Syftet med denna pilotstudie var att beskriva hur sjuksköterskor som arbetar som Case Managers uppfattar effekterna av denna arbetsmodell avseende medicinsk vård, social situation, missbruk, vård- och omsorgskvalitet samt samordning för patienter med missbruk och samtidig psykisk störning. Metoden var kvantitativ och genomfördes med en webbenkät. Resultatet visade att respondenterna anser att Case Management haft en positiv påverkan på patienternas medicinska vård och sociala situation. Det ledde också till en bättre kontakt med patienten, och förbättrad bedömning av patientens sammansatta situation. Sammantaget framkom en övervägande positiv uppfattning även av vård- och omsorgskvaliteten, samordningen och de arbetsmetoder som använts. Vad gäller missbruket uppgav en del av respondenterna att det påverkades positivt och en del av respondenterna uppgav att det inte påverkades alls. Vid en fullskalig studie hade det varit intressant att göra enkäten mer nyanserad med fler svarsalternativ och även ha med bakgrundsvariabler för att se samband och göra jämförelser. Pilotstudien indikerar att Case Management är en arbetsmodell som kan underlätta omvårdnadsarbetet för patienter med komplex problematik och stort behov av vård och stöd, och även vara en metod för att lättare samordna insatser från olika vårdgivare. Sjuksköterskan kan genom Case Management arbeta hälsofrämjande för att stödja patienter med missbruk och samtidig psykisk störning i olika områden som påverkar hälsan. / The aim of this pilot study was to describe how nurses who work as Case Managers perceive the effect of this approach for medical treatment, social status, substance abuse, quality of health care and coordination for patients with substance abuse and concurrent psychiatric disorder. The method was quantitative and was conducted with a web survey. The results showed that the respondents believe that case management had a positive impact on patients' medical care and social situation. It also led to a better contact with the patient, and improved assessment of the patient's complex situation. Overall, the answers also revealed a generally positive perception of the care quality, the coordination and used methods. As for the abuse, some respondents answered that Case Management had affected the abuse in a positive way, and others that it had not been affected at all. In a full scale study it would have been interesting to make the questionnaire more nuanced with more response options, and also have the background variables to make comparisons. The pilot study indicate that case management is an approach that can facilitate nursing care for patients with complex problems and need of care and support, and also be a method to help to coordinate the efforts of various health care providers. The nurse can through Case Management support patients with substance abuse and mental disorders in different areas of health.

The involvement of individuals with mental illness in the criminal justice system is receiving increased attention. Under the current law, the court or jury makes a special verdict of “Not Criminally Responsible on Account of Mental Disorder” if the accused did not at the time of the offence appreciate what he or she was doing, or that it was wrong, due to a mental disorder. This paper will outline the current Criminal Code mental disorder regime, before examining how Bill C-54, the Not Criminally Responsible Reform Act, proposes to build on the existing law. By exploring the provisions of Bill C-54 aimed at enhancing public safety, this thesis will discuss whether the reforms are supported by empirical evidence, and will likely achieve its stated objective. This paper will also consider the possibility of constitutional challenge in light of the ‘twin goals” statutory framework and Supreme Court jurisprudence.

The involvement of individuals with mental illness in the criminal justice system is receiving increased attention. Under the current law, the court or jury makes a special verdict of “Not Criminally Responsible on Account of Mental Disorder” if the accused did not at the time of the offence appreciate what he or she was doing, or that it was wrong, due to a mental disorder. This paper will outline the current Criminal Code mental disorder regime, before examining how Bill C-54, the Not Criminally Responsible Reform Act, proposes to build on the existing law. By exploring the provisions of Bill C-54 aimed at enhancing public safety, this thesis will discuss whether the reforms are supported by empirical evidence, and will likely achieve its stated objective. This paper will also consider the possibility of constitutional challenge in light of the ‘twin goals” statutory framework and Supreme Court jurisprudence.

Dailės terapijos mokslinės literatūros analizė parodė, jog sutrikusį intelektą turintys vaikai piešia nekreipdami dėmesio į realų objekto vaizdą, nepastebi esminių detalių, nesuvokia objektų tarpusavio ryšių. Tokių vaikų piešiniams būdingi šablonai, apimantys tiek besikartojančią temą, tiek pasikartojančius tuos pačius objektus. Piešinių stereotipiškumas atspindi vaikų reakciją į supantį pasaulį, kur dėmesys fiksuojamas ties aktualiu, keliančiu rūpestį išgyvenimu. Dažniausiai piešiami objektai – namas, medis, žmogus. / The analysis of the art therapy’s scientific sources has revealed that the children having mental disorder draw without focusing on a real image of the object, they don’t pay attention to essential details, don’t realize the existence of the relationship between the objects. The drawings of these kids have got typical patterns with a recurring theme and repeated objects in their pictures. The stereotypical drawings reflect the kids’ reaction to the surrounding. Their attention concentrates on the urgent emotionally stressful experience. The most common objects in such pictures are houses, trees and people.

