Voice hearing has a diverse history but is currently understood as symptomatic of a disease within psychiatric frameworks. Alternatives to 'treatment' include peer-support 'Hearing Voices Network groups' (HVNGs) which have grown in popularity and exist alongside treatment-based hearing voices groups. Few studies have investigated processes underlying change in HVNGs. Established research into therapeutic factors and personal recovery may provide frameworks elucidating change processes. This study aimed to investigate how HVNG attendees experienced change within the group and how this change influenced their lives. A qualitative design was employed using interpretative phenomenological analysis (IPA) to elucidate group processes through immersion in the perspectives of group attendees. Semi-structured interviews were conducted with eight individuals who were purposively sampled from two HVNGs. Interviews lasted from 34 to 54 minutes, were recorded on a Dictaphone and later transcribed verbatim. Four superordinate themes emerged: 'healing', connecting with humanity; group as an emotional container; making sense of the voices and me; and freedom to be myself and grow. The study concluded that relationships, safety, exploration of voices and group ownership are key components of HVNG and fit into frameworks of therapeutic factors and recovery processes. Development of HVNGs should take these processes into account. Future studies should further elucidate processes.

Young people within the youth justice system experience three times higher rates of mental health problems than the general youth population yet are one of the least likely groups to seek help. Very little theory or research is available within this population to explain these high rates of unmet need. This study aimed to develop a theory about the barriers and facilitators that Youth Offending Team workers experience when supporting young people to access mental health services. Eleven semi-structured interviews were conducted with participants; eight youth offending team workers, two young people and a mental health worker. Interviews were audio-recorded and transcribed verbatim before being analysed using “grounded theory”. This method was chosen to allow the in depth exploration of participants experiences and the development of theory within an under researched area. The results showed that Youth Offending Team workers appeared to play a crucial role in supporting a young person’s help seeking from mental health services. A preliminary model was developed which demonstrated the complex relationships between six identified factors which influenced this role. The study concluded that Youth Offending Team workers would benefit from more support, training and recognition of the key role they play in supporting young people to become ready for a referral to mental health services. Mental health services could be well placed to provide this. Clinical implications are discussed. Further research is needed to develop our understanding of what influenced the help seeking of this vulnerable population.

Culture can often influence how psychological distress is experienced and where help is sought. South Asians are the largest ethnic minority group in the United Kingdom (UK). This paper aimed to explore how second-generation South Asian adolescents make sense of their experiences of psychological distress and the meanings attributed to help-seeking. Semi-structured interviews were carried out with nine second-generation adolescents aged 13-19 years. Interpretative Phenomenological Analysis was employed. Five superordinate themes emerged from the analysis: feeling distressed, negative impact of family and cultural ideals on the self, connectedness to others, perception of help-seeking outside the family and intergenerational differences in help-seeking. The results indicated that help is sought from families when participants perceive they are able to relate to the source of distress. However, when there is a lack of understanding of distress, participants sought this from external sources of help. Professional help-seeking appeared influenced by the interplay between not meeting family ideals, intergenerational differences in understanding of distress and the stigma of seeking help. Clinical and research implications are discussed.

