Papers by Urban Markström
Users perceptions of programme characteristics and everyday activities in day centres and clubhou... more Users perceptions of programme characteristics and everyday activities in day centres and clubhouses - a longitudinal study.
Urban Planning
There is broad consensus among policymakers about the urgency of developing healthy, inclusive, a... more There is broad consensus among policymakers about the urgency of developing healthy, inclusive, and socially sustainable cities. In the Swedish context, social services are considered to have knowledge that needs to be integrated into the broader urban development processes in order to accomplish such ends. This article aims to better understand the ways in which social service officials collaborate in urban development processes for developing the social dimensions of healthy cities. We draw from neo-institutional theories, which set out actors (e.g., social service officials) as acting according to a logic of appropriateness, which means that actors do what they see as appropriate for themselves in a specific type of situation. Based on semi-structured interviews with social services officials in 10 Swedish municipalities on their experiences of collaboration in the development of housing and living environments for people with psychiatric disabilities, we identified that they act...
Tidskriften Kurage; (2021), May 1, 2021
Journal of Psychosocial Rehabilitation and Mental Health
User-focused monitoring (UFM) is a method of evaluating mental health services, conducted by peop... more User-focused monitoring (UFM) is a method of evaluating mental health services, conducted by people with lived experience of mental ill health. Research on UFM and on user involvement focused on service monitoring and evaluation is lacking. This study addresses this knowledge gap by examining UFM as a strategy for user involvement. More specifically, this study aims to synthesize patterns in UFM reports to characterize the phenomenon, as well as to further discuss negotiation processes and political opportunities in UFM. The empirical material consists of 136 Swedish UFM reports that have been analyzed in two steps: All reports were mapped according to general characteristics and a sample of 20 reports were selected to provide additional information on the method. This study has been conducted in collaboration with actors representing the user movement and municipality-based mental health services. Our analysis shows that long-term contracts between user organizations and service pr...
Is ACT possible to implement in a highly sectorized system? A longitudinal analysis of outcomes a... more Is ACT possible to implement in a highly sectorized system? A longitudinal analysis of outcomes and critical implementation components in a Nordic case.
Trots manga problem i genomforandet av psykiatrireformen kan reformen inte ses som ett ensidigt m... more Trots manga problem i genomforandet av psykiatrireformen kan reformen inte ses som ett ensidigt misslyckande. Det ar en av slutsatserna i avhandlingen.
European Planning Studies, 2020
In the governance of housing provision, the public sector is considered unable efficiently to man... more In the governance of housing provision, the public sector is considered unable efficiently to manage such problems through the traditional bureaucratic organizations and associated governing tools. Instead, municipalities are expected to engage in collaborative processes across sectors and with external stakeholders, with the overarching objective to deliver more efficient planning outcomes. As the processes are carried out across sectors, it opens up the opportunity to privilege certain sectors' perspectives and marginalize others. By drawing from Mouffe's agonistic political theories, this article makes an empirical account of the political in organizing cross-sectoral collaborative planning in Swedish municipalities, with the empirical example of developing municipal programmes for housing provision. The article concludes that social service is severely marginalized in what is generally a depoliticized housing provision planning process. Underpinning the collaboration is the conceptualizing of housing provision as primarily a general deficit in constructing housing. Primarily organizing objectivist knowledge, housing provision is constructed as a technical and procedural matter rather than ideological and political. Through such organizing principles, the overarching housing provision problem remains undealt with, e.g. how do we provide housing to 'all' our citizens? ARTICLE HISTORY
Scandinavian Journal of Disability Research, 2020
A disability policy defines the relationship between the state and the disabled and is generally ... more A disability policy defines the relationship between the state and the disabled and is generally based on ideas in different legislation. These ideas have an impact on decision makers and the disabled's everyday life and are under current pressure for change; therefore, it is important to thoroughly scrutinise the ideas, make them conscious and visible. The purpose of this study is to reveal the ideas expressed in the Swedish Social Services Act (SoL), which supports people with disabilities, and to compare the results with ideas expressed in the Swedish Disability Act (LSS). A text analysis of SoL identified the following ideas, that is, conceptions of reality and values: (1) the social contract and justice, (2) the collective and integration/ normalisation, (3) the individual and autonomy and (4) decentralisation and the shift of power. There are great similarities between the ideas in the legislation, but there are also few but significant differences.
