AIMS AND OBJECTIVES: To describe lesbian, gay and bisexual parents' experiences of nurses' attitudes in child health care.

BACKGROUND: Lesbian, gay and bisexual people are often reluctant to disclose their gender identity for fear of discrimination. This fear may lead to avoidance of healthcare for themselves or their children and may negatively affect families' health and well-being.

DESIGN: A qualitative inductive design was employed.

METHODS: Semi-structured interviews were conducted with 14 lesbian, gay or bisexual parents (11 mothers and 3 fathers) with child health care experiences in southern Sweden. Interviews were analysed using qualitative content analysis.

RESULTS: Two themes were identified. One, a 'sense of marginalization', included lesbian, gay and bisexual parents' experiences of heteronormative attitudes among child health care nurses which led them to feel alienated and questioned as parents. Another, 'being respected for who you are', included experiences of being respected and included at child health care appointments.

CONCLUSIONS: Findings paint a complex picture of lesbian, gay and bisexual parents' interactions with child health care nurses in that they experienced both positive and negative attitudes. Knowledge gaps about lesbian, gay and bisexual families within the child health care field must be filled.

RELEVANCE TO CLINICAL PRACTICE: Child health care nurses should work with the entire family to provide the best care for the child; however, discrimination in health care is common and often caused by a lack of knowledge. The number of children living with same-sex parents has increased more than ten-fold since the end of the 1990s. It is therefore important to explore lesbian, gay and bisexual parents' experiences with child health care nurses' attitudes to improve quality of care.

AIM: This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases.

BACKGROUND: People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases.

METHOD: The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases.

FINDINGS: The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized.

CONCLUSION: In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices.

OBJECTIVE: Homecare workers play a pivotal role in palliative care, but research on their experiences is limited. The aim of this study was to describe how homecare workers in Sweden experience their work in palliative homecare.

METHOD:This qualitative study used open-ended interviews with a purposive sample of 15 homecare workers. The data was analysed by means of qualitative content analysis.

RESULTS: One main theme emerged from the analysis: upholding an ideal image of palliative work. This had four subthemes: doing good; doing their best work; feeling work satisfaction; and facing difficulties.

CONCLUSION: Palliative care performed by homecare workers is demanding. Homecare workers need more practical support and would benefit from a care model that involves working with registered nurses, as a team, to provide humanistic care to dying patients and their relatives.

A queer moment in care. Although the perspective of caring sciences propose to cover the suffering of patients as well as humanistic aspects of caring relationships its theoretical frame lacks assumptions connected gender and sexuality. From a starting point of a concrete caring situation within the context of psychiatric care this autobiographic study makes shortcomings within the theoretical frame of caring sciences obvious. The shortcomings are related to issues of instability of gender, gender performances and heteronormativity as for granted taken assumptions. The situation concerns an encounter between me as a nurse and a patient who experienced himself as both a man and a woman. By means of queer theories, aspects of what happened in the situation are interpreted. Queer theoretical concepts such as the binary heterosexual matrix, gender instability, performativity, and subversive performativity are penetrated in relation to the caring situation. It is suggested that in order to develop and complement the theoretical frame of caring sciences the perspective of queer should be used.

Objective: Several studies have reported that care and support staff has a tendency to ignore recognising violence against women with mental illness, which lead to increased feelings of stigma in these women. Today there is a lack of in-depth knowledge about factors that may influence care providers attitudes in encounters with these women. The aim of this qualitative study was to describe how staff experience and understand their everyday work with abused women with mental illness.

Methods: 13 professionals who in their working practice encountered women with mental illness and experience of abuse were interviewed by means of unstructured thematic interviews. Data were analysed by using latent content analysis in order to identify categories a nd themes.

Results: Participating staff found it hard to understand abuse against women with mental illness. They lack knowledge about how to handle and interpret this phenomenon and developed personal frames of interpretations and strategies for handling the women’s needs. They experienced their everyday work with these women as painful and ambiguous and made them act pragmatic mainly in a practical way that sometimes included assertive attitudes.

