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Social integration for people with mental health problems: Experiences, perspectives and practical changes
Nordic Council of Ministers, Nordic School of Public Health NHV.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The goal of social integration is part of the ideological motivation behind the transition from institutionalised to decentralised psychiatric care. Modern community mental health care considers social integration vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated.Aim: The overall aim of the study was to achieve a deeper understanding of the phenomenon of social integration of people with mental health problems in the community. An additional aim was to develop the healthcare professionals’ insight into this phenomenon by means of co-operative inquiry. The specific research questions were: How have people with mental health problems affected their neighbourhood after re-establishing in the community? How do people with mental health problems experience social integration in the community? How does knowledge of social integration promote practical changes in mental health professionals’ practice?Methods: This study, which comprises four papers, has a hermeneutic design. The data collection methods took the form of interviews with 19 neighbours of group homes for people with mental health problems (Paper I) and focus groups in two separate studies of people with mental health problems, one of which comprised 12 participants in three groups (Paper II) and the other 17 participants in three different multistage focus groups (Paper III), i.e. a total of 14 focus groups. Paper IV utilises findings from Papers I-III by means of a co-operative approach. There were two areas of knowledge development in the research process: dialogue-based teaching and focus groups. The main emphasis of the dialogue-based teaching was to facilitate the articulation of practical and tacit knowledge. Twenty-two healthcare professionals and social workers participated in two different multistage focus groups, a total of 6 focus groups (Paper IV). Data-analysis methods included both the constant comparative process and qualitative content analysis.Findings: The first paper begins with the experiences of neighbours of people who suffer from mental health problems. The neighbours reported frightening behaviours as well as complications in their contact with people who had long-term mental health problems, which led to increased insecurity and fear. The reaction of the neighbourhood was exclusion and segregation in the form of distancing or watching. The next two papers employed a user perspective and revealed that, when meeting people, the participants experienced shame and fear of exclusion due to lack of acceptance and loss of autonomy. Integrity proved a necessary quality for the possibility to be treated as an equal. Lack of work or a meaningful occupation and a low income contributed to a sense of worthlessness and loneliness. Those who had a job or took part in club activities seemed to achieve social companionship, which gave them a sense of being more socially integrated. The co-operative research project enabled co-researchers to gain increased professional knowledge and awareness, as well as providing potential for improvements in clinical practice. Systematic reflection on practice leads to an increased awareness of one’s own attitudes and intervention methods, societal conditions and the community’s attitude to the increased social integration of people with mental health problems. The experiential knowledge gained may contribute to health-promotion strategies such as social integration.Conclusions: Integration difficulties are experienced by both individuals with mental health problems and their neighbouring community. In order to achieve social integration, a person with long-term mental health problems needs to develop adequate social competence. Those working in community mental health care must ensure that people suffering from mental health problems experience a sense of belonging in the community, which can enable them to develop a network and achieve social integration in the planning and development of day-time activities and work, thus promoting social integration. The neighbourhood requires, at the very least, general information when a group home is established. Co-operative inquiry can be beneficial in the public sector, although in order to achieve the best possible result, the whole team must be involved and play an active role in all areas of the research project. If the groups are too large, the participants’ level of engagement may suffer. Multistage focus groups proved to be a powerful method for knowledge acquisition and should be further developed as a means of expanding new knowledg

Abstract [no]