Nordic Journal of Working Life Studies, 2020
The aim of this article is to broaden the understanding of how Swedish disability policies are co... more The aim of this article is to broaden the understanding of how Swedish disability policies are constructed to meet the objectives of the ratified UN Convention on the Rights of Persons with Disabilities (CRPD) regarding active citizenship and full participation on an equal basis with others. The study examines two policy domains: health and employment. Recently issued legal documents are analyzed using the approach of directed content analysis and the theories of ‘social risk’ and ‘governance’. The results suggest that the policy area of employment implicitly and explicitly overshadows the policy area of health and related rights accounted for in the CRPD. A more nuanced perspective in disability policies concerning employment in relation to active citizenry and full participation is required, accompanied by social policy schemes that encompass the perspective of the CRPD as a whole in all support-to- work services, instead of the limited focus of finding full-time employment
International Journal of Mental Health Systems, 2020
Background The person-centred Individual Enabling and Support (IES) model is a novel return-to-wo... more Background The person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model. Methods A case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from...
Alter, 2019
Encourager des citoyens-travailleurs réels ou imaginaires ? Accomplissement de soi et aide à l'em... more Encourager des citoyens-travailleurs réels ou imaginaires ? Accomplissement de soi et aide à l'emploi dans les récits de personnes atteintes d'autisme de haut niveau de fonctionnement
European Journal of Social Work, 2019
Mental health service user movements have historically to a large extent employed collective form... more Mental health service user movements have historically to a large extent employed collective forms of mobilisation, where people with service user experience have joined in formal organisations or informal groups. Currently, expressions of service user engagement are changing, and we can now observe the growth of more individualised expressions, often enacted online. This article introduces the concept 'service user entrepreneur' (SUE), that relates to this development. SUEs are individuals with service user experience who have made a career of their engagement in mental health issues. Based on their individual narratives of mental ill-health, SUEs often express themselves in participatory media, hold lectures and write books on the subject. The aim of this article is to examine how SUEs in their communication establish authority. Applying case study methodology, we follow four Swedish SUEs involved in mental health issues and analyse their communication primarily in digital arenas. Intimate personal narratives, mobilisation of collectives and institutional perspectives constitute authority sources for SUEs. Balancing individual and collective narratives as well as maintaining a desirable level of vulnerability is a continuous effort. How SUEs manage these issues is further discussed. SAMMANFATTNING Brukarrörelser på området psykisk ohälsa har till stor del använt sig av kollektiva former för mobilisering, där personer med brukarerfarenhet slutit sig samman i formella organisationer eller i informella grupper. På senare år har brukarengagemanget genomgått förändringar och vi kan idag se framväxten av mer individualiserade former som ofta tar sig uttryck online. Denna artikel introducerar i det sammanhanget begreppet 'brukarentreprenör'. Brukarentreprenörer är individer med brukarerfarenhet som har skapat en karriär genom sitt engagemang i frågor som rör psykisk ohälsa. Med grund i sina individuella narrativ om psykisk ohälsa framträder brukarentreprenörer ofta i sociala medier, håller föreläsningar och skriver böcker om ämnet. Syftet med denna artikel är att undersöka hur brukarentreprenörer i sin kommunikation etablerar auktoritet. Med fallstudie som metodologisk ansats följer vi fyra svenska brukarentreprenörer som ägnar sig åt frågor som rör psykisk
International Journal of Environmental Research and Public Health, 2017
Depressed patients had risks of non-adherence to medication, which brought a big challenge for th... more Depressed patients had risks of non-adherence to medication, which brought a big challenge for the control of tuberculosis (TB). The stigma associated with TB may be the reason for distress. This study aimed to assess the psychological distress among TB patients living in rural areas in China and to further explore the relation of experienced stigma to distress. This study was a cross-sectional study with multi-stage randomized sampling for recruiting TB patients. Data was collected by the use of interviewer-led questionnaires. A total of 342 eligible and accessible TB patients being treated at home were included in the survey. Psychological distress was measured using the Kessler Psychological Distress Scale (K10). Experienced stigma was measured using a developed nine-item stigma questionnaire. Univariate analysis and multiple logistic regression were used to analyze the variables related to distress, respectively. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to present the strength of the associations. Finally, the prediction of logistic model was assessed in form of the Receiver Operating Characteristic (ROC) curve and the area under the ROC curve (AUC). According to the referred cutoff point from K10, this study revealed that 65.2% (223/342) of the participants were categorized as having psychological distress. Both the stigma questionnaire and the K10 were proven to be reliable and valid in measurement. Further analysis found that experienced stigma and illness severity were significant variables to psychological distress in the model of logistic regression. The model was assessed well in predicting distress by use of experienced stigma and illness severity in form of ROC and AUC. Rural TB patients had a high prevalence of psychological distress. Experience of stigma played a significant role in psychological distress. To move the barrier of stigma from the surroundings could be a good strategy in reducing distress for the patients and TB controlling for public health management.