Interpersonal violence is a matter of growing concern. Where the safety of the common man is concerned, the dangerousness of mental patients, the ongoing de-institutionalization within psychiatry, and the role of alcohol is disputed. In order to analyze the significance of abuse and mental disorder in violent behaviour, this subject was approached from two different perspectives; from a specific violent offence - homicide - examining the mental status of the offenders, and from individuals with a specific mental disorder - schizophrenia -and assessing the rate of criminal offence amongst them. Homicides in northern Sweden and in Stockholm, legally characterized as murder, manslaughter or assault and causing another’s death, and homicides followed by the offenders’ suicide, were studied. Medicolegal autopsy records, police reports, pretrial psychiatric reports and court records were collected and scrutinized. The criminal records of 644 persons, discharged from hospitals in Stockholm with a diagnosis of schizophrenia, were studied. The relative risk of criminal offence was analyzed by indirect standardization using the general population as a standard. Violent offenders were further examined from psychiatric records. In the homicide material, 16 females and 160 males killed 94 men, 78 women, and 15 children. Forty percent of all surviving offenders were abusers without a major mental disorder, 39% were mentally disordered, 11% committed suicide, and 10% were considered "normal". The abusers and their victims were older, often socially and mentally deteriorated, and well known to each other. The victim was the prime aggressor in half of the cases. Killings by mentally disordered persons and by those who committed suicide were characterized by intimacy between offender and victim; one third were also abusers. Multiple homicides and child murder were mainly seen among homicide-suicice cases. The "normal" offenders were more often of foreign origin and two thirds of the victims initiated the violence by physical attacks. Relatively more of the homicides in northern Sweden concerned intimate parties, use of firearms, and cases of homicide-suicide, as compared to homicides in Stockholm where drug abuse was more prevalent. Sixteen offenders (9%) in the homicide sample had schizophrenia (all males), while 38 subjects (6%) in the cohort of schizophrenics had committed a violent offence. No homicide was recorded and most of the offences were of minor severity. The rate of violent offence was four times higher in the study group as compared to the general population. Most homicides involved closely related persons with separation and dependence as the dominating psychological theme, especially in homicide- suicide cases. Intoxication was regularly seen among the abusers but not among the non-abusers. The acute effect of alcohol intoxication may be of lesser importance in violence as compared to the long-term effects of abuse. Schizophrenics do not impress as a particularly dangerous group. Prevention by psychiatry is difficult; most offenders did not have any contact with psychiatry prior to the act. / <p>S. 1-70: sammanfattning, s. 71-176: 5 uppsatser</p> / digitalisering@umu

I förarbeten till lagarna LVM och LPT framkommer det att det finns en problematik kring vården av personer som lider av både missbruk och psykisk ohälsa. Det framgår att samarbetet mellan psykiatri och socialtjänst i vissa avseende är att anse som bristfälligt och att brukarna faller mellan stolarna. Syftet med studien har varit att, genom granskning av rättskällorna, ta reda på och tydliggöra vad som ska ses som gällande rätt, för om en person med både missbruk och psykisk ohälsa ska få vård enligt LVM eller LPT. Metoden som har använts är en rättsvetenskaplig metod där fokus legat på granskning av rättskällorna. En rättsfallsstudie har även gjorts för att bredda bilden av hur rekvisiten för lagstiftningarna tillämpas. Resultatet har analyserats och redovisats utifrån den rättsdogmatiska metoden. Rättsfallen har tematiserats och redovisats i diagram. Studien visar att det finns gällande rätt kring ämnet, men att gällande rätt varierar beroende på personens situation. Huvuddraget i resultatet är att LPT vid allvarlig psykisk ohälsa bör gå före LVM. Vidare framkommer det att det inte finns något hinder, för att under en kortare period, vårdas enligt båda lagstiftningarna samtidigt. / In the preparatory works to the laws of LVM and LPT it has been pointed out that there is a problem regarding the care of persons that both suffer from an addiction as well as mental illness. It appears that the cooperation between psychiatry and social services is deficient and that the users are falling through the cracks. The purpose of the study has been, through review of the sources of law, to find out and define what is to be considered a correct, application of the law for a person that suffers from an addiction as well as a mental illness. Is it to be admitted to compulsory care and treatment according LVM or LPT? The method and material used for this purpose is the sources of law. To broaden the picture a study of court cases has also been made, regarding how the legislation is applied by a lower administrative court. The results has been analyzed and reported through the legal method. Court cases has been thematized and presented in different diagrams. The study shows that the outcome of the law varies depending on the person’s situation. The main feature of the result is that if someone is suffering from serious mental illness, LPT should be chosen instead of LVM. Further it is possible, during a shorter time, to be treated according to both LVM and LPT simultaneously.

