Mellan frisk och sjuk - en studie av psykiatrisk öppenvård

Sammanfattning: In the past few decades a comprehensive restructuring of psychiatric care has taken place in Sweden. The activities of the traditional closed institutions have been curtailed through a drastic reduction in the number of beds available in such institutions. "Day treatment," has arisen as a new form of intensive outpatient care in the new, geographically localized psychiatric care of patients with long histories of mental illness. The day treatment center that I studied was intended to be a permanent unit, but it lasted only five years. The dissertation is based on interviews and first hand observations from this day treatment facility. I have interviewed 32 patients, often more than once. The staff members - psychologists, psychiatrists, physical therapists, occupational therapists, doctors, counsellors and psychiatric nurses - were interviewed twice each. The purpose of the study is to investigate the patients' views of illness and health, treatment, rehabilitation, and relations between the patients themselves and patients and staff, in light of how these are affected by the new day treatment form of care. I also investigated what the personnel believed to be unique and specific about their work in order to demarcate and establish this new form of care. Interpretations of the patients' and personnel's responses are made against the background of the social processes and social contexts in which they participate. The study finds that the patients see themselves as both healthy and ill. The patients describe their own activity, their own initiatives, as important in being healthy, and that the people around them must respond positively to these initiatives and activities. The patients develop various coping strategies in other everyday relations to deal with their problems and treatment. Frequently this means partially of entirely hiding one's illness and treatment. The patients find "that extra" or " exceptions" from ordained routines in their treatment to be especially positive and health promoting. Relationships with the staff are also emphasized as of the utmost importance in the treatment process. The patients evaluate the various curative effects of therapy as changes, patterns and discoveries. According to the personnel, what hallmarks the activities of the unit is the way care is planned, basing activity on what is healthy, utilizing all available resources, and developing special relationships with the patients. What was unique about the center was that it could offer a variety of treatment and rehabilitation methods. Day treatment was a novel and untried alternative when the center opened. This study shows that day treatment was important for the patients. An important question is thus, what role does the lack of stability and longevity play when new forms of care are established? There are a variety of effective treatment and rehabilitation methods that can improve the situation of the mentally ill in society. The real challenge now is in delivering these alternatives to patients in an accessible, consistent, and reliable manner.