Purpose: In Sweden, in the wake of deinstitutionalization, in 1995 the responsibility for support regarding accommodation, employment, and an active everyday life for persons with severe mental illness (SMI) became a matter for the municipality’s social services. The overall aim of this study was to investigate whether there are differences in functioning and needs among older adults (65+) with severe mental illness (SMI) when divided into Psychosis and Non‑Psychosis groups.

Materials and methods: Data was collected from 5 surveys, and data from national registers. A group of older adults with SMI, with a history of long-term stays in mental hospitals, was identified and divided into two groups: Psychosis diagnosis (N = 222) and Non-Psychotic diagnosis (N = 253).

Results: The level of functioning was significantly lower in the Psychosis group, but at the same time, long periods of institutionalization, regardless of diagnosis category, also contributed to lower functioning scores. Diagnostic group did not explain differences in the proportion of unsatisfied needs; however, the length of institutionalization did.

Conclusions: Although there were diagnostic group differences in functioning, there were no diagnostic group differences in unmet needs, suggesting that social services were responding to individuals’ actual level of functioning. In line with the studies by Barton and by Goffman, it can be argued that the long periods of institutionalization were the most decisive factors influencing functional levels.

Drawing on interpretive policy analysis with its strong focus on emotions and ethnography, this chapter explores the role of emotions in institutional policy change. By applying the concept of emotionability that accounts for the concrete micro-level mechanisms through which practices of affective citizenship are realized in the context of institutional interactions, the chapter discusses the ways in which social policy changes are brought to life by interacting and relating welfare workers and welfare clients. Emotionability is therefore presented here as a real-life phenomenon accompanying policy changes and an analytical tool enabling the analysis of such changes.

In Sweden, older persons living with severe mental illnesses (SMI) increasingly live independently in the community with support from informal and formal carers and welfare services. A proportion of this group is older people with SMI who, due to age or disability, receive municipal eldercare services such as home care in their ordinary housing, or in residential care. The situation and needs of this group demand that eldercare staff have an understanding for the older person's situation and the tools to provide appropriate care. The aim of this present study is to explore the experiences of eldercare staff working with older people with SMI. Focus group interviews were conducted with staff from three residential care facilities and two home care teams in one mid-sized Swedish municipality. To analyse the interviews, qualitative content analysis was used. The overarching theme from the analysis was "Doing the best they can," which was unpacked in two categories: "Working with fragmentary knowledge" and "Finding the right approach." We could also see differences between the experiences of staff in residential care and in home care. The eldercare staff in our interviews faced lack of formal training, insufficient information and skills concerning mental illness and its treatment. Nevertheless, they tried to make the situation of the older people with SMI as good as possible using experiential and tacit knowledge. Our results also point to system level barriers that hinder effective care for older people with SMI.

After the Swedish Mental Health Care reform enacted in1995, many individuals with severe mental illnesses (SMI) were released from long-term care institutions. Many older adults with SMI experienced most of their care during an era of care ideology characterized as that of the total institution, which meant longer periods of institutionalization. Managing new living and support situations challenged many older adults with SMI and as a result, many experienced re-institutionalization. The aim of the current analyses was to identify the older adults with SMI who were re-institutionalized after the 1995 care reforms. We used data from surveys collected in 1996, 2001, 2006, and 2011 from 441 older adults with SMI in a region in southern Sweden (mean agein 1996 = 61.2, SD=11.4; 54.6% female), and data from national registers. The sample was divided into 3 groups: remained in their own home (N=251), moved from their home to an institution (N=37), and remained in an institution (N=153). Logistic regression indicated that total years of institutionalization and current level of functioning distinguished all 3 groups. Compared with group 1, adults in group 2 were older, were younger at first admission to a mental hospital, had more total years of institutionalization, more needs assessed by the Camberwell Assessment of Needs, and less education. Results reveal the long-term consequences of lengthy institutionalization, including greater risk of developing “institutional syndrome” that can inhibit ability to adjust to living in the community, particularly for adults also experiencing the challenges of aging.

Purpose: To evaluate the long-term effects of an Arts on Prescription (AoP) programme on sense of coherence (SOC) in Sweden.

Design: A controlled intervention study with a quasi-experimental prospective design, including questionnaires at baseline, with follow-ups at 6 and 12 months. Participants were on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain, recruited from primary care in six regions. The intervention group also included participants from open psychiatric care. The study sample comprised 586 participants (335 in the intervention group and 251 in the control group).

Results: Both groups showed a significantly stronger SOC at follow-up, with a medium effect size for the intervention group and a small effect size for the control group. No statistically significant difference in SOC change over time was observed between the groups. Participants from open psychiatric care in the intervention group showed a significant improvement in SOC compared to those from primary care. Concerns about finances had a significant main effect on SOC for the entire study population.

Originality: Unlike most AoP studies, this controlled study with a relatively large sample provides insights into the long-term effects of AoP on SOC, with results reported using p-values and effect sizes.

Aims: Involvement in arts has shown potential to promote mental health. Thus, arts may be able to complement conventional healthcare to address common mental disorders (CMD). The aim of this study was to evaluate the long-term effect of a 10-week Arts on Prescription program regarding CMD (stress, anxiety, depression), compared to conventional healthcare. The study also aimed to examine whether CMD differed between groups.