Psykisk ohälsa är ett stort folkhälsoproblem i Sverige. Ångestsyndrom drabbar cirka 25% av befolkningen och årligen begår cirka 1100 personer suicid. Ambulanssjuksköterska har en bred kompetens gällande somatiska åkommor men i grund- och specialistutbildningen läggs liten vikt på psykisk ohälsa. Detta kan medföra att patienter med psykisk ohälsa ej bedöms och vårdas optimalt. Sahlgrenska Universitetssjukhus genomförde 1 oktober – 31 december 2015 ett projekt, Prehospital Psykiatrisk Resurs (PPR). Projektet innebar att en bedömningsbil, normalt enkelbemannad av en ambulanssjuksköterska, bemannades med en psykiatrisjuksköterska och en ambulanssjuksköterska. Psykiatrisjuksköterskan har triagerat patienterna med hjälp av psykRETTS och alla patienter inom projektet har sorterats utifrån symtom enigt Emergency Symtoms and Signs (ESS) och vitalparametrar. Denna enhet tilldelades ärenden där larmcentralen misstänkte att det förekom  psykisk ohälsa. Syftet var att beskriva de psykiatriuppdrag enheten larmades ut på utifrån patientkarakteristiska, symtom och diagnos samt beskriva omhändertagandet som gavs av PPRsjuksköterskan. Under studiens period bedömdes 91 patienter, 46% lämnades hemma, med eller utan hänvisning till annan vårdinstans, och 54% transporterades till slutenvården.  Det är en relativ ung population i denna patientgrupp och majoriteten av patienterna var kvinnor. Flertalet har haft kontakt med psykiatrin tidigare och hälften har en psykiatrisk diagnos.  Ångest, suicidbedömning och missbruk var de vanligaste ESSkoderna. En minoritet av patienterna fick en fullständig bedömning av sitt somatiska tillstånd. Resultatet tyder på att ångest är en vanlig anledning till att söka akut hjälp. Förslag på utbildningsinsatser inom prehospital akutsjukvård gällande psykisk ohälsa kan bestå av utökade behandlingsriktlinjer (läkemedel), introduktion av bedömningsinstrument, t.ex. suicidstegen, samt införande av vårdkedjor för att slussa patienterna till rätt hjälp. / Mental illness is a major public health problem in Sweden. Anxiety disorder affects approximately 25% of the population and every year about 1100 people commit suicide. An Ambulance nurse has a broad expertise concerning somatic complaints, but the basic and specialized training dedicats just a small part on mental health. This can lead to that patients with mental disorders are stigmatized. Sahlgrenska Universitetssjukhus preformed during October 1th until December 31th 2015 a project call Prehospital Psykiatrisk Resurs (PPR). The project meant that a assessmentcar which normally is manned with a single ambulance nurse, now were manned by a specialist trained psychiatric nurse and an ambulance nurse. The psychiatric nurse has triacted the patients using psykRETTS and all the patients have been sorted out by their symptoms , acccording to the Emergency Symtoms and Signs (ESS) and vital parameters. This unit was assigned with cases where the emergency call centre suspected existence of mental illness. The purpose was to describe which missions that the unit was sent on where patient had characteristic symptoms of mental dissorder, describe the diagnosis and the disposal which the PPR-nurse used. During the project were 91 patient assessed, 46% of these were left at home with or without no further information, 54% were transported to closed care. The population of the project were relatively young and the majority was women. Most of the patients had had former contact with the psychiatry care before and half had a psychiatric diagnosis. Anxiety, suicide assessment and alcohol and drug abuse were the most common ESScodes. The result indicates that anxiety is a common reason to seak emergency care. Training programs regarding mental illness can be done thorough expanded treatment guidelines, the introduction of assessment instruments and increase delegation of drugs.