Conclusion: Staff working with abused women with mental illness is in a vulnerable position due to lack of understanding and knowledge about the phenomenon. In such position it is at risk to adopt stigmatised attitudes against the women and thereby challenge the professionals’ occupational safety.

Hot och våld som riktas mot kvinnor med psykisk sjukdom är vanligt förkommande i vårt samhälle i dag och medför att kvinnornas psykiska hälsa och självkänsla försämras. För att tillgodose deras behov av vård och stöd måste personal inom det samhällsbaserade vård- och stödsystemet i större utsträckning än vad som görs i dag ställa frågor om utsatthet samt informera om hjälp som finns att tillgå. Dessutom behöver personal utbildning för att bättre förstå bakomliggande orsaker till våld mot dessa kvinnor samt hur de på bästa sätt ska bemötas. För att personal ska kunna tillgodose behov hos våldsutsatta kvinnor med psykisk sjukdom måste verksamhetsledningen oavsett beslutsnivå legitimera personalens arbete med denna grupp kvinnor.

The main aim of the study was to investigate whether the three hypothesized subscales of Antonovsky's sense of coherence (SOC) scale: comprehensibility, meaningfulness and manageability, can be found when measuring SOC in a sample of patients with schizophrenia living in the community. A further aim was to study the relationship between SOC and psychopathology. The concept of SOC has been proposed to explain successful coping with life stressors. A total of 120 patients completed the SOC scale and the Brief Psychiatric Rating Scale (BPRS) was used to assess the psychopathology of the patients. The SOC scale was analysed by means of a factor analysis with a varimax rotation and the Spearman rank correlation test was used to test for associations between subscales, factors and psychiatric symptoms. A four-factor model presented the best solution and explained 48% of the total variation in SOC. The first factor, which included 12-items of the SOC scale, turned out to be the most salient factor explaining 29% of the total variation. All factors displayed some overlapping between items. Affective symptoms were negatively related to all the three subscales and the four factors of SOC, while positive symptoms were similarly related to two of the subscales and two of the factors while negative symptoms were not associated with any of the factors or subscales. The findings in this study corroborate those in studies with other patient groups and indicate that the theoretical framework of SOC should not be adopted uncritically. Furthermore, the use of the three subscales in the SOC scale in studies of patients with a severe mental illness is questioned and a further investigation of the relationship between SOC and psychopathology is proposed.

The aims of the study were to investigate: (1) self-reported adulthood and last-year victimization in male and female outpatients suffering from psychosis; (2) relationships to perpetrators; (3) whether drugs or alcohol were involved in victimization situations; (4) places where victimization occurred. Patients were randomly selected from five outpatient units geared to patients with psychosis; 174 patients participated in a structured face-to-face interview. Experiences of victimization in adulthood were reported by 67%, 33% in the previous year. During adulthood 51% had been physically and 32% sexually victimized and 39% threatened. In the previous year 21% reported threats, 20% physical and 15% sexual victimization. Women reported greater exposure to physical and sexual victimization than men during adulthood and in the previous year. Strangers and acquaintances were mainly reported as perpetrators and half (55%) of those victimized in the previous year stated no involvement of alcohol or drugs. Victimization mainly occurred in the patients' own home (59%), outside downtown (34%), or in others homes (38%). The results of this study give reason to highlight the importance for research and clinical practices to adopt a broad frame of interpretation concerning victimization in patients, covering both individual and environmental factors.

Since the closure of large psychiatric institutions, various types of community-based supportive housing for people with serious mental illness (SMI) have been developed. There is currently limited knowledge about users' experiences of living in supportive housing. The aim of the present study was to describe user experiences of living in supportive housing for people with SMI. Twenty-nine people living in such facilities participated in open, qualitative interviews. Data were subjected to latent content analysis. Three main themes emerged from this analysis: (i) having a nest, which included the subthemes of a place to rest and having someone to attach to; (ii) being part of a group, with the subthemes of being brought together and a community spirit; and (iii) leading an oppressive life, including the subthemes of questioning one's identity, sense of inequality, and a life of gloom. It could be concluded that user experiences of living in supportive housing are complex and paradoxical. In order to provide supportive housing, staff need to recognize and work within social group processes, and perform continual and structural evaluations of users' social and emotional needs.