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine. In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p&lt;0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II). We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p&lt;0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p&lt;0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively.  In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention.

Several interventions have been developed and implemented to reduce the stigma attached to mental illness. However people who experience mental illness are still stigmatised in the communities in which they live, as well as in the healthcare centres where they receive treatment. The objective of this study was to critically synthesize the best available evidence regarding interventions to reduce stigma attached to mental illness. This study aimed to provide clinical practitioners with accessible information on interventions to reduce stigma attached to mental illness. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What best evidence is available regarding interventions to reduce the stigma attached to mental illness? A thorough search was done on selected electronic databases: EBSCOhost; Science Direct; Web of knowledge; Scopus; Sabinet; ProQuest; SA Nexus; Cochrane; Google Advance Scholar were searched for primary studies that were published from 2001-2011, including the available 2012 literature and reference lists. The following key words were used in the search: Intervention, stigma, program, mental illness, mental disorder, psychiatric patients. During the selection of studies pre-determined inclusion and exclusion criteria were applied. Seventeen studies (n=17) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP) the John Hopkins Nursing Evidence-Based Practice (JHNEBP) Research Evidence Appraisal Tool and Evidence Analysis Manual; Academy of Nutrition and Dietetics. All seventeen studies (n=17) were identified as evidence that answers the research question. Extraction of evidence, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in the Evidence Analysis Manual (EAM, 2012:70). Findings indicated some interventions that reduce the stigma attached to mental illness. Using Web-based approaches and reading printed educational materials, documentary films and anti-stigma films, live and video performances, and humanising and traditional, naturalistic educational methods are effective in reducing stigma attached to mental illness for health professionals because there were no stigmatising attitude and social distance towards individuals with mental disorders. The German WPA (World Psychiatric Association) “Program against stigma and discrimination because of Schizo-phrenia – Open the doors” is effective in reducing stigma attached to mental illness for the general population. Combining education and video-based contact, in vivo contact and videotaped education, Active Minds and documentary films are effective in reducing stigma of mental illness for students. The use of puppets, psycho-education and contact (via DVD) and public education programs are effective in reducing stigma attached to mental illness for adolescents. The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, nursing education and nursing research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Several interventions have been developed and implemented to reduce the stigma attached to mental illness. However people who experience mental illness are still stigmatised in the communities in which they live, as well as in the healthcare centres where they receive treatment. The objective of this study was to critically synthesize the best available evidence regarding interventions to reduce stigma attached to mental illness. This study aimed to provide clinical practitioners with accessible information on interventions to reduce stigma attached to mental illness. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What best evidence is available regarding interventions to reduce the stigma attached to mental illness? A thorough search was done on selected electronic databases: EBSCOhost; Science Direct; Web of knowledge; Scopus; Sabinet; ProQuest; SA Nexus; Cochrane; Google Advance Scholar were searched for primary studies that were published from 2001-2011, including the available 2012 literature and reference lists. The following key words were used in the search: Intervention, stigma, program, mental illness, mental disorder, psychiatric patients. During the selection of studies pre-determined inclusion and exclusion criteria were applied. Seventeen studies (n=17) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP) the John Hopkins Nursing Evidence-Based Practice (JHNEBP) Research Evidence Appraisal Tool and Evidence Analysis Manual; Academy of Nutrition and Dietetics. All seventeen studies (n=17) were identified as evidence that answers the research question. Extraction of evidence, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in the Evidence Analysis Manual (EAM, 2012:70). Findings indicated some interventions that reduce the stigma attached to mental illness. Using Web-based approaches and reading printed educational materials, documentary films and anti-stigma films, live and video performances, and humanising and traditional, naturalistic educational methods are effective in reducing stigma attached to mental illness for health professionals because there were no stigmatising attitude and social distance towards individuals