Kalejdoskopiska rum Diskurs, materialitet och praktik i den decentraliserade psykiatriska vården

Detta är en avhandling från Stockholm : KTH Royal Institute of Technology

Sammanfattning: During the period 1967-1995, Swedish mental healthcare underwent a complete re-organisation, starting with county councils taking over responsibility for mental healthcare from the state. Asylums were then phased out and mental health care moved closer to patients. The Mental Health Reform of 1995 completed this decentralisation and put the emphasis on an independent and integrated life as a citizen in society and the idea of a dwelling of one’s own. This thesis describes and analyses spatial aspects of decentralised mental healthcare in Sweden, focusing on the decentralisation discourse regarding organisation, localisation, patient care and working methods behind decentralisation and its spatial performance. A case study of decentralised mental healthcare in Nacka, a Stockholm suburb, between 1958-1999 examines in particular the emerging decentralisation discourse 1958-1973, The Nacka Project 1974-1980 (one of the first examples of community care in Sweden), psychiatry in Nacka 1980-1994 and the official report Welfare and Freedom of Choice from 1995. The methods used include studies of documents, interviews, visual and architectural drawing analysis. The theoretical point of departure for the analysis is a post-structural heterogeneous concept of space where spatial materiality and discursiveness are looked upon as intertwined.   The result shows that the re-organisation of mental healthcare brought about a substantial spatial transformation. Normalisation of patients’ lives involved integration into society and support for independent living. The local environment was the main trope for the early stage of decentralised mental healthcare, but the notion of a dwelling of one’s own became the important trajectory to an independent life after 1995. The idea of the patient is challenged by the independence discourse, which could be said to contain an idea of the ‘non-patient’. Overall, it can be concluded that spatial organisations of the built environment are never value-free or neutral. They reflect, enable and constrain power relations in a society and material space can contribute to the power of one group at the expense of another. Furthermore, the results of the spatialities, or the meanings, cannot be predicted. It is therefore crucial to distinguish power in all its configurations and scales and to keep negotiations alive, especially within the field of mental healthcare, but also in the care sector as a whole and in other societal institutions where policies buildings and built environment interact with user practices. This kaleidoscopic perspective can be used for examining complexities in the past and present and for encouraging future potentialities in the process of making/enacting spatial relations.