The aim of this Swedish study was to describe landlords' experiences of having tenants suffering from severe mental illness. Sixteen landlords working in private and public housing agencies participated in open in-depth interviews. Data were subjected to a thematic latent content analysis. The results showed that having tenants with severe mental illness entails being confronted with various difficult circumstances, ranging from mismanagement of apartments to sensitivity among neighbours as well as issues regarding provocative behaviour. It involved providing assistance that was far beyond their professional obligations and to be neglected by the community-based psychiatric service system when in need of help. In order to support landlords and to prevent evictions of individuals with severe mental illness, community-based psychiatric services need to be more pro-active in their attempts to achieve collaboration with the parties at hand.

Aim: The study investigated clinical and social changes during an 18-month follow-up period in a group (n = 76) of schizophrenic outpatients admitted to a newly implemented outpatient psychosis team. Changes related to level of contact with the psychosis team were also examined as well as aspects of the content of the treatment interventions and work situation from a staff perspective. Methods: Structured face-to-face interviews with the patients were performed at baseline and after 18 months. The Camberwell Assessment of Need instrument, the Lancashire Quality of Life Profile and the Interview Schedule for Social Interaction were used on both interview occasions along with Global Assessment of Functioning Scale and Brief Psychiatric Rating Scale. Thematic open-ended questions were used in staff interviews. Results: Psychiatric symptoms, number of needs and number of met needs decreased, and perceived quality of life improved for the total sample during the follow-up period. Patients only in contact with a psychiatrist in the psychosis team improved more in symptoms and spent fewer days in hospital during follow-up time compared with those who had combined psychiatric and supportive contacts, and were also more satisfied with their medication. Patients with a combined contact deteriorated in psychosocial functioning compared with the group only in contact with a psychiatrist. Some of the elements in treatment interventions and work situation as well as hindrances in providing community-based care adapted to the patients' needs were identified. Conclusions: Community-based psychiatric services, to a larger extent, need to embrace evidence-based interventions and to perform regular, structured and comprehensive need assessments in order to ensure the effectiveness of interventions. Attention should be paid to staff motivation and education as well as to providing practical guidelines, supervision and support.

Background/Objectives

Persons suffering from severe mental illness (SMI) live – and prefer to live – independently, in either private or public apartment blocks without on-site services. Living in own apartments increase feelings of safety and well-being and function as a robust social status marker. Landlords are important actors in gaining stability and sustainability and it has been found that landlords have a plethora of preconceptions, attitudes, emotions as well as well as ethical dilemmas in offering apartments to this group of persons. Today there is a lack systematic knowledge about the role landlords have come play in providing sustainable housing for these persons. The main aim of this qualitative study was to describe landlords’ experiences of having tenant suffering from SMI

Methods

Sixteen landlords in various parts of Sweden participated in open in-depth interviews three years after the government proclaimed a vision zero regarding homelessness among individuals with SMI. Data was subjected to thematic latent content analysis.

Results

Landlords experienced being confronted with difficult circumstances such as mismanagement of apartments, sensitivity and provocative behaviors in relation to both tenants with SMI and neighbors. In acute situations landlords tried to collaborate with the community based psychiatric service system but were neglected. As a result and without the knowledge of how to best help they started to provide support to tenants with SMI involving going beyond professional boarders.

Discussion/Conclusion

The findings give reasons to conclude that community-based psychiatric services need to be more pro-active in their collaboration with landlords. Also education interventions with a focus on how to best help tenants with SMI need to be developed and implemented.

Background: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients.

Method: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning.

Results: The correlation between subjective and interviewer-rated quality of life was moderate (ICC=0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1 of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5 of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network.

Conclusion: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected.