with mental disorders. The German WPA (World Psychiatric Association) “Program against stigma and discrimination because of Schizo-phrenia – Open the doors” is effective in reducing stigma attached to mental illness for the general population. Combining education and video-based contact, in vivo contact and videotaped education, Active Minds and documentary films are effective in reducing stigma of mental illness for students. The use of puppets, psycho-education and contact (via DVD) and public education programs are effective in reducing stigma attached to mental illness for adolescents. The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, nursing education and nursing research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Among all the causes of hospital admissions due to mental and behavioral disorders, abusive use of alcohol and other drugs represents one of the main reasons for hospitalizations. The growing number of users, and especially of drug dependents, makes abusive use of alcohol and other drugs a global public health problem. Thus, the present study had as objective to analyze the evolution of hospital admissions, due to abusive use of alcohol and other drugs, carried out in the State of Alagoas, from 2008 to 2015. An analytical, observational study of the ecological type was carried out, based on the information found in the national databases Of the Hospitalization System of the Unified Health System (SIH / SUS). Averages, proportions and gross rates were calculated. Among the first ten causes of hospitalizations due to mental disorders, the use of some type of drug is the second largest responsible (15.10%), second only to hospitalizations by Schizophrenia (57.25%). When specifically observed hospitalizations due to the use of drugs, it is verified that the disorders generated by the abuse of alcohol and multiple drugs concentrate 99,17% of hospitalizations. There was a strong trend of growth in these hospitalizations (R² = 0.8419), an increase of 90.56% when compared to the extremes of the evaluated period, regardless of the sex considered. In population terms, when the population is considered as a reference, in relation to the number of hospitalizations, there is no shocking increase related to these causes. However, in comparison to the other causes of mental disorders, an important increase in the accomplishment of such hospitalizations has been observed. Comparatively, men are the majority among hospitalizations for alcohol abuse (p = 0.0000), while women are more susceptible to the use of hypnotic sedatives (p = 0.0000), cocaine (p = 0.0000), volatile solvents (p = 0.0000), stimulants (p = 0.0000) and the use of multiple drugs (p = 0.0000). No difference was observed regarding the use of cannabinoids (p = 0.6283) and opiates (p = 0.0080). The volume of hospitalizations for alcohol and other drugs abuse is increasing, and it is necessary to elaborate and implement multisectoral preventive strategies, since this situation is directly related to the Social Determinants of Health. / Dentre todas as causas de internações hospitalares, decorrentes dos transtornos mentais e comportamentais, o uso abusivo de álcool e outras drogas representa um dos principais motivos de hospitalizações. O número crescente de usuários e principalmente, de dependentes de drogas, faz com que o uso abusivo de álcool e outras drogas seja um problema de saúde pública mundial. Dessa forma, o presente estudo teve como objetivo analisar a evolução das internações hospitalares, por uso abusivo de álcool e outras drogas, realizadas no Estado de Alagoas, no período de 2008 a 2015. Foi realizado um estudo analítico, observacional, do tipo ecológico, a partir das informações constantes nas bases nacionais do Sistema de Internações Hospitalares do Sistema Único de Saúde (SIH/SUS). Foram calculadas médias, proporções e taxas brutas. Entre as dez primeiras causas de internações devido aos transtornos mentais, o uso de algum tipo de droga é o segundo maior responsável (15,10%), perdendo apenas para as internações por Esquizofrenia (57,25%). Quando observadas, especificamente, as hospitalizações devidas ao uso abusivo de drogas, verificam-se que os transtornos gerados pelo uso abusivo do álcool e múltiplas drogas concentram 99,17% das internações. Observa-se uma forte tendência de crescimento nessas internações (R²= 0,8419), sendo verificado um incremento de 90,56% quando comparados os extremos do período avaliado, independente do sexo considerado. Em termos populacionais, quando se considera a população como referência, em relação ao número de internações, não se observa um aumento impactante relacionado a tais causas. No entanto, em comparação às demais causas de transtornos mentais, tem-se observado um importante aumento na realização das internações por uso de álcool e outras drogas. Comparativamente, os homens são maioria entre as hospitalizações por uso abusivo de álcool (p=0,0000), enquanto que as mulheres são mais suscetíveis ao uso de sedativos e hipnóticos (p=0,0000), cocaína (p=0,0000), solventes voláteis (p=0,0000), estimulantes (p=0,0000) e ao uso de múltiplas drogas (p=0,0000). Não foi observada diferença frente ao uso de canabinóides (p=0,6283) e opiáceos (p=0,0080). É crescente o volume de internações hospitalares por uso abusivo de álcool e outras drogas, sendo necessário elaborar e implementar estratégias preventivas multissetoriais, uma vez que tal situação tem relação direta com os Determinantes Sociais da Saúde.