Nordic Social Work Research, 2018
The aim of this study was to examine changes in an organizational field over time when implementi... more The aim of this study was to examine changes in an organizational field over time when implementing a freedom of choice model. Main focus was on the range and characteristics of providers and services. Our findings suggest that the expected effects of the reform in terms of variety of providers and services within the organizational field did not materialise due to a lack of market competition. Providers complemented each other rather than competed with each other, and the logics of care, choice, and advocacy challenged each other within the quasimarket. All informants described financial conditions in the market as extremely strained. Strong personal commitment characterized providers entering and exiting the market. A gap was found between policy goals and experiences among stakeholders, and efficiency was found to be the policy goal achieved most often in practice. This raises the questions of how the Swedish community mental health service market will develop in the future and what the implications are for the participants.
International Journal of Mental Health, 2017
Despite the lack of scientific evidence for the effectiveness of Flexible Assertive Community Tre... more Despite the lack of scientific evidence for the effectiveness of Flexible Assertive Community Treatment (Flexible ACT), the model disseminates rapidly in the mental health services in a number of countries. This is in contrast to many evidence-based practices that often face comprehensive implementation barriers. Knowledge is needed on the dissemination of Flexible ACT to understand the relative success. The aim of this study was to explore program fidelity and factors influencing the implementation of Flexible ACT in a Swedish healthcare context over a 2-year period. Seven mental healthcare teams who decided to implement Flexible ACT were included in the study. Interviews were conducted regularly with project leaders and team leaders, and steering group meeting notes and implementation progress reports were collected during a 2-year period. Flexible ACT fidelity assessments were conducted 6 and 18 months after implementation started. Data was analysed using conventional and directed content analysis and the Sustainable Implementation Scale. All teams reached at least good fidelity 6 months after implementation, and the fidelity scores remained stable over an 18-month period. An active national initiative and support to implement Flexible ACT, as well as a willingness among managers and staff to implement the model, contributed to the seemingly swift and easy implementation. Despite the highly sectored Swedish healthcare context, implementation of high fidelity Flexible ACT was possible. Positive mental health professional attitudes, belief in the practice, and desire to offer the practice appear to have central roles when implementing new practice models in mental healthcare.
protocols.io, 2017
This is part of the project to survey the rural TB patients in China, which we focus on the role ... more This is part of the project to survey the rural TB patients in China, which we focus on the role of stigma in psychological distress.
International Journal of Environmental Research and Public Health, 2017
The detection and analysis of cases of low medication adherence is important for helping to contr... more The detection and analysis of cases of low medication adherence is important for helping to control tuberculosis (TB). The purpose of this study was to detect low adherence in rural TB patients by using the eight-item Morisky Medication Adherence Scale of Chinese version (C-MMAS-8) and to further analyze the adherence-related variables. A total of 358 rural TB patients recruited through multi-stage randomized sampling participated in the survey. Data were collected by the use of interviewer-led questionnaires. First, the reliability and validity of the C-MMAS-8 were determined. Second, the adherence level was assessed, and factors related to low adherence were analyzed by using Pearson's chi-square test and then in multiple logistic regression model. Finally, the prediction of the logistic model was assessed with Receiver Operating Characteristic (ROC) curves. The C-MMAS-8 could be used to detect low adherence in TB patients with good reliability and validity. By using the referred cutoff points of MMAS-8, it was found that more than one-third of the participants had low medication adherence. Further analysis revealed the variables of being older, a longer treatment time, and being depressive were significantly related to low adherence. The ROC of the model was assessed as good using the cutoff point. We conclude that appropriately tailored strategies are needed for health-care providers to help rural TB patients cope with low medication adherence.
Global Journal of Health Science, 2016
OBJECTIVE: The aim of the study was to compare users of community-based mental health day centres... more OBJECTIVE: The aim of the study was to compare users of community-based mental health day centres (DCs) and clubhouses in Sweden regarding reported social networks and social interaction and the stability of these over time. A further aim was to investigate social network predictors both cross-sectionally and longitudinally.METHODS: People regularly attending DCs (n=128) or clubhouses (n=57) completed questionnaires about social network and social interaction (social engagement and social functioning), self-esteem and socio-demographics at baseline and a nine-month follow-up. RESULTS: Perceived social engagement and social functioning did not differ between the groups and remained stable over time. Fewer in the DC reported having a close friend but there was no difference regarding having recently (the past week) seen a friend. When naming “someone with whom you can share your innermost thoughts and feelings”, the DC group named more professional contacts, fewer friends and more oft...
Scandinavian journal of occupational therapy, Jan 27, 2016
Meaningful everyday occupations are important for mental health and recovery and are provided by ... more Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features. This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored. Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments. DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more s...
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Papers by Urban Markström