The aims of the study were to investigate self-reported physical, sexual, emotional and economical abuse in Swedish female users of psychiatric services, who the perpetrators were and in which places abuse occurred. An anonymous self-administrated questionnaire was answered in the waiting room of the services. The drop-out rate was 21% and n=1382 women completed the questionnaire. Fifty-three per cent of the women had been abused during childhood, 63% during adulthood and 31% during past year. Seventy-four per cent of those exposed during childhood were also exposed later in life. Women subjected to abuse reported longer contact with psychiatric care. Regardless of life period, the majority reported multiple and frequent abuse. Emotional abuse was most frequent reported in both childhood and adulthood followed by physical and sexual abuse. The reported perpetrators were mainly male persons to whom the woman had an intimate relationship. Mostly the abuse occurred in the women's own home. However, other women, strangers, acquaintances and relatives were also stated as perpetrator and abusive acts also took place in other homes, outdoors or down town. The high prevalence of abuse and its multiplicity point to the necessity for the care and support system to prioritize abuse against women with psychiatric illness.

The phenomenon of abused women with mental illness is often unrecognised by staff working within welfare services. This may be explained by staff members' attitudes, insecurity or lack of awareness. Today, there are shortcomings in the knowledge of staff members' experiences and interpretations of abuse against women suffering from mental illness. The aim of this qualitative study was to describe how staff members experience and understand their work with abused women suffering from mental illness. Thematic interviews were conducted with 13 staff members from various welfare services. Data were subject to content analysis. The findings showed that working with abused women was experienced as ambiguous and painful and made the staff act pragmatically. Feelings of ambiguity were mainly related to the lack of theoretical frameworks for interpreting why women with mental illness are exposed to abuse. Painful experiences involved intertwined feelings of distress, frustration, worthlessness, ambivalence and powerlessness. These were all feelings that emerged in the direct encounters with the abused women. In response to the abused women's comprehensive needs, staff members acted pragmatically, implying networking without any sanction from the leaders of the organisation, compliance with routines and taking action in here-and-now situations. By acting pragmatically, staff members could achieve concrete results through their interventions. It is concluded that staff members, working with abused women with mental illness, are in a vulnerable situation and in need of formally accepted and implemented support and legitimacy as well as theoretical knowledge regarding causes and consequences of abuse in this particular group of women.

BACKGROUND: Although user involvement in research is an area of high priority there is a lack of knowledge about how users of the mental health system perceive participation in studies carried out by other users.

AIM: The aim of the study was to describe how users experience participation in research interviews performed by other users.

METHOD: A varied sample of 17 mental health users with experience of being interviewed in a research project by another user was thematically interviewed in this qualitative study. Data was subject to content analysis.

RESULTS: Being interviewed by another user was a special experience including both negative and positive aspects, and took place in an atmosphere of comradeship. However, being interviewed by another user could generate feelings of insecurity. This finding indicates requirements from the informants how to perform user-involved research in the future.

CONCLUSIONS: In planning for user-involved research education, it is necessary to consider training and issues related to secure ethical principals concerning the informants.

The aims of the study were to investigate the prevalence of adult abuse in female users of psychiatric care, the relationship between abuse and self-esteem and self-reported consequences of abuse, and women's self-reported needs of support. A total of 1382 women participated in the study. A self-administrated anonymous questionnaire with both closed-ended and open-ended questions was used. Quantitative data were analysed by mainly descriptive statistics and qualitative data were analysed by content analysis. Forty-six per cent (n = 638) of the women had been exposed to emotional, sexual, and/or physical abuse in adulthood. Twenty-eight per cent (n = 385) reported experiences of moderate physical abuse, 27% (n = 373) reported threats of injury, and 20% (n = 277) reported threats of being killed. Further, 19% (n = 261) reported experience of sexual violence, and 12% (n = 164) had experiences of serious physical violence. Women who had been abused rated lower self-esteem than those who were not abused. Self-reported consequences of abuse included intrapersonal problems such as poor self-esteem, fears, anxiety, and worries but also problems in social relations especially with regard to close relationships and reliance to others. To a lesser extent, disease-specific manifestations were reported. The needs of support included interventions directed to the experiences of abuse by professionals trained in the area, family interventions, self-help groups, medical care, legal support, or practical help to find new housing situations. It is concluded that female users of psychiatric care services constitute a vulnerable group with regard to abuse. To meet the women's needs, the care system has to adopt a perspective that includes personal, social, and societal factors.

Män och kvinnor som drabbats av psykossjukdom utsätts i betydligt större omfattning än folk i allmänhet för hot om våld och fysiskt och sexualiserat våld ute i vårt samhälle.

