In recent decades, outpatient commitment orders have been increasingly used in the follow-up of p... more In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients' experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients' daily lives were dominated by the agenda set by health care providers and many said
The aim of this study was to explore relatives' experiences when their family member is under an ... more The aim of this study was to explore relatives' experiences when their family member is under an outpatient commitment order. A descriptive and exploratory approach was used based on qualitative interviews with 11 relatives. The relatives felt they had responsibility for the patient, but experienced a lack of recognition for their contribution to the treatment. Relatives paid little attention to coercion, but were more concerned about whether the follow-up care improved the patient's social functioning. They further reported an unmet need for information and guidance from healthcare staff to improve cooperation in the patient's care and treatment. Changes in mental health care have meant that many people with severe mental disorders live and receive follow-up care in the local community (Molodynski, Rugkasa, & Burns, 2010). This trend has led to increased involvement of these patients'
Social Psychiatry and Psychiatric Epidemiology, Feb 12, 2016
Purpose Outpatient commitment orders are being increasingly used in many countries to ensure foll... more Purpose Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals' experiences with the scheme. The purpose of this study was to examine health professionals' experiences with patients subject to outpatient commitment. Methods This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis. Results The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients' lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient. Conclusion Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients' need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients' autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.
... I utarbeidelsen av dette milepælsdokumentet har hele personalgruppa deltatt aktivt i kunnskap... more ... I utarbeidelsen av dette milepælsdokumentet har hele personalgruppa deltatt aktivt i kunnskapsutviklingen bak mål og verdigrunnlag. Bjørn Stensrud, Kjell Nordby og Dag Østby i miljøterapiprosjektet har vært aktive bidragsytere til dette notatet. ...
Background: The goal of social integration is part of the ideological motivation behind the trans... more 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 cooperative 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 cooperative approach. There were two areas of knowledge development in the research process: dialogue-based teaching and focus groups. The main emphasis of the dialoguebased 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 cooperative 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 daytime activities and work, thus promoting social integration. The neighbourhood requires, at the very least, general information when a group home is established. Cooperative 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 knowledge.
Much of contemporary health and mental health practice pays little attention to suffering, and wh... more Much of contemporary health and mental health practice pays little attention to suffering, and when it does, invariably suffering is conflated with pain. Within such views, the health care practitioner ought to be concerned with removing or stopping the suffering as, for many parts of the occidental world at least, suffering is regarded as antagonistic to the pursuit of happiness. However, it has been recognized since ancient times that the experience of suffering can give rise to growth. This view sees suffering as an inevitable aspect of the human condition and experience; as something that might need to be endured, minimized, relieved, explored for meaning and maybe even learned from. The former conceptualization of suffering leaves little, if any, room for the sufferer to be proud of his suffering and to consider it ennobling rather than degrading, and such views are highly congruent with the increased pathologizing of “everyday life” and with that, the inexorable proliferation of pharmacological “treatment.” Accordingly, we assert that there is a clear need for Psychiatric/Mental Health nurses to re-think their views of suffering and consider how they might help the person discover meaning in the experience; how they might accompany the individual on his/her suffering journey. We therefore identify a range of approaches and interventions that Psychiatric/Mental Health nurses can use when attempting to help those experiencing mental health-related suffering.
Occupational Therapy in Mental Health, Oct 2, 2014
This study aimed at gaining knowledge of users' experience of green care services (interventi... more This study aimed at gaining knowledge of users' experience of green care services (interventions using nature to improve health) for people with mental health or drug problems. Data were obtained from interviews with 20 participants in green care services and were analyzed qualitatively. Findings revealed that work in a social context close to nature and work with animals increased mastery and meaningfulness. Participation resulted in personal changes, new practical skills, improved social networks, and feelings of well-being. There appears to be powerful potential in using green care services as a recovery tool for people with mental health or drug-related problems.
Det må ikke kopieres fra rapporten i strid med åndsverkloven og fotografiloven eller i strid med ... more Det må ikke kopieres fra rapporten i strid med åndsverkloven og fotografiloven eller i strid med avtaler om kopiering inngått med KOPINOR, interesseorgan for rettighetshavere til åndsverk. Forfatterne er selv ansvarlige for sine konklusjoner. Innholdet gir derfor ikke nødvendigvis uttrykk for Høgskolens syn. I rapportserien fra Høgskolen i Hedmark publiseres FoU-arbeid og utredninger. Dette omfatter kvalifiseringsarbeid, stoff av lokal og nasjonal interesse, oppdragsvirksomhet, foreløpig publisering før publisering i et vitenskapelig tidsskrift etc. Rapporten kan bestilles ved henvendelse til Høgskolen i Hedmark.