Bakgrunn: En viktig ideologisk motivasjon for overgang fra institusjonalisert til desentralisert psykisk helsearbeid er målet om sosial integrering. Moderne lokalbasert psykisk helsearbeid anser sosial integrering som avgjørende for å bedre menneskers psykisk helse. Men rapporter viser at mennesker med psykiske problemer ikke har oppnådd tilfredsstillende sosial integrering.Mål: Det overordnede målet for studien var å oppnå en dypere forståelse av fenomenet sosial integrering for mennesker med psykiske problemer i lokalsamfunnet. Et tilleggsmål var å utvikle helse- og sosialarbeideres innsikt i fenomenet med bruk av handlingsorientert forskningssamarbeid. De spesifikke forskningsspørsmålene var: Hvordan har mennesker med psykiske problemer påvirket deres nabolag etter reetablering i lokalsamfunnet? Hvordan erfarte mennesker med psykiske problemer sosial integrering i lokalsamfunnet? Hvordan kan kunnskap om sosial integrering fremme praksisforandringer for psykisk helsearbeidere?Metode: Denne studien, som omfatter fire artikler, har et hermenautisk design. Metodene for datainnsamling var kvalitative intervjuer med 19 naboer til fellesboliger for mennesker med psykiske problemer (Art. I), og fokusgruppeintervjuer, i to separate studier, med mennesker med psykiske problemer. En studie med 12 informanter i 3 fokusgrupper (Art. II) og en studie med 17 informanter i 3 flersteg-fokusgrupper (Art. III), totalt 14 fokusgruppeintervjuer. Art. IV brukte funnene fra Art. I-III i et handlingsorientert forskningssamarbeid. Det var to former for kunnskapsutvikling i forskningsprosessen: Dialogbasert undervisning, som skulle fremme praktisk og taus kunnskap, samt fokusgruppeintervjuer. 22 helse- og sosialarbeidere deltok i 2 flersteg-fokusgrupper, totalt 6 fokusgruppeintervjuer (Art. IV). Datamateriale ble analysert med Grounded Theory og kvalitativ innholdsanalyse.Funn: Naboer til fellesbolig for mennesker med psykiske problemer beskriver i den første studien opplevelser som gav usikkerhet, skremmende adferd og problemer med å få kontakt med menneskene som hadde alvorlige psykiske problemer. Dette ledet til økt usikkerhet og frykt. Nabolaget reagerte med eksklusjon og segregering. De to neste studiene hadde et brukerperspektiv, og viste at informantene opplevde skam og frykt for eksklusjon som en følge av manglende akseptasjon og tap av autonomi i møte med mennesker. Integritet var en nødvendig forutsetning for å bli møtt som likverdig. Mangel på arbeid eller annen meningsfull dagaktivitet, samt lav inntekt, bidro til en følelse av verdiløshet og ensomhet. De som hadde et arbeid eller var aktiv deltager i klubbvirksomhet fikk et sosialt felleskap som gjorde at de kjente seg sosialt integrerte. I siste studie gav handlingsorientert forskningssamarbeid medforskerne økt profesjonell kunnskap og bevissthet, samt potensiale for å forbedre praksis. Systematisk refleksjon på praksis leder til en økt bevissthet for egne holdninger og interveneringsmetoder, sosiale betingelser og lokalsamfunnets holdninger til økt sosial integrasjon for mennesker med psykiske problemer. Økt kunnskapsdannelse i praksis kan bidra til forebyggende helsearbeid som sosial integrering.Konklusjon: Både mennesker med psykiske problemer og deres nabolag erfarte vanskeligheter med integrering. For at mennesker med alvorlige psykiske problemer skal erfare sosial integrering må de ha tilstrekkelig sosial kompetanse. Det må arbeides for at mennesker med psykiske problemer opplever tilhørighet i lokalsamfunnet, noe som kan sette dem i stand til å utvikle nettverk, og få til sosial integrering i planlegging og utvikling av dagaktiviteter og arbeid, og på den måten fremme sosial integrering. Nabolag bør i hvert fall ha generell informasjon når det etableres fellesboliger. Handlings- orientert forskningssamarbeid kan være gunstig i kommunehelsetjenesten. En forutsetning for et best mulig resultat er at hele team blir involvert og deltar i kunnskapsskapningen i praksis. Blir enhetene som deltar for store, blir det ikke noe eierforhold til forskningssamarbeidet. Flersteg-fokusgruppeintervju viste seg å være en god metode for kunnskapsutvikling, og metoden burde utvikles videre.Nøkkelord: Psykisk helsearbeid i kommunehelsetjenesten, sosial integrering, sosialt nettverk, handlingsorientert forskningssamarbeid, kvalitativ metode

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2008. , 99 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2008:6
Keyword [en]
Community mental health work, social integration, social network, qualitative methods, co- operative inquiry.
Keyword [no]
Psykisk helsearbeid i kommunehelsetjenesten, sosial integrering, sosialt nettverk, handlingsorientert forskningssamarbeid, kvalitativ metode.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3506ISBN: 978-91-85721-38-2 (print)OAI: oai:DiVA.org:norden-3506DiVA: diva2:760710
Public defence
2008-06-04, Nordic School of Public Health NHV, Göteborg, Sweden, 14:16 (Norwegian)
Opponent
Supervisors
Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2014-11-04Bibliographically approved
List of papers
1. The new neighbor: experiences of living next door to people suffering from long-term mental illness.
Open this publication in new window or tab >>The new neighbor: experiences of living next door to people suffering from long-term mental illness.
2003 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 12, no 1, 3-10 p.Article in journal (Refereed) Published
Abstract [en]

The transition from hospital to community care for people with long-term mental illness is of growing concern. The aim of the present study was to illuminate if and how people with long-term mental illness have affected their neighbourhood after re-establishing themselves in apartments of their own. Nineteen neighbours of group homes for people with long-term mental illness, in seven different communities in eastern Norway, have been interviewed. The grounded theory procedures as well as the constant comparative method were employed to analyse the findings. From the data, one main category was identified: the need for information.

