Suchergebnisse

The notion of family and carer involvement appears throughout European mental health policy and guidelines. However, it has been noted that carer involvement policy may derive from a responsibilization agenda rather than from evidence that it genuinely supports re- covery. We review qualitative research on family life with depression from the perspective of people with depression. Studies were included if they elicited accounts from adults with a professional diagnosis of depression. Nineteen studies were included which incorporated the experiences of 493 adults with depression. A metasynthesis of findings from these stu- dies is discussed within three themes: family issues and depression interact; family support as a double-edged sword; benefits and limitations of psychosocial interventions. Findings reveal a complex inter-relationship between family roles, relationship dynamics, gender, culture and attitudes towards depression. Family involvement in primary care and medical settings can be a double-edged sword and the perceived benefit may depend on the extent to which family perspectives on treatment fit with the depressed person's understanding of their depression as medical or psychosocial. Psychosocial interventions for individual cli- ents have several limitations in terms of improving family relationships while family-based group interventions may be more beneficial, depending on the engagement of the family and the partner in particular. The review findings emphasise the complexity of family life with depression indicating that the requirement for 'carer involvement' as simplified in cur- rent policies and guidelines is naïve policy at best and that family or couple psychosocial interventions may often be more appropriate.

I dette nummer af Tidsskrift for Forskning i Sygdom og Samfund sætter vi fokus på stoffer og stofbrug og forskellige sociale, kulturelle, ideologiske og/eller professionelle betydninger, funktioner og formål, stoffer kan have i forhold til sundhed og sygdom.

The recent process of deinstitutionalization of the psychiatric treatment system, in both Denmark and other European countries, has relied heavily on the involvement in treatment and recovery of cohabitant relatives of diagnosed people. However, political objectives regarding depression and involvement rely on a limited body of knowledge about people's ways of managing illness-related problems in everyday life. Drawing on a discursive notion of gender laid out by Raewyn Connell, the aim of the article is to elucidate how the involvement of relatives is guided by an extra-individual rationale about gender and caregiving, and how this gendered discourse might frame different challenges and burdens, depending on the gender of the diagnosed person and the cohabitant relative. Drawn from a larger, multisited field study on involvement processes in Danish psychiatry, the article is based on field notes and 21interviews with seven heterosexual couples. The analysis shows that gender works as a decisive premise for the division of caregiving labour among the couples, and clarifies how the couples' gendered institution is disrupted after the onset of depression.The article argues that gender-blind involvement strategies could produce divergent treatment outcomes and varying social effects in relation to couples' everyday family lives.

The recent process of deinstitutionalization of the psychiatric treatment system, in both Denmark and other European countries, has relied heavily on the involvement in treatment and recovery of cohabitant relatives of diagnosed people. However, political objectives regarding depression and involvement rely on a limited body of knowledge about people's ways of managing illness-related problems in everyday life. Drawing on a discursive notion of gender laid out by Raewyn Connell, the aim of the article is to elucidate how the involvement of relatives is guided by an extra- individual rationale about gender and caregiving, and how this gendered discourse might frame different challenges and burdens, depending on the gender of the diagnosed person and the cohabitant relative. Drawn from a larger, multisited field study on involvement processes in Danish psychiatry, the article is based on field notes and 21 interviews with seven heterosexual couples. The analysis shows that gender works as a decisive premise for the division of caregiving labour among the couples, and clarifies how the couples' gendered institution is disrupted after the onset of depression. The article argues that gender-blind involvement strategies could produce divergent treatment outcomes and varying social effects in relation to couples' everyday family lives.

Psykisk Sundhedsarbejde og Politik

Artiklens formål er at identificere, analysere og diskutere udviklingen af velfærdsrationa- lerne i de nationale politikker, der i perioden 2009-2019 er offentliggjort som politiske bud på at styre og forandre det psykiatriske område i Danmark. I lyset af Bacchis tilgang til analyse af politiske velfærdsrationaler undersøges de tre elementer, som tilsammen kon- stituerer rationalerne i politikkerne i perioden: 1) De generiske måder hvorpå målgrup- pen beskrives i perioden, 2) de politiske redskaber der foreslås til at forandre og håndtere målgruppen i perioden og 3) de begrundelser der bruges i politikkerne til at legitimere indsatserne gennem perioden. Målgruppen repræsenteres som risikable, syge, sårbare, om- kostningsfulde og i særlige tilfælde farlige og komplekse. Repræsentationen danner grund- lag for en betoning af civilsamfundets ansvar, frivillighed recovery og forebyggelse, mens fremstillingen af de farlige og komplekse lægger op til øget brug af tvang. Velfærdsrationa- lerne i perioden afspejler, at majoriteten af målgruppen frivilligt forventes at påtage sig rollen som risikabel, sårbar og psykisk syg og deltage i de beskrevne tiltag for ikke at belaste velfærdsstaten. Trods en politisk ambition om en omfattende reform af det psykiatriske område, der imødekommer udfordringer som stigmatisering, umyndiggørelse og ulighed i sundhed, reflekterer politikkerne i stigende grad, at staten er villig til at fratage hele eller dele af ikke-frivilligt-deltagende og farlige personers selvbestemmelse igennem perioden. Derved repræsenterer politikkernes velfærdsrationaler ikke et bud på en radikal ændring af psykiatriens struktur, organisering og funktion. I stedet har de sidste ti års velfærdspolitik- ker stabiliseret paradigmet i det eksisterende system, snarere end at radikalt reformere det.

Citizens with complex problems are often in touch with different welfare services and administrative systems in order to receive the help, they need. Sometimes these services overlap and sometimes they conflict. The lack of ready-made services to match the complex, multiple, and often shifting needs of citizens with complex problems presents a challenge to caseworkers in the welfare system. In this article, we zoom in on the management of a single user´s case, in order to examine in detail how caseworkers nevertheless make casework 'work'. We employ the concept of 'tinkering' to highlight the ad hoc and experimental way in which caseworkers work towards adjusting services to the unique case of such citizens. Tinkering has previously been used in studies of human-technology relations, among others in studies of care-work in the welfare system. In this paper, we employ the concept to capture and describe a style of working that, although not a formally recognized method, might be recognizable to many caseworkers in the welfare system. We show how tinkering involves the negotiation of three topics of concern, namely the availability of services, the potentials of services to be adjusted to the particular problems of the citizen, and finally, the potential for interpreting these problems and the citizen's needs in a way that they match the service. We further demonstrate that casework tinkering involves both short-term and long-term negotiation of services. Firstly, tinkering is involved in the continual adjustment and tailoring of services to the immediate needs of the citizen, but secondly, it also speaks to a more proactive process of working towards a more long-term goal.

The present study is a part of a broader multisited field study on involvement of relatives in Danish psychiatry. The article aims to elucidate which political classifications of normality and mental illness that are displayed in two health political campaigns regarding anti-stigmatization and social inclusion and how such classifications co-constitute the subjectivity of individuals suffering from mental illness and their relatives. Drawing on a discourse theoretical perspective laid out by political theorists Laclau and Mouffe, we analyze how the campaigns bring into effect a weak and ineffective subject of deviance and how it is constituted by a subject of normality characterized by opposing traits. The article takes up the discussion of how the campaigns' articulations of the subjects of normality and deviance are imbedded in a hegemonic discourse of neoliberalism and individualism that asserts involvement as an expanded division of responsibility for the identification, classification and regulation of mentally ill subjects between public and private spheres of the Danish welfare state.