The new frame for interdisciplinary postgraduate programmes of mental health work in Norway was a... more The new frame for interdisciplinary postgraduate programmes of mental health work in Norway was approved in 1997. The aim of this study was to evaluate the programmes with respect to what extent they had for professional identity and competence. 202 former students from 13 colleges replied to the mail survey. The majority of the replies came from women and nurses aged 35 to 50. They chose the colleges closest to there home, and they were mostly part-time students. Their interdisciplinary understanding has been strengthened, but their own discipline has become vaguer. Even though 35% did not work in mental health, the education had great impact on their work. Increased insight into mental health work, interdisciplinary environment, and personal development meant the most in the programme. The colleges should improve their modes of teaching and their administrative conditions. The participants recommend the programme.
Rapporten fokuserer på sosial integrering og sosialt nettverksarbeid i kommunehelsetjenestene. Ut... more Rapporten fokuserer på sosial integrering og sosialt nettverksarbeid i kommunehelsetjenestene. Utgangspunktet for ny kunnskap er brukernes erfaringer. Rapporten har også et vedlegg som beskriver eksempel fra Hamar kommune på sosial integrering for mennesker med psykiske lidelser
... Title: The planned milieu therapeutic dialogue report in The Milieu therapy project Authors... more ... Title: The planned milieu therapeutic dialogue report in The Milieu therapy project Authors: Kari Nysveen, Kjell Nordby, Kari Veisten and ... Videre har arbeidsgruppa i miljøterapiprosjektet ved Jan Kåre Hummelvoll, Bjørn Stensrud, Dag Østby og Tone Lise Brattrud vært aktive ...
It is well documented that Europe and the Occidental world face pressing mental health-care chall... more It is well documented that Europe and the Occidental world face pressing mental health-care challenges that are linked to their ageing populations. Moreover, in addition to the current and projected alarming rise in diagnosis of dementia, this population also often simultaneously face multiple pathological, psychological and experiential health challenges. Accordingly, this chapter focuses on providing psychiatric/mental health nursing care to and for older adults, from a humanistic and holistic perspective. The chapter outlines developments in Europe’s demography and examines different gerontological theories and theoretical approaches to ageing and mental health, with an emphasis on psychosocial views and theory, resting on the conviction that both mental well-being and mental ill health are closely related to and dependent on one’s social environment and personal story. Commonly occurring mental health problems among older people are considered, including those that are related to particular lived experiences such as social losses, crises and transitions of old. The chapter then concentrates on psychiatric/mental health nursing and how theories of gerontological mental health care can be operationalized for this population, focusing on ecological and local community perspectives.
In recent decades, outpatient commitment orders have been increasingly used in the follow-up of p... more In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients' experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients' daily lives were dominated by the agenda set by health care providers and many said
The aim of this study was to explore relatives' experiences when their family member is under an ... more The aim of this study was to explore relatives' experiences when their family member is under an outpatient commitment order. A descriptive and exploratory approach was used based on qualitative interviews with 11 relatives. The relatives felt they had responsibility for the patient, but experienced a lack of recognition for their contribution to the treatment. Relatives paid little attention to coercion, but were more concerned about whether the follow-up care improved the patient's social functioning. They further reported an unmet need for information and guidance from healthcare staff to improve cooperation in the patient's care and treatment. Changes in mental health care have meant that many people with severe mental disorders live and receive follow-up care in the local community (Molodynski, Rugkasa, & Burns, 2010). This trend has led to increased involvement of these patients'
Social Psychiatry and Psychiatric Epidemiology, Feb 12, 2016
Purpose Outpatient commitment orders are being increasingly used in many countries to ensure foll... more Purpose Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals' experiences with the scheme. The purpose of this study was to examine health professionals' experiences with patients subject to outpatient commitment. Methods This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis. Results The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients' lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient. Conclusion Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients' need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients' autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.
... I utarbeidelsen av dette milepælsdokumentet har hele personalgruppa deltatt aktivt i kunnskap... more ... I utarbeidelsen av dette milepælsdokumentet har hele personalgruppa deltatt aktivt i kunnskapsutviklingen bak mål og verdigrunnlag. Bjørn Stensrud, Kjell Nordby og Dag Østby i miljøterapiprosjektet har vært aktive bidragsytere til dette notatet. ...
Background: The goal of social integration is part of the ideological motivation behind the trans... more 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 cooperative 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 cooperative approach. There were two areas of knowledge development in the research process: dialogue-based teaching and focus groups. The main emphasis of the dialoguebased 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 cooperative 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 daytime activities and work, thus promoting social integration. The neighbourhood requires, at the very least, general information when a group home is established. Cooperative 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 knowledge.