I takt med att samhället förändras och antalet unga med psykisk ohälsa ökar utvecklas och förändras även de hjälpformar som finns tillgängliga för ungdomar med psykisk ohälsa. Internets framväxt har bland annat resulterat i att traditionella former av hjälp, där den unge möter den professionella ansikte mot ansikte, har kompletterats med onlinehjälp så som onlinechattar. Med hänsyn till denna utveckling syftar denna studie till att undersöka och jämföra ungdomars attityder till att söka hjälp hos kurator och via onlinechatt vid psykisk ohälsa. Detta har åstadkommits med hjälp av ett kvantitativt tillvägagångssätt där pappersenkäter använts som insamlingsmetod. Sammanlagt besvarades enkäterna av 223 högstadie- och gymnasieungdomar mellan 15-20 år i Stockholmsområdet. Studiens resultat visar att ungdomarna känner större tillit till kuratorer än onlinechattar. De är även mer positiva till att söka hjälp hos kurator än via onlinechatt vid psykisk ohälsa. Ungdomarna uppgav varierande svar på vad som påverkar deras attityder till att söka respektive hjälpform. Lättillgänglighet, tillit och kommunikationsform uppgavs vara de faktorer som främst påverkar deras vilja att söka hjälpa hos kurator medan brist på tillit och stigma främst påverkar deras ovilja att söka denna hjälpform. De respondenter som kunde tänka sig att söka hjälp via onlinechatt uppgav däremot lättillgänglighet och anonymiteten som främsta anledningar. Den majoritet som inte kunde tänka sig att söka hjälp via onlinechatt uppgav brist på tillit och kännedom samt kommunikationsform som främsta orsaker till att inte söka denna hjälpform. Studiens respondenter är inte bara mer positiva till att söka hjälp hos kurator än via onlinechatt vid psykisk ohälsa; de har dessutom mer erfarenhet av att söka denna hjälpform. De faktorer som ungdomarna upplevde som positiva och negativa med sina erfarenheter skiljde sig dock avsevärt från de faktorer som påverkade deras attityder till att söka respektive hjälpform. Ungdomarna uppmärksammade exempelvis den professionellas bemötande och om de fick hjälp med sitt problem som positiva och negativa faktorer som utmärkte deras erfarenheter. Generellt hade dock majoriteten av ungdomarna positiva erfarenheter av att söka hjälp hos både kuratorer och onlinechattar. / In pace with changes in society, and as the number of youth with mental illness increases, the forms of help available to youth with mental health issues also develop and change. The evolution of the internet, among other things, has resulted in traditional forms of help, where the one meets a professional face-to-face, being supplemented with online forms of help, such as online chats. In view of this development, this study aims to examine and compare the attitudes of young individuals towards seeking help for mental illnesses from a counselor and an online chat. This thesis will be accomplished using a quantitative approach where paper questionnaires are used as a data collection method. A total of 223 questionnaires were answered by adolescents aged 15-20 years in the Stockholm area. The study’s results show that respondents feel more secure with and trust towards a counselor’s help and are also more likely to seek this form of help than online chat.  Responses varied in regards to what affected attitudes toward each form of assistance, but ease of access, trust and the medium of communication was reported to be the main factors affecting willingness to seek the help of a counselor, while lack of trust and stigma were the main factors contributing to reluctance. The respondents who were willing to seek help from an online chat stated however that accessibility and anonymity were primary factors. The majority who could not imagine seeking such online assistance stated lack of confidence and awareness as well as medium of communication as the foremost explanations. The study also showed that respondents are not only more willing to seek help for mental illness from a counselor than through online chat; they also have more experience in seeking this type of support. The factors that respondents felt to be positive and/or negative with their experience differed considerably from those factors that influenced the respondents' attitudes toward seeking help from a counselor or an online chat. Respondents drew attention to factors like the professionals' attitude and whether they received help with his or her problem as factors that characterized their experiences. Generally, however, the majority of respondents’ had positive experiences of seeking help from both counselors and online chats.

Bakgrund: Den psykiska ohälsan har ökat bland personer som söker sjukvård. Personer med psykisk ohälsa känner sig diskriminerade och stigmatiserade i mötet med vården. De upplever att de inte blir behandlade med samma respekt som personer utan psykisk ohälsa. Personer med psykisk ohälsa har ökad sjuklighet och dödlighet jämfört med övrig befolkning och de upplever att de inte får tillräcklig information. Syfte: Syftet var att beskriva sjuksköterskans upplevelser av att vårda personer med psykisk ohälsa. Metod: Studien genomfördes som en litteraturöversikt för att få kunskap om forskningen inom detta specifika område. Elva vetenskapliga artiklar valdes ut där fem var av kvalitativ design, fyra av kvantitativ design och två var av mixad design. Resultat: Utifrån analysen identifierades fyra teman. Tema ett var kunskapsbrist där det visade sig att det fanns en kunskapsbrist som ledde till osäkerhet och rädsla inför vårdandet av patienter med psykisk ohälsa. Det andra temat påfrestande arbete innehöll upplevelser av maktlöshet, hopplöshet och situationer som skapade oro och ångest. I temat negativa känslor för patienten uttrycktes att dessa personer upplevdes som aggressiva, en fara för sig själva och en fara för andra. Sista temat organisatoriska hinder innehöll bristen av stöd från personal och ledning och att flertalet sjuksköterskor kände att det inte var deras ansvar att vårda patienter med psykisk ohälsa. Diskussion: Resultatet visar på kunskapsbrist för allmänsjuksköterskor som vårdar personer med psykisk ohälsa. Detta diskuteras utifrån bakgrunden, konsensusbegreppet vårdande och begreppet livsvärld. Sjuksköterskornas förförståelse och utbildning diskuteras i förhållande till författarnas tankar och den teoretiska referensramen. / Background: Mental illness is increasing among people seeking care. People with mental illness feel discriminated against and stigmatized in nursing care. They feel they are not being treated with the same respect as people without mental illness. People with mental illness have an increased morbidity and mortality compared with the rest of the population and they feel they do not receive sufficient information. Aim: The aim of this study was to describe nurses' experiences of caring for people with mental illness. Method: The present study was conducted as a literature review to gain knowledge about the research in this specific field. Eleven articles were selected, five of which are based on a qualitative design, four on a quantitative design and two were of mixed designs. Results: Based on the analysis the authors identified four themes. Theme one is knowledge which showed that there was a lack of knowledge that led to uncertainty and fear when caring for patients with mental illness. The second theme strenuous work contained the experiences of powerlessness, hopelessness and situations that created anxiety. Under the theme negative feelings towards the patient it was expressed that people with mental illness are experienced as aggressive, a danger to himself and a danger to others. The last theme organizational barriers included a lack of support from the staff and management and that most nurses felt it was not their responsibility to care for patients with mental illness. Discussion: The results show a lack of knowledge for general nurses who care for people with mental illness. This is discussed on the basis of the background, the consensus concept of caring and the concept of life-world. Nurses' pre-understandings and education are discussed in relation to the authors' thoughts and the theoretical framework.