Keyword
Community care, Grounded theory, Information. Mental illness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3502 (URN)14685954 (PubMedID)
Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2014-11-04Bibliographically approved
2. Preserving integrity: experiences of people with mental health problems living in their own home in a new neighbourhood.
Open this publication in new window or tab >>Preserving integrity: experiences of people with mental health problems living in their own home in a new neighbourhood.
2003 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 10, no 6, 602-13 p.Article in journal (Refereed) Published
Abstract [en]

For patients with mental health problems, de-institutionalization has meant a shift from institutional care to living in the community. However, several studies show that problems of stigmatization, loneliness and negative attitudes devalue the dignity and autonomy of these patients. The aim of this study was to gain a deeper understanding of how people with mental health problems experience living in an apartment of their own. The data collection method was focus group interviews. The constant comparative method revealed the main category 'preserving integrity'. The subcategories were: the need for control over information, similar relationships with both friends and neighbours (symmetrical contact), and 'My home is my castle'. Participants who lived in a group home had little or no contact with their neighbours. The participants experienced lack of acceptance and loss of autonomy when meeting people. Integrity was a necessary condition in order for them to become equal citizens, experience autonomy and dignity, and have the opportunity to develop social contacts.

Keyword
Autonomy, Focus Group, Integrity, Mental Health Problems. Neighbour
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3503 (URN)14650479 (PubMedID)
Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2014-11-04Bibliographically approved
3. The struggle for social integration in the community--the experiences of people with mental health problems.
Open this publication in new window or tab >>The struggle for social integration in the community--the experiences of people with mental health problems.
2006 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 13, no 3, 288-93 p.Article in journal (Refereed) Published
Abstract [en]

The goal of social integration is part of the ideological motivation behind the transition from institutionalized to decentralized psychiatry. Modern community mental health care considers social integration as vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated. The aim of this study was to explore how people with mental health problems experience their ability to integrate socially into a community in central Norway. Three multistage focus groups, consisting of 17 people with mental health problems, were set up in two counties of different sizes. In this explorative study, data were analysed using a qualitative content analysis method. The participants experienced shame and fear of exclusion in their struggle to become integrated in the community. They had a sense of loneliness, had to struggle for equality and experienced being neglected. The days passed very slowly and they reported a lack of financial resources. They wanted to work or take part in other daytime activities and sought reciprocal relationships. In conclusion, those working in community mental health care need to ensure that people suffering from mental health problems experience a sense of belonging in the community, thus enabling them to develop a network and achieve social integration.

Keyword
Community Mental Health, Social Integration, Social Network
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3504 (URN)10.1111/j.1365-2850.2006.00950.x (DOI)16737495 (PubMedID)
Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2014-11-04Bibliographically approved
4. Knowledge about social networks and integration: a co-operative research project.
Open this publication in new window or tab >>Knowledge about social networks and integration: a co-operative research project.
2007 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 58, no 4, 348-57 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This paper is a report of a study investigating how knowledge of social network and integration influenced mental health professionals' understanding and practice.

BACKGROUND: Community mental health work focuses on people suffering from mental health problems as well as the consequences for the person involved and their family or network. There is a need to expand community mental health workers' knowledge about social networks and their functions.

METHOD: A qualitative study using a co-operative research approach was used to develop participants' knowledge of social network and social integration theory. Action research has the potential to facilitate changes in the field. Data were collected using focus groups. Qualitative content analysis was employed to develop the theme and categories. The data were collected in 2004-2005.

FINDINGS: The main theme identified was the potential of experiential knowledge-based competence, which was characterized by the following categories: (1) increased knowledge, (2) awareness of social interactions, (3) cross-disciplinary professionalism and (4) potential for changes in practice. Participants' knowledge and awareness of the potential of social integration as a tool for social network interventions were considerably strengthened. However, this knowledge needs to be implemented in practice.

CONCLUSION: Co-operative research is an approach that can be beneficial in the public sector. To achieve the best possible results, the whole team must be involved and play an active part in all areas of the research project. If the groups involved are too large, participants' level of engagement may suffer.

Keyword
Co-Operative Research, Content Analysis, Experiential Knowledge, Focus Groups, Mental Health Nursing, Social integration, Social Network
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3505 (URN)10.1111/j.1365-2648.2007.04239.x (DOI)17425599 (PubMedID)
Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2014-11-04Bibliographically approved

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