Much of contemporary health and mental health practice pays little attention to suffering, and wh... more Much of contemporary health and mental health practice pays little attention to suffering, and when it does, invariably suffering is conflated with pain. Within such views, the health care practitioner ought to be concerned with removing or stopping the suffering as, for many parts of the occidental world at least, suffering is regarded as antagonistic to the pursuit of happiness. However, it has been recognized since ancient times that the experience of suffering can give rise to growth. This view sees suffering as an inevitable aspect of the human condition and experience; as something that might need to be endured, minimized, relieved, explored for meaning and maybe even learned from. The former conceptualization of suffering leaves little, if any, room for the sufferer to be proud of his suffering and to consider it ennobling rather than degrading, and such views are highly congruent with the increased pathologizing of “everyday life” and with that, the inexorable proliferation of pharmacological “treatment.” Accordingly, we assert that there is a clear need for Psychiatric/Mental Health nurses to re-think their views of suffering and consider how they might help the person discover meaning in the experience; how they might accompany the individual on his/her suffering journey. We therefore identify a range of approaches and interventions that Psychiatric/Mental Health nurses can use when attempting to help those experiencing mental health-related suffering.
Occupational Therapy in Mental Health, Oct 2, 2014
This study aimed at gaining knowledge of users' experience of green care services (interventi... more This study aimed at gaining knowledge of users' experience of green care services (interventions using nature to improve health) for people with mental health or drug problems. Data were obtained from interviews with 20 participants in green care services and were analyzed qualitatively. Findings revealed that work in a social context close to nature and work with animals increased mastery and meaningfulness. Participation resulted in personal changes, new practical skills, improved social networks, and feelings of well-being. There appears to be powerful potential in using green care services as a recovery tool for people with mental health or drug-related problems.
Det må ikke kopieres fra rapporten i strid med åndsverkloven og fotografiloven eller i strid med ... more Det må ikke kopieres fra rapporten i strid med åndsverkloven og fotografiloven eller i strid med avtaler om kopiering inngått med KOPINOR, interesseorgan for rettighetshavere til åndsverk. Forfatterne er selv ansvarlige for sine konklusjoner. Innholdet gir derfor ikke nødvendigvis uttrykk for Høgskolens syn. I rapportserien fra Høgskolen i Hedmark publiseres FoU-arbeid og utredninger. Dette omfatter kvalifiseringsarbeid, stoff av lokal og nasjonal interesse, oppdragsvirksomhet, foreløpig publisering før publisering i et vitenskapelig tidsskrift etc. Rapporten kan bestilles ved henvendelse til Høgskolen i Hedmark.
The new frame for interdisciplinary postgraduate programmes of mental health work in Norway was a... more The new frame for interdisciplinary postgraduate programmes of mental health work in Norway was approved in 1997. The aim of this study was to evaluate the programmes with respect to what extent they had for professional identity and competence. 202 former students from 13 colleges replied to the mail survey. The majority of the replies came from women and nurses aged 35 to 50. They chose the colleges closest to there home, and they were mostly part-time students. Their interdisciplinary understanding has been strengthened, but their own discipline has become vaguer. Even though 35% did not work in mental health, the education had great impact on their work. Increased insight into mental health work, interdisciplinary environment, and personal development meant the most in the programme. The colleges should improve their modes of teaching and their administrative conditions. The participants recommend the programme.
Rapporten fokuserer på sosial integrering og sosialt nettverksarbeid i kommunehelsetjenestene. Ut... more Rapporten fokuserer på sosial integrering og sosialt nettverksarbeid i kommunehelsetjenestene. Utgangspunktet for ny kunnskap er brukernes erfaringer. Rapporten har også et vedlegg som beskriver eksempel fra Hamar kommune på sosial integrering for mennesker med psykiske lidelser
... Title: The planned milieu therapeutic dialogue report in The Milieu therapy project Authors... more ... Title: The planned milieu therapeutic dialogue report in The Milieu therapy project Authors: Kari Nysveen, Kjell Nordby, Kari Veisten and ... Videre har arbeidsgruppa i miljøterapiprosjektet ved Jan Kåre Hummelvoll, Bjørn Stensrud, Dag Østby og Tone Lise Brattrud vært aktive ...
It is well documented that Europe and the Occidental world face pressing mental health-care chall... more It is well documented that Europe and the Occidental world face pressing mental health-care challenges that are linked to their ageing populations. Moreover, in addition to the current and projected alarming rise in diagnosis of dementia, this population also often simultaneously face multiple pathological, psychological and experiential health challenges. Accordingly, this chapter focuses on providing psychiatric/mental health nursing care to and for older adults, from a humanistic and holistic perspective. The chapter outlines developments in Europe’s demography and examines different gerontological theories and theoretical approaches to ageing and mental health, with an emphasis on psychosocial views and theory, resting on the conviction that both mental well-being and mental ill health are closely related to and dependent on one’s social environment and personal story. Commonly occurring mental health problems among older people are considered, including those that are related to particular lived experiences such as social losses, crises and transitions of old. The chapter then concentrates on psychiatric/mental health nursing and how theories of gerontological mental health care can be operationalized for this population, focusing on ecological and local community perspectives.
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