The purpose of this qualitative study was to explore the lived experience of fall risk from a lifeworld perspective in elderly women with previous fragility fractures. Thirteen elderly women with a high risk of fall and fracture, aged 76-86, living in their own homes in rural areas, were recruited from a voluntary fracture prevention programme. All women had a history of fragility fractures and were interviewed in their homes from spring to autumn 2004. A phenomenological reflective lifeworld approach was chosen to analyse in-depth interview data. The study was conducted within an interdisciplinary research group inspired by dialogical research. Elderly women's life space has been narrowed due to advanced age, physical injury or by efforts to prevent new injuries leading to changes in self-perception. However, the women seek strategies to challenge limitations and insecurity, and strive to retain mobility and daily life routines. The four major constituents of the phenomenon 'elderly women's experiences of fall risk' emerged in this study: a changing body, living with precaution, ambiguous dependency and influence and need for understanding. Employing the women's thoughts and resources in trust-based dialogues with caregivers may strengthen their concord and the prospects to continue an active life. Elderly women seek strategies to challenge limitations and feelings of insecurity, and strive to maintain mobility and daily life routines. A trust-based care respecting the preferences of the women seemed to stimulate behavioural change in maintaining an active life.

Despite the general move to support people with learning disabilities in their own homes or in home-like settings, many institutional settings still exist and little research has been carried out on the role of the care workers who work in them. In this study, participant observations over a 16-month period describe care workers’ experiences of working in an institutional care setting in Sweden, and 18 care workers were interviewed. The three main themes to emerge from the thematic analysis were: care workers were engaged in creating a family-like atmosphere; they were engaged in making the everyday ordered and structured; and they were exposed to stress factors.It became evident that care workers need additional support, training and opportunities for reflection to handle their complex work situation

Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work.

The purpose of this study was to determine and describe the ideas, that is, a mental construction of perceived reality and values, which are expressed in the Swedish Disability Act and its Government Bill. By means of text analysis, four concepts of reality and values have been identified: (1) Citizenship and justice, (2) The collective and integration, (3) The individual and autonomy, and (4) Decentralization and power shifts. The study also shows that social rights and social citizenship have been strengthened via legislation for individuals with comprehensive disabilities. It is also demonstrated that there is considerable room in the legislation for conflicts between the two concepts and values of collective/integration and the individual/autonomy. It can also be observed that there is a considerable risk that citizens are not treated in a similar manner as regards the interpretation and application of the Disability Act, which may lead to lack of legal security.

This study was aimed at investigating the psychometric properties of the Interview Schedule for Social Interaction (ISSI), in terms of construct and discriminant validity and unidimensionality, in three psychiatric samples with varying prerequisites for social interaction: 1) an outpatient sample of working age with mixed diagnoses, 2) an outpatient sample with schizophrenia, and 3) an inpatient sample composed of mentally ill, male offenders. The target constructs were psychosocial functioning and satisfaction in different life domains. It was hypothesized that the ISSI would mainly be related to psychosocial functioning and life domains characterized by social interaction, such as friends and family. A second hypothesis was that the ISSI ratings would discriminate between the three samples. The first hypothesis was confirmed, but the pattern of relationships was somewhat different between the groups. Whereas family contacts were of great importance for social integration in Samples 1 and 2, friends seemed more important for the mentally ill offenders. The second hypothesis was partly confirmed: three ISSI sub-scales out of four discriminated between the samples. Moreover, the ISSI proved to be a unidimensional construct. The support for the four proposed sub-scales was not unanimous, however, and the sub-scales targeting attachment constituted less stable factors. This study demonstrated the construct and discriminant validity of the ISSI when applied to samples with various mental disorders. The fact that similar results were obtained in all three samples, despite varying prerequisites for social interaction, strongly supports the validity of the ISSI. Providing the sub-scales are used with caution, the ISSI seems to be a reliable tool for use with patients with severe mental disorders.

