Den svenska psykiatrireformen : bland brukare, eldsjälar och byråkrater

Sammanfattning: In 1990, a government commission was formed with the task of improving care and services to persons with serious psychiatric disabilities. The government bill that resulted from the work of the Commission constitutes an attempt to clarify the responsibility of the municipal social services for residential and occupational services. The Swedish Mental Health Reform came into eff ect in 1995. The aims of the thesis are to describe, analyze and critically review the planning and implementation of the Reform and to present it within a historical perspective on caregiving.The thesis consists of two case-studies: One encompassing fi ve municipalities and their method of planning and implementing the Reform. The second is about a vocational rehabilitation project for persons with psychiatric disabilities which began in connection with the Reform. In addition to the two component studies, the substance of the report is composed of comprehensive written material. In the analysis it becomes evident that the report of the Commission is a document characterised by a strong ideology and one that takes a position regarding the questions of division of responsibility and work methods. The Commission’s problem lies in diffi culties in delineating and defi ning the target group.The result from the studies shows that the boundaries of responsibility between the social services and psychiatric care organization have become clearer, but grey zones continue to exist in the areas of rehabilitation and outpatient care.Few local policians, and a very small part of the local administrations were involved in the implementation of the Reform — the responsibility has rested with certain key individuals. The implementation has not been promoted by specifi c strong professions, and many eff orts to re-educate personell have been half-hearted and based on “old” knowledge. Personnel in the new settings express uncertainty, as they are unclear as to the expectations of the organization — those who were recruited from psychiatric care often feel degraded and insuffi ciently utilized.User- and family organizations have, in connection with the Reform, built up and developed their activities by means of earmarked funding provided by the state. As a result, an alternative knowledge base has developed in relation to work with the psychiatrically disabled.A conclusion is that the implementation of the Reform has been diffi cult, but that it is far from a complete failure. There are just too many positive experiences. However, much of the success must be attributed to the funding by the state.The long-term discourse will take shape and depend on how enduring the early initiatives prove to be.