Suchergebnisse

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure that outlines the nature of the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit.

AbstractThe aim of this study is to explore the IPS implementation process in a first‐episode psychosis (FEP) mental health service team in Sweden. More specifically, the study explores how integration processes and critical situations are perceived over time by team members who originated from two diverse welfare organizations. A serial interview design was used (initially, at 6 and 12 months) to describe experiences of 16 team members. Material was analyzed using a constant comparison grounded theory approach. Team members dealt with the ambivalence of sharing mental health information, and whether the new way of working was a risk or benefit for users. They gradually learned new perspectives and knowledge, built trust and shared common views. After a year, the team workload perceived reduced and became person‐centred. Some members described remaining unclear roles and requested further support. Negotiated goals for integration and early knowledge transfer are critical. Organizational change and trusting team relationships have to be facilitated. Anticipated gains of integration should be clearly described and discussed early on, and continuous support for sustainability should be considered. This study confirmed the importance and potential of integrating IPS into FEP teams.

AbstractWhen developing Community Mental Health Services to support people with psychiatric disabilities, European countries are advocating evidence‐based practice (EBP). Individual Placement and Support (IPS) is an evidence‐based model designed to support people in acquiring and maintaining competitive employment. Implementation science is a growing research field, with a focus on components that impact the process of implementing EBP programmes. In this multiple case study, we have followed three IPS demonstration sites for two years, in order to describe and analyze barriers and facilitators for implementation, according to constructs described in the Consolidated Framework for Implementation Research (Damschroder et al. 2009). The results highlight the importance of strategic networking, as well as the need for planning and preparations carried out before the start of an EBP programme, since deficiencies related to these constructs are difficult to compensate for.

AbstractThe deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.

"In welchem Zustand befindet sich der schwedische Wohlfahrtsstaat im Anschluss an die massiven Sparmaßnahmen der 1990er Jahre? Da das Modell untrennbar mit dem Konzept der Chancengleichheit verbunden ist, muss eine Bewertung seiner Entwicklung auch die Veränderungen bezüglich der Gleichheit der Lebensbedingungen der schwedischen Bevölkerung berücksichtigen. Zudem weist in analytischer Hinsicht insbesondere die schwedische Wohlfahrtsstaatsforschung darauf hin, dass zwischen den wohlfahrtsstaatlichen Institutionen als solchen und den Ressourcen unterschieden werden muss, die es dem Einzelnen ermöglichen, sein eigenes Leben selbst zu bestimmen. Letztere beeinflussen die persönliche Wohlfahrt entscheidend. Der Beitrag fragt daher: Wie hat sich - nach einem Jahrzehnt des Wirtschaftswachstums oberhalb des europäischen Durchschnitts - die Ungleichheit in Schweden zu Beginn des 21. Jahrhunderts verändert? Und worin bestehen in Bezug auf politische Reformen und im Hinblick auf die Lebensbedingungen der Menschen die zukünftigen Herausforderungen?" (Autorenreferat)