Efter mentalsjukhuset : en studie i spåren av avinstitutionaliseringen av den psykiatriska vården

Sammanfattning: 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.