Bakgrund: Naturens positiva inverkan på hälsa har belysts sedan antiken. Forskning kring naturbaserad terapi har ökat de senaste decennierna och terapiformen har gett positiva effekter för flertalet patientgrupper. Mer än en tredjedel av EU:s befolkning lider av någon form av psykisk ohälsa och många går utan adekvat behandling. Omvårdnad vid psykisk ohälsa ska enligt riktlinjer innefatta ett personcentrerat förhållningssätt och utformas utifrån kunskap om vårdmiljöns betydelse. Syfte: Att beskriva betydelsen av naturbaserad terapi för personer med psykisk ohälsa. Metod: En allmän litteraturstudie med systematisk ansats genomfördes. Artikelsökning gjordes i PubMed, Cinahl, AMED, PsykInfo och Scopus. Valda artiklar kvalitetsgranskades och analyserades utifrån kvalitativ innehållsanalys. Resultat: Den naturbaserade terapin hade en positiv inverkan på hälsa för personer med psykisk ohälsa. Resultatet baserades på 17 artiklar och speglades i fyra kategorier: naturen som tillflyktsort, betydelsen av social kontext, förändrad syn på livssituation samt symtomförbättring och dess konsekvenser. Konklusion: I studien framkom att naturbaserad terapi kan ha stor betydelse för tillfrisknande och daglig funktion för personer med psykisk ohälsa. Studien visar även att omvårdnad som utgår ifrån ett salutogent perspektiv i en terapeutisk naturmiljö bidrar till en förbättrad psykisk hälsa. / Background: The positive impact of nature on health has been highlighted since ancient times. The scientific research about nature-based therapy has increased during the last decades and has presented positive effects for patients with different diagnoses. More than one third of the European Union population suffers from some kind of mental illness and many lack adequate treatment. Nursing care of mental illness should according to guidelines include a person-centered approach and knowledge about the significance of the care environment. Aim: To describe the impact of nature-based therapy for people with mental illness. Method: A general literature study with a systematic approach was conducted. The search for articles was made in PubMed, Cinahl, AMED, PsykInfo and Scopus. The quality of the selected articles were examined and analyed using qualitative content analysis. Results: Nature-based therapy had a positive impact on health for people with mental illness. The result was based on 17 articles and four categories were identified: nature as a refuge, the importance of social context, altered view of life situation and improvement of symptoms and its consequences. Conclusion: The findings conclude that nature-based therapy can have an impact on recovery and daily function for persons with mental illness. The study also revealed that nursing care with a salutogenic approach in a therapeutic nature environment leads to an increased mental health.

