Contribution of the Nordic School of Public Health to the public mental health research field: a selection of research initiatives, 2007-2014.

The field of public mental health has been defined by an expert group convened by the Nordic School of Public Health (NHV) as encompassing the experience, occurrence, distribution and trajectories of positive mental health and mental health problems and their determinants; mental health promotion and prevention of mental disorders; as well as mental health system policies, governance and organization. The mental health priorities of the Nordic Council of Ministers in 2010 signalled a mutual Nordic exchange of knowledge in the following thematic areas: child and adolescent mental health; working life and mental health; mental health in older people; strengthening the role of primary care in mental health service provision; stronger involvement of users and carers; and reduction of use of coercion in psychiatric care. Efforts to realize these priorities included commissioning the Nordic Research Academy for Mental Health, an NHV-based network of research institutions with a common interest in mental health research across the Nordic countries, to develop, organize and follow-up projects on public mental health. The research initiatives included mental health policy analysis, register-based research and research focused on the users' perspective in a Nordic context, as well as EU-level research policy analysis. The public mental health research conducted at the NHV highlighted the complexity of mental health and emphasized that the broad determinants of mental health need to be increasingly addressed in both public health research and practice. For example, health promotion actions, improved access to health care, a healthy alcohol policy and prevention of suicides and violence are all needed to reduce the life expectancy gap - a red flag indicator of public health inequalities. By exchanging knowledge and best practice, the collaboration between the Nordic countries contributes to the welfare of the region. The expertise and traditions developed at the NHV are of significant importance in this work.

Establishment of community mental health systems in a postdeinstitutional era: a study of organizational structures and service provision in Sweden.

This article analyzes the state of community mental health services for people with psychiatric disabilities and the interplay between different organizational levels. The study is based on document analysis and interviews with stakeholders in 10 Swedish municipalities. The results show how systems are slow to change and are linked to local traditions. The services are often delivered in closed settings, and the organizations struggle to meet the needs of a new generation of users. There is a gap between local systems and national policies because the latter pays attention to the attributes of a recovery approach.

Who is responsible for supporting "long-term mentally ill" persons?: reforming mental health practices in Sweden.

The Swedish Mental Health Reform of 1995 was intended to expand community services, improve inter-organizational co-operation between welfare agencies, and achieve goals of social participation for the mentally ill and disabled. The implementation of the reform was characterized by weak legal steering mechanisms and a strong commitment to transform norms. Time-limited economic incentives at the local level and efforts by enthusiastic key persons were salient traits. The result indicates that community-based services such as supported housing and rehabilitative methods have increased. However, inter-organizational co-operation is still difficult, and traditional norms according to which people with mental health problems are seen as ill rather than disabled remain intact.

A holistic view in psychiatric rehabilitation: the effects of structure in psychiatric institutions.

Achieving independence in society following hospitalization is difficult for people with mental illness. Using quantitative and qualitative research methods, this study examines rehabilitation procedures and identifies possible deficiencies. Patients (n = 150) and employees (n = 50) were invited to participate. The results show little coordination among professionals, patients, and programs. Employees generally believe rehabilitation is more beneficial than do users. Better results could possibly be achieved if the interactional model was used along with the medical model. The findings emphasize the validity of giving patients voices that can lead to better rehabilitation and quality of life.

Struggling for recognition and inclusion-parents' and pupils' experiences of special support measures in school.

During the last decade an increasing use of differentiated support measures for pupils with special educational needs, indicative of a discrepancy between educational policies and practices, has been witnessed in Sweden. Another trend has been the increased use of medical diagnoses in school. The aim of this study was to explore the main concern of support given to pupils with special educational needs and how pupils and parents experience and handle this. Interviews were conducted with eight pupils in Grades 7-9-and their parents-at two compulsory schools in a city in northern Sweden. A grounded theory approach was used for analyzing the interview data. A conceptual model was generated illuminating the main concern of special support measures for pupils and parents. The core category of the model, struggling for recognition and inclusion, was related to two categories, which further described how this process was experienced and handled by the participants. These categories were labeled negotiating expertise knowledge within a fragmented support structure and coping with stigma, ambivalence, and special support measures. The developed conceptual model provides a deeper understanding of an ongoing process of struggle for recognition and inclusion in school as described by the pupils and parents.

Welfare state and women's work: the professional projects of nurses and occupational therapists in Sweden.

In this article we explore how Swedish welfare politics within health-care and rehabilitation has opened up a space for nurses' and occupational therapists' professional projects. Using historical data, an analysis of the policy-making process behind welfare programs central to the professionalization of nursing and occupational therapy is presented. The time period covered is, in the case of nurses, the larger part of the twentieth century, while the modern history of occupational therapists first began in the 1940s. Special emphasis is placed on the corporative nature of the Swedish welfare state and the professional strategies utilized by nurses and occupational therapists in their struggle for jurisdiction. In the article, politicization is identified as a core strategy by which female-dominated welfare state occupations in Sweden have tried to gain influence over the welfare policy-making process and their occupations' jurisdiction.