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  • 1.
    Bülow, Per
    Linköping University, Department of Department of Health and Society, Tema Health and Society. Linköping University, Faculty of Arts and Sciences.
    Efter mentalsjukhuset: en studie i spåren av avinstitutionaliseringen av den psykiatriska vården2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The focus of this thesis is the reorganisation of psychiatric care, the deinstitutionalisation process, which has been carried through in Sweden and other countries in the western world. Psychiatric care has been both specialised and decentralised and new actors, outside the medical service, have been involved in care, support and service to people with severe mental illnesses. The deinstitutionalisation process has been followed by a constant debate about its merits and shortcomings. The critics assert that people with severe mental illnesses have been abandoned by an indifferent society, which has resulted in negative consequences like premature death, homelessness and criminalisation. The proponents of the process, on the other hand, state that people who previously lived their lives in mental hospitals and in the margin of the society now have regained their citizenship and can participate in community life.

    The overall aim of the thesis was to study and illuminate changes in care, support and service in the wake of the deinstitutionalisation process in Sweden. The study is a retrospective, longitudinal cohort study that extended over a period of 15 years, from 1984 to 1998. It takes its starting-point in one of the about thirty mental hospitals in Sweden at that time. Data were collected from "the Cause of death" Register at Statistics Sweden (SCB), the Swedish Police Register, the Social Insurance Office, from medical records, and via inquiry form from contact persons and staff close to the patients. Through the collected data changes in variables such as criminality, mortality, homelessness, treatment in inpatient and outpatient settings, daily activities, living conditions and other social conditions were followed over the lS-year period covering all 138 patients included in the study.

    The amount of days in hospitals decreased while attendance at outpatient clinics increased. There was a considerable increase in social service delivery in the form of housing and occupational support. However, many patients lacked social contacts outside their regularly visits at outpatient clinics. There were no increases in premature death or suicide and the criminality showed a decline between 1992-1998. The results of the study suggest that there are some reasons to adopt a positive attitude toward the deinstitutionalisation process in Sweden.

  • 2.
    Levin, Sara K.
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Regional Forensic Psychiatric Hospital, Vadstena, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Bülow, Per
    Regional Forensic Psychiatric Hospital, Vadstena, Sweden; Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden; Department of Behavioural Science and Social Work, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Adherence to planned risk management interventions in Swedish forensic care: What is said and done according to patient records2019In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 64, p. 71-82Article in journal (Refereed)
    Abstract [en]

    Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.

  • 3.
    Levin, Sara
    et al.
    Region Östergötland, Local Health Care Services in West Östergötland, Department of Forensic Psychiatry. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Bülow, Per
    Department of Behavioural Science and Social Work, School of Health Sciences, Jönköping University,Jönköping, Sweden.
    Staff Perceptions of Facilitators and Barriers to the Use of a Short- Term Risk Assessment Instrument in Forensic Psychiatry2018In: Journal of Forensic Psychology Research and Practice, ISSN 2473-2850, Vol. 18, no 3, p. 199-228Article in journal (Refereed)
    Abstract [en]

    Prospective adverse events within forensic settings should be assessed using structured risk assessment instruments. Our aim was to identify the barriers and facilitators of a structured instrument for assessment of short-term risk within inpatient forensic psychiatric care. The instrument was piloted at a forensic psychiatric clinic. Three focus group interviews were conducted with staff. Content analysis revealed three main categories of barriers and facilitators for clinical use: implementation object, context, and users. Complexity of the instrument, insufficient continuous training and support, difficulties retrieving assessments on wards, and insecurity about translating assessments into actions were perceived barriers to clinical use. Routines for documentation improved communication and the inclusion of protective and short-term dynamic clinical factors were perceived as clinically relevant. Problem-solving ability, attitude, and motivation of staff were facilitating factors. Comprehensive risk assessment instruments require substantial support for staff to find them manageable. Systematic documentation is required to measure actual daily clinical use.

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