Socialpsykiatri har utvecklats åt olika håll runt om i världen. I Sverige har begreppet socialpsykiatri framför allt avsett socialtjänstens utbud av stöd och service för personer med psykiska funktionsnedsättningar. Den här boken tar sig an socialpsykiatri som vetenskapligt område och syftar till att avtäcka socialpsykiatrins grunder som ett multidisciplinärt forskningsfält, där ämnen som filosofi, medicin, psykologi, antropologi och socialt arbete ingår. Oavsett utgångspunkt står det sociala perspektivet i fokus och utgör bakgrunden till forskning kring psykisk ohälsa.

Reports indicate a decrease in youth mental health in Sweden but at the same time research suggests that what is interpreted as mental ill-health could be considered everyday challenges by young people themselves. The distribution of mental health and illness among young people is uneven based on inequities related to factors such as race, gender and socioeconomic status. Sweden in particular is a country with large socioeconomic inequities in youth mental health and in school results, compared to other European countries. The aim of this study was to explore young people's experiences of the role of race, gender and socioeconomic status in relation to everyday challenges. Sixty-five young people aged 13–15 years old were recruited by student health services and participated in focus group discussions at schools in the southernmost part of Sweden. Data were analysed by secondary analysis with deductive qualitative content analysis using Ecosocial theory of disease distribution as theoretical framework. The analysis resulted in one main theme; Navigating inequities to gain and keep social status, with three underlying themes; Guided by social norms, Negative impact in everyday life and Importance of family influence. Participants were aware and critical of norms and expectations related to race, gender and socioeconomic status. Experiences of prejudice and unfairness was both own lived experiences by the participants as well as observed through friends and classmates. Young people spontaneously identify everyday challenges related to race, gender and socioeconomic status, even when not asked directly about these issues. Conforming to sexist, racist and classist, expectations is a way to lose and gain status in a school setting. Many of the inequities discussed related to socioeconomic status and the direct consequences of having or not having money. Young people's everyday experience of inequities is important to consider in youth mental health promotion aiming to tackle health inequities. Further research is needed on those experiences and how this affects mental health.

Background: Supporting families where one person suffers from long-term severe mental illness (SMI) is essential, but seems hard to reach. The aim of this study was to examine professionals’ views of supporting relatives of persons with SMI. Material: Individual interviews mirroring personal narratives and group interviews reflecting group-processed answers were conducted among 23 professionals and analyzed thematically. Results: Three themes emerged: (a) information and group interaction reduces stigma and increases well-being, (b) professionals need to feel secure and confident about how the support structure works and (c) collaboration is difficult but required on several levels. Conclusion: Trusting relationships with families were considered important, although seldom achieved; professionals wished to feel secure in their role toward relatives of a person with SMI; and professionals wanted to feel confident when working together with other services to support families.

The general objective of this dissertation was to study the putative underutilisation of mental health services in a multicultural context. The method followed a qualitative interview-based naturalistic approach, and the interview format was primarily semi-structured. Special attention in the method section has been given to the role of the interpreter in research. For some time the research areas of underutilisation of mental health care among immigrants, and that of children of immigrant parents suffering from mental illness, have been dominated by a vulnerability approach. Results from the present thesis show that this one-dimensional picture of immigrants as a category associated with psychopathology ought to be balanced with that of strength and resilience. It was also found in the studied group that underutilisation of mental health care is partly due to the perception of mental conditions as normal life crises, rather than illnesses. Thus, instead of focusing on health care resources, interviewees conveyed their need for greater social and financial support. The results of this study suggest that there is a lack of extended possibilities, for both adults and children of immigrant background, to express their own needs outside a predefined context. Investigating aspects of resilience in future research on mental ill health in multicultural contexts would challenge the focus on vulnerability, and perhaps so promote resilience.

Background: According to a survey from 2005 the population of Rosengård, a cultural heterogeneous borough of Malmö, Sweden, utilizes half as much psychiatric health services as expected in relation to estimated needs. Aim: To examine perceptions of mental illness trying to find possible reasons behind the low utilization. 206 Method: Unstructured interviews were conducted with 30 people living and/or working in the area. Result: Mental illness health was associated with insanity and shame. Numerous conditions were considered as “normal life crises” rather than medical states and are consequently taken care of in other ways than seeking mental health care. Conclusion: Several reasons behind low utilization of psychiatric health services among inhabitants in Rosengård were detected. Explanations are to be found both in different perceptions of mental illness, in the social situation in the area but also in the assumptions made in the survey this study was based upon. Despite that Sweden, with its developed welfare system, frequently is described as the country that has coped best with the growing number of immigrants and their various needs, it seems as if the needs are still unexplored, and there is no service for “normal life crises”.

Tysta(de?) Röster Vem lyssnar på Rosengårdsbarn som lever med en psykiskt sjuk förälder? Forskning visar att föräldrars psykiska ohälsa kan påverka livet för deras barn avsevärt, både direkt och indirekt. Det är även välkänt att dessa barn inte får tillräckligt stöd och att deras behov sällan tillgodoses. Trots att det finns en mängd studier kring dessa barn i allmänhet, saknas forskning om barn till föräldrar med psykisk ohälsa och invandrarbakgrund. Vi vet att psykisk ohälsa är ett känsligt ämne och nära förknippat med galenskap och skam. Vi vet också att personer med invandrarbakgrund i större utsträckning undviker att söka psykiatrisk vård. Därmed kan vi anta att det finns en hel del barn som lever med föräldrar som lider av psykisk ohälsa, utan att barnen är kända och därmed kan få möjligheten att prata om det och motta särskilt stöd. Syftet med studien var att undersöka situationen för invandrarbarn som lever med en förälder med psykisk ohälsa. Planen var att intervjua barn i åldern 10-18 år och göra barnens egna röster hörda. Syftet kunde emellertid inte uppfyllas då starka ”gate keepers” hindrade oss från att få kontakt med barnen. Svårigheterna med att rekrytera barn för studien är fokus för detta paper.

