC is materialized as a physical object in the coordinated care plan. The interviewees talked about the template form for the coordinated care plan as almost synonymous with CCC. It helped clarify responsibilities and facilitated coordination between the organizations. These changes extended even beyond services for the targeted patients under CCC. The requirement of a coordinated care plan thus served as a political steering strategy for enhancing collaboration.

    In the written court decisions about CCC we found deficiencies in procedural fairness in all four requirements for a fair trial that were investigated: transparency, clarity, consistency and impartiality. For example, more than 99 % of the decisions were made in favor of the claims of treating psychiatrist and a substantial minority of courts routinely delegated decision-making authority to treating psychiatrists. The special provisions often involved surveillance controlling techniques. The control is mostly physical, because of the unique role of medication, but also spatial and temporal. Even though no formal coercive measures are allowed, the special provisions as controlling measures seem to have real impact on patients. CCC may therefore be understood as disciplinary power.

    A legal requisite for coercive care is that the patient oppose care. However, in practice it is assumed that a patient under CCC will accept the coercive elements (i.e. special provisions). The legal requisites for allowing and discharging from CCC are thus met at the same time. Restrictions of patient autonomy in the legislation is often motivated in terms of enhanced autonomy in the future, for example through avoiding relapse. Another rationale for the restriction of autonomy is to safeguard the health and quality of life of patients. There is no research evidence that compulsory community works. Accordingly, it is hard to identify what benefits CCC provide that can trump the autonomy of the patient.

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  • 6.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Socialt kapital som verktyg i planering för socialt hållbara bostadsområden2023In: Socialtjänstens arbete med social hållbarhet: insatser på individ-, grupp- och samhällsnivå / [ed] Björn Blom; Malin Eriksson; Marie-Louise Snellman, Umeå: Studentlitteratur AB, 2023, 1, p. 139-152Chapter in book (Other academic)
  • 7.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ravry, Cecilia
    Umeå Municipality, Umeå, Sweden.
    Santosa, Ailiana
    School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Ng, Nawi
    School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Neighbourhood social sustainable development and spatial scale: a qualitative case study in Sweden2023In: Local Environment: the International Journal of Justice and Sustainability, ISSN 1354-9839, E-ISSN 1469-6711Article in journal (Refereed)
    Abstract [en]

    Social sustainability has increasingly become a goal for urban policy and planning, and for local and regional developmental strategies. Neighbourhoods are a common spatial scale for studying social sustainability and there is a growing focus on social sustainability in urban neighbourhoods for both researchers and policymakers. This paper is based on a qualitative case study of a neighbourhood defined by the municipality as at-risk of negative social development in a municipality in northern Sweden. The aim is to describe the perceived threats and promoters for social sustainable development in a neighbourhood defined as at-risk, and to analyse these in relation to a perspective of spatial scale. The study is based on data from interviews with municipal representatives, local professionals and residents, representing different experiences and perspectives in the neighbourhood. Four themes illustrating threats to socially sustainable development were identified: crime, unrest and unsafety; segregation and social exclusion; reputation and stigmatisation; and low involvement in municipal processes. The promoters for socially sustainable development identified in the respondents’ stories reflect four themes: strong community spirit; safety and low criminality; lively civic society and well-functioning public services. Our results show that neighbourhood social sustainability cannot be studied or acted upon without being put in a context of spatial scale and an understanding that processes occurring at a particular scale only can be adequately understood when considered in relation to other scales, i.e. the development in the neighbourhood can only be understood in relation to the development in the city and at national level. There is also a need for an awareness of how different aspects of socially sustainable development relate to each other, by strengthening or counteracting each other.

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  • 8.
    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)
  • 9.
    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.

  • 10.
    Zetterberg, Liv
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Santosa, Ailiana
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ng, Nawi
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Matilda
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Impact of COVID-19 on neighborhood social support and social interactions in Umeå municipality, Sweden2021In: Frontiers in Sustainable Cities, E-ISSN 2624-9634, Vol. 3, article id 68573Article in journal (Refereed)
    Abstract [en]

    The objectives are to, for neighborhoods with different levels of social capital, (1) map out the levels of social interactions, emotional support, and instrumental support before the COVID-19 crisis, (2) analyze how social interactions, emotional support, and instrumental support had changed during the pandemic and, (3) analyze changes in self-rated health during the pandemic. This study is based on a telephone survey with a subsample of 168 respondents in Umeå municipality who participated in a large base-line social capital survey in 2006. We asked whether neighbors talk to, care for, and help each other, before and during the Covid crisis. Individuals rated their health as poor or good. We compared people's self-rated health and their perceptions about their neighborhoods between those who lived in high or low/medium social capital neighborhoods. Before the pandemic, participants in high social capital neighborhoods reported more active neighborhood interaction and support. During the crisis, social interaction and support increased in all neighborhoods, but more in high social capital neighborhoods. Overall, people seemed to help and care for each other more during than before the crisis. More individuals in the high social capital neighborhoods reported improvement in their health during the pandemic, than those in the low/medium social capital neighborhoods. Our findings indicate that neighborhoods social capital can be strengthened during a crisis, in particular in areas with existing high levels of social capital. The findings need to be interpreted carefully due to its small sample size but observed patterns warrant further investigation.

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  • 11.
    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.

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