Research findings that link personality factors to functioning and symptoms in schizophrenia are inconsistent, and further studies are needed within the area. The purpose of this study was to investigate how personality, as measured by the Temperament and Character Inventory (TCI), was related to demographic factors, subtypes of diagnoses, level of functioning, and aspects of psychological health, including sense of coherence, perceived control, and self-esteem, among people with schizophrenia. Subjects were 104 individuals, aged 20-55 years, in psychiatric outpatient care. The results indicated that personality was not related to subtypes of diagnoses or demographic characteristics of the respondents, but to level of functioning and all aspects of psychological health. Especially self-directedness distinguished three groups of functioning and was highly correlated with the different aspects of psychological health. The article discusses how knowledge of schizophrenic patients' personality structure might be used for tailoring psychiatric treatments. (C) 2003 Elsevier SAS. All rights reserved.

Community-based psychiatry as an arena for studying work efforts is relatively unexplored. The professional role of a housing support worker (HSW) in congregated supported housings for people with severe mental illness (SMI) is fairly new. The role has emerged due to major changes in Swedish mental care and services. Our aim was to describe the work experiences of HSWs and to understand the conditions provided when work assignments are being constructed. By doing this we provide an important piece of the puzzle in understanding the processes in contemporary congregated supported housings for people with SMI. Four focus group interviews were conducted and included 25 participants. Four different facilities of congregated supported housings for people with SMI were represented in the material. The interpretation of the material was inspired by a constructionist approach. The work of an HSW is experienced as complex and ambiguous. Together with different significant actors (including objects), the HSWs are negotiating the content of the responsibilities. Thus, different actors help co-construct the work content. Furthermore, the HSWs are caught between two different logics, one that is related to a complex practice and one that is related to instrumental and routine-based ideas. The complex emotional work of an HSW is often not supported by the principles of the organization. The findings can be helpful when organizing the work in congregated supported housings for people with SMI. This paper highlights the importance of bridging the gap between organizational demands and expectations and the individual preconditions and basic needs.

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on eleven interviews, we illustrate how stories are understood, used and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Secondly, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.

BACKGROUND: Work and employees are often marginalized in studies on community-based psychiatric care and support systems. This paper highlights the role of the worker at congregated supported housing for people with severe mental illness (SMI). Housing support workers (HSW) are a fairly new professional role and have developed as a result of major changes in Swedish mental health care and services. The development of new roles is not unproblematic and raises intriguing questions.

OBJECTIVE: The purpose of this article is to describe housing support workers’ experiences of meaning in their work, and in addition illuminate how the work identity of HSWs can be negotiated and constructed.

METHODS: Four focus group interviews were conducted with a total of 25 participants. Additionally, three follow up sessions were conducted with the same participants. The material consists of employees from four different sites. The intepretation of the material was inspired by a constructionist approach.

RESULTS: The analysis generated three themes: to do a good job, everyday needs and the formal role. The work identity for HSWs is complex and not easily interpreted.

CONCLUSIONS: The experience of an unclear assignment affects the description of what is meaningful and important—the work identity and significant affiliations for HSWs. In the long run, this fragmented world can have negative implications for the HSW.

The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.

Introduction:  The aims of this study were to investigate: (1) the prevalence of childhood abuse in women admitted to psychiatric services in a county in the south of Sweden; (2) who the perpetrators were; and (3) the women's self-reported consequences of childhood abuse.

Method:  The study had a cross-sectional design and was a part of a more comprehensive study. An anonymous self-reported questionnaire was used which included both closed and open-ended questions. The data material were analysed by means of descriptive statistics, Mann–Whitney U-test and manifest content analysis.

Results:  The total number of women who participated in the study was 259, 51% of whom reported experiences of abuse during childhood, with 53% of these having been exposed to more than one type of abuse. The most frequent perpetrator was the woman's parents; mainly the fathers but also the mothers turned out to be frequent perpetrators of abuse. Some 75% of the women reported current psychological problems in adulthood related to abuse in childhood. According to a manifest content analysis, five themes of self-reported psychological problems emerged: psychiatric problems, shortcomings in social relations, poor self-confidence, fears and bad memories.

AIMS: To describe persons visiting the psychiatric emergency room (PER) in Sweden and to compare persons who frequently (PFV) and infrequently (PIFV) visit PERs in terms of group size, age, gender, PER location inside versus outside the home municipality, diagnosis (ICD 10), temporal patterns of visits and hospital admissions.