Methods: A quasi-experimental prospective design with intervention and control group and 6- and 12-month follow-up was used to evaluate an Arts on Prescription program in Sweden, focusing on the effects on stress, anxiety, and depression. Participants were on sick leave due to CMD and/or musculoskeletal pain. Data was collected using questionnaires.

Results: The study population consisted of 479 participants (n=247 intervention group, n=232 control group). The result indicates a greater effect size (ŋ) in the intervention group compared to the control group for reduction in stress, anxiety, and depression at follow-up after 12 months. The difference in depression was significant.

Conclusions: The results indicate AoP could be an adjunct to conventional healthcare interventions to address CMD, especially depression.

BACKGROUND: The concept of deinstitutionalization started in the 1960s in the US to describe closing down or reducing the number of beds in mental hospitals. The same process has been going on in many countries but with different names and in various forms. In Europe, countries like Italy prescribed by law an immediate ban on admitting patients to mental hospitals while in some other European countries psychiatric care was reorganized into a sectorized psychiatry characterized by open psychiatric care. This sectorization has not been studied to the same extent as the radical closures of mental hospitals, even though it entailed major changes in the organization of care. The deinstitutionalization in Sweden is connected to the sectorization of psychiatric care, a protracted process taking years to implement.

METHODS: Older people, with their first admission to psychiatric care before or after the sectorization process, were followed using three different time metrics: (a) year of first entry into a mental hospital, (b) total years of institutionalization, and (c) changes resulting from aging. Data from surveys in 1996, 2001, 2006, and 2011 were used, together with National registers.

RESULTS: Examination of date of first institutionalization and length of stay indicates a clear break in 1985, the year when the sectorization was completed in the studied municipality. The results show that the two groups, despite belonging to the same age group (birthyears 1910-1951, mean birthyear 1937), represented two different patient generations. The pre-sectorization group was institutionalized at an earlier age and accumulated more time in institutions than the post-sectorization group. Compared to the post-sectorization group, the pre-sectorization group were found to be disadvantaged in that their level of functioning was lower, and they had more unmet needs, even when diagnosis was taken into account.

CONCLUSIONS: Sectorization is an important divide which explains differences in two groups of the same age but with different institutional history: "modern" and "traditional" patient generations that received radically different types of care. The results indicate that the sectorization of psychiatric care might be as important as the Mental Health Care Reform of 1995, although a relatively quiet revolution.

Psychiatric care in Sweden is jointly organized by psychiatric practice and municipal social services. To determine who is entitled to support from the municipalities, the concept of “psychiatric disability” was created in connection with psychiatric reform in 1995. Psychiatric disability is a poorly identified concept and in Sweden, a person has severe mental illness (SMI) if they have difficulties in carrying out activities in crucial areas of life, these difficulties are caused by a mental disorder, and they are prolonged. Internationally, SMI is often synonymous with psychosis, but in Sweden other severe psychiatric conditions are included, but not dementia. Both practically and ethically, the unclear definition of SMI is a problem because it determines whether a person is granted interventions and what forms the interventions take. We investigated similarities and differences in people defined as SMI, divided into two groups, psychosis (Nf222) and non-psychosis (Nf253). Adults with SMI aged 65 or over (in 2016) have been assessed using data from four surveys carried out between 1996 and 2011, as well data available from national registers. People with psychosis had worse functional levels on the Global Assessment of Functioning and more unmet needs, according to Camberwell Assessment of Needs. However, differences between psychosis and non-psychosis groups varied across measures (e.g., education, income, living situation) and results differed depending on age at onset, year of first admission to a mental hospital, and length of institutionalization. These variables had a greater impact on the similarities and differences between measures than the diagnosis itself.

Internationalization of higher education and international social work are commonly accepted as positive developments. However, the quest for creating international knowledge and programmes is not free from difficulties. In this article, we problematize the process of internationalizing social work programs through the perspective of social work students. With two study sites, one in Sweden and one in South Africa, we discuss the meaning and challenges associated with internationalization by drawing on the emerging disparity between personal and professional points of view. We conclude by reflecting upon the role of social work educators in translating the ideas of internationalization to the future social workers.

Background and Objectives: Swedish eldercare is strained by an increased administrative workload, which draws time away from individual care of and interaction with older people. This study explores how eldercare staff, working closely with residents in Swedish special housing (nursing homes), make accounts for how they prioritize work tasks.

Research Design and Methods: Openly structured, thematic interviews were conducted with 12 permanently employed, female assistant nurses, including a group interview with 3 of them. Positioned accounts (small stories) concerning prioritizations due to insufficient resources were analyzed, using Bamberg's three-level positioning analysis.

Results: The analysis shows that the staff take a favorable position toward the older people by distinguishing between care and "the other things."They also justify prioritizations at odds with their care values. The assistant nurses present themselves as doing the best they can in organizationally restricted situations. Organizational demands limit the space for care, giving rise to an idealization of "icing on the cake."Morale is complex in residential care. A narration of "the torn carer"was found as a co-constructed storyline explaining why the staff did not perform eldercare consistent their care values.

Discussion and Implications: When ideals and practice differ, interaction in the peer group becomes important in order to maintain a positive professional identity. "The torn carer"is a way for the staff to escape blame for not living up to care values, but it also victimizes them. Staff could be empowered by a working environment characterized by a reflective practice.