Bakgrund: Psykisk ohälsa har ökat världen över de senaste åren och innebär ett växande folkhälsoproblem i flera länder. Litteratur visar att det finns negativa attityder gentemot personer med psykisk ohälsa inom den somatiska vården. Kunskapsbrist och brist på förståelse om psykisk ohälsa leder till stigmatisering och negativa attityder gentemot denna patientgrupp. Syfte: Belysa hur patienter med psykisk ohälsa upplever bemötandet inom somatisk vård. Metod: Litteraturstudie med kvalitativ design där data från 12 vetenskapligt granskade artiklar analyserades. Resultat: Patienter med psykisk ohälsa upplever både positivt och negativt bemötande i den somatiska vården där stigmatisering och barriärer är de mest förekommande upplevelserna. Brist på värdighet och respekt men även diskriminering är något denna patientgrupp tvingas utstå. Barriärer mellan vårdpersonal och patienter med psykisk ohälsa uppstår genom brist på kommunikation, en sporadisk kontakt och ett dåligt bemötande från vårdpersonal. Slutsats: Kunskap om bemötande av patienter med psykisk ohälsa i somatisk vård och en vård som är ojämlik behöver åtgärdas. Genom utbildning kan vårdverksamheten utvecklas och förändras för att skapa välbefinnande för denna patientgrupp. Nyckelord: bemötande, patientupplevelser, psykisk ohälsa, somatisk vård. / Background: Mental illness has been increasing world wide for years and is a growing problem in many countries. A lack of understanding about mental illness creates stigmatization and negative attitudes toward patients. Aim: The purpose of this study is to elucidate how people with mental illness perceive themselves when treated in somatic health care. Method: A literature review with qualitative study design was chosen and data was collected from twelve peer reviewed articles. Results: Patients with mental illness experience both positive and negative perceptions within somatic care but most are negative feelings about the treatments. Discrimination and lack of dignity and respect toward patients with mental illness is common. Obstacles between mental illness patients and health care staff arise because of lack of communication, close contact between them and negative treatments. Conclusion: Knowledge of how to treat patients with mental illness in somatic care needs to be increased. The health care sector can create an improved well being for patients with mental illness through awareness and further education. Keywords: mental illness, patient experiences, somatic care, treatment.

The nature of capital punishment cases makes mortality a highly salient factor during trial proceedings. Previous research has explored the effect of mortality salience on human’s decision making in a legal context. This study extends this vein of research by examining the role death plays in jurors’ psychological processes when sentencing a defendant who is severely mentally ill in a capital trial. The current experiment measured mock jurors’ (n=169) and college students’, n=116) Mental Illness Worldview (MIWV), and then experimentally manipulated type of mortality salience (dual-focused: mock jurors who were specifically asked to contemplate their own mortality and were exposed to trial-related death references vs. trial focused: only exposed to death references) and the type of defendant (severely mentally ill vs. neutral) accused of a capital offense. We found that mock jurors perceived mental illness to be a mitigating factor when dual (i.e., self) focused mortality salience was induced, whereas participants only exposed to trial-related death references considered mental illness to be an important aggravating factor in sentencing.

Syftet med föreliggande studie var att undersöka vilken betydelse hopp, egenmakt samt stigmatisering kan ha i en återhämtningsprocess från psykisk ohälsa. En kvalitativ metod tillämpades och individuella intervjuer med deltagare ur Högskolan Dalarnas erfarenhetspanel genomfördes. För att analysera empirin tillämpades en kvalitativ innehållsanalys som resulterade i följande teman: att bli accepterad, hoppets förutsättningar samt normaliserande. Resultatet visade att hopp snarare var en produkt av återhämtningen än det var en bidragande faktor. Att bli accepterad främjade egenmakt och skyddade mot stigmatisering. Normaliserande faktorer som medmänsklighet och att se till de friska sidorna främjade egenmakt och bröt vanmakt. Uppsatsens resultat kan betraktas som erfarenhetsbaserad kunskap, vilket är en grundförutsättning för en evidensbaserad socialtjänst där brukarperspektivet betonas. / The aim of the present study was to investigate the importance of hope, empowerment and stigma in a recovery process of mental illness. A qualitative method was used and individual interviews with participants from Dalarna University experience panel was conducted. To analyze the empirical data a qualitative content analysis was applied which resulted in the following themes; To be accepted, hope conditions and normalizing. The results showed that hope rather was a product of the recovery than it was a contributing factor. To be accepted promoted empowerment and protected from stigma. Normalizing factors like compassion and to emphasize the healthy sides promoted the empowerment and broke impotence. Thesis results can be considered as experience-based knowledge, which is a prerequisite for evidence-based social service where the user perspective is emphasized.