METHODS: This register study included all visits to PERs in one Swedish county over 3 years, 2013-2015 (N = 67,031 visits). The study employed descriptive statistics as well as Chi-square tests combined with Bonferroni correction to compare PFV with PIFV.

RESULTS: Of the total of 27,282 visitors, 2201 (8.1%) were identified as PFV (five or more visits within 12 months) and they accounted for 38.1% of the total visits. The study found differences between PFV and PIFV in gender, diagnostic profile, hospital admissions and temporal patterns. Differences were also detected with regard to distance between PERs and home municipalities. However, no age-related differences were found between the two groups.

CONCLUSIONS: PFV and PIFV have different clinical profiles and temporal patterns. These results may be important when planning, developing and evaluating interventions targeting the needs of each group, which is in accordance with a person-centred approach. Such an approach might eventually result in fewer visits to PERs.

AIM: To investigate self-reported needs for care, support and treatment among persons who frequently visit psychiatric emergency rooms (PERs).

DESIGN: A cross-sectional design. Qualitative and quantitative data were collected using an interview-based manual. Qualitative data were analysed using content analysis, whereas quantitative data were analysed using descriptive, non-parametric statistical tests.

RESULTS: Persons who frequently visit PERs self-reported unmet needs for care, support and treatment in life domains such as health, socialisation, daytime activities, and emotional and financial security.

CONCLUSION: To meet the needs of persons who frequently visit PERs, close cooperation between concerned welfare actors should be implemented.

Background: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. Method: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. Results: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. Conclusions: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.

Aims and objectives To illuminate the meaning of living with alcohol dependency as a woman. Background The number of women suffering from alcohol dependency is increasing. Today there are shortcomings in knowledge about the lived experiences of being a woman with alcohol dependency; knowledge which might be of importance for meeting these women's specific needs of care. Design The study has a qualitative design. Fourteen women with alcohol dependency participated in open in-depth interviews. Method Data were analysed according to a phenomenological-hermeneutic method, and interpreted by help from gender and caring perspectives as well as results from previous research of alcohol dependency. Results In relation to the women's senses of well-being, four main gender formations were found; An unstable self involving continual and rapid swings between emotional and bodily reactions. Ambivalence – meaning ambiguous feelings towards themselves as human beings and how they lead their lives. Introspectiveness – involving reflections, pondering and being introverted. Attempts to perform normality – covering – dealing with life through various strategies and facades to live up to the expectations of how to behave as a woman. Conclusion Living with alcohol dependency as a woman constitutes of a rapid shifting everyday life resulting in senses of alienation as well as private introspection leading to self-degradation, and to a lesser extent meaningfulness and hope. It also constitutes of managing to perform normality. Relevance to clinical practice When supporting women with alcohol dependency towards wellbeing, professionals need to work towards approaching the woman's inner thoughts, share them and reflect over them together. To support these women to find balance in life, caregivers need to cooperate with the women to find out how best to live a life adjusted to the woman's abilities and wishes.

Despite the fact of increased levels of alcohol dependency in women and gender differences in how the disease affects men and women, the research on alcohol dependency continues to have a dominating perspective on men. The meaning of the phenomenon of caring in formal care for women with alcohol dependency is not well known. Thus, formal caregivers may find it problematic to know what is caring for women with alcohol dependency. The aim of the study was to illuminate the meaning of caring in formal care for women with alcohol dependency, as narrated by the women. The study was performed using a phenomenological-hermeneutic method. Data were collected in ten in-depth interviews with alcohol-dependent women. The themes presented are availability, being a patient and being a learner. The findings reveal that the women with alcohol dependency receiving a mandate from formal care, experience the relation between them and their caregiver as a mutual transformation. Within the mutual transformation, the participants experienced being respected as a responsible human being which renders possibilities for the women with alcohol dependency to continue in formal care even when the struggle against the disease became hard. Continual meetings with the caregiver allowed the women to gain structure in their daily life as well as allowing the women and their caregivers to develop mutual transformation, which both relieved the women's suffering and increased their experience of being involved in the care process.