BACKGROUND: : The literature concerning interpretation in research primarily concentrates on rigorous techniques to eliminate bias. This article analyses other significant issues that arise when interpreters participate in research. MATERIAL: : Empirical examples are drawn from a research project concerning mental ill health in a multicultural neighbourhood. DISCUSSION: : Interpreters influence interview data in ways commonly unnoticed by researchers. One often-overlooked factor is that languages are dynamic and interpreters are not instruments. CONCLUSION: : Research conducted with an interpreter is a complex undertaking. Solely relying on checklists to improve methodological rigour can result in a false sense of the material's validity.

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city’s population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one’s disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client’s socio-economic and psychosocial needs, rather than solely follow a medical model.

Severe mental illness causes suffering for the patient as well as the patientâ s immediate family. The Swedish National Board of Health and Welfare has recommended the implementation of multifamily psychoeducation in order to assist patient and family in the recovery process. The aim of this study was to determine how introducing multifamily psychoeducation in Sweden has been viewed by professionals. Semi-structured interviews were conducted with 11 service providers, who were involved in evaluating multifamily psychoeducation. Our main findings fell under the headings of defensive culture and unsuitable model. Resistance to introducing the new intervention was found on multiple levels. The model proposed was considered too rigid for both the target group and the organizations because it could not be adjusted to the needs of patients, families, or facilitators. Despite good evidence for the effectiveness of the intervention, there were difficulties introducing the multifamily psychoeducation model in clinical practice. The feasibility of an intervention needs to be evaluated before adopting it as a national guideline.

In this paper, we discuss traditional Somali concepts of mental ill health.Qualitative interviews were conducted with some 20 Swedish Somali interviewees about factors causing mental ill health, traditional classification, strategies to deal with mental ill health, and attitudes to the mental health care services in Sweden. Social mobilisation and religious healing are cornerstones of traditional Somali measures to deal with mental suffering. Traditional Somali views of mental ill health stand in stark contrast to classification of mental ill health in the western biomedical model. These views deserve attention since they may have an impact on health-seeking behaviour among Somali immigrants in western countries. Yet a too strong focus on cultural aspects may over-shadow the fact that much mental suffering among Somali migrants must be understood within social, economic, and political contexts.

Treatment and support of people diagnosed with severe mental illness in Sweden takes place in out-patient psychiatric services or municipality services. Most of the responsibility for support in daily life are provided by the close family. One crucial matter is how to support these families. This research project aimed to investigate the Swedish construction with shared responsibility between county psychiatric care and municipality social care for consumers with severe mental illness affects actions in municipalities in relation to family support. Ten representatives from five municipality settings were interviewed. Five semi-structured interviews were analysed using a thematic analysis. The following themes emerged; One overarching theme, "a mismatch of paradigms", and sub-themes: (a) "accentuating differences", (b) "doubts about including the entire family in the same session" and (c) "lack of a uniform family support policy". We conclude that a shared mandate needs a dialogue between psychiatric and municipality services concerning this mismatch.

BACKGROUND: Close relatives of people with severe mental illness (SMI) experience problems known as family burdens. In addition, they may have their own needs for support, something often overlooked by the healthcare system. Meta-syntheses in this area may help explore the meaning of the experience of living with someone who has a SMI. AIM: Our aim was to describe the burdens experienced and needs perceived on a daily basis by relatives to someone who has a SMI. METHODS: The databases PubMed, CINAHL, and PsychInfo were searched using a systematic search strategy. Studies were screened for relevance and quality was appraised. A meta-synthesis of nine qualitative studies was then conducted. RESULTS: The nine studies discerned the following themes. Burden themes; Forced to carry a sometimes unbearable burden; Burdened by own ill-health and disrupted relationships; Distressed and stigmatized by society. Needs themes; strengthening protective factors; Skills and practical support greatly appreciated. CONCLUSIONS: The burdens and needs of relatives of persons with SMI strongly influence their lives. They require relief from both practical and emotional burdens. Family interventions and other programs to support relatives should be encouraged with this knowledge in mind

Family-based psycho-education – a model outmoded in psychiatric services today? Aim: To illuminate aspects of the resistance against a family based intervention a qualitative interview study with professionals was accomplished. Background: Family-based psycho-educational models, developed in the beginning of the 1970s, have in several Cochrane reviews shown evidence for a reduced rate of relapse and increased adherence to medication. Studies included in these meta-analyses all encompassed patients receiving in-patient care, and requiring relatives partaking in an extensive educational program. A multi-center randomised control study in Sweden, aimed to investigate the effects of a twelve-month long intervention of a psycho - educational model for people with severe mental illness, SMI, in psychiatric and community settings, showed a powerful resistance from primarily the professionals which had been well trained in the model and secondly the patients which had been offered the intervention. Method: In-depth interviews with 24 professions in psychiatric and community outpatient settings engaged in the RCT study. Results: The findings showed that both patients and professional partners are skeptical about treatment programs of family psycho-pedagogical nature and prefer pure patient perspective and more acute short interventions. A reason for this was according to the professions lack of resources, while their patients experienced a hindrance in bothering their loved ones. Conclusion: The findings might show that the model per se is outmoded, not fitting the new structures of support, with reduced inpatient care, for people with SMI. In worst case, the findings might indicate that family psycho education, notwithstanding evidence based, is unavailable to people with SMI and their relatives which might contribute to a structural stigmatization of this population. More research is needed to understand if our findings are consistent with findings in other international contexts.