Abstract The purpose of the study was to explore the need for and the utilisation and functionality of the specialized psychiatric health care services available to children and adolescents of comprehensive and senior secondary school age. Special-needs students' need for psychiatric treatment and the functioning of their treatment chain was described and evaluated. Data were collected from comprehensive schools and senior secondary schools, 112 (82%) with a total of 18,532 students, in Oulu Province in 1998–2002. Special schools 37 (97%) had altogether 1276 students. The data for the first and the second sub-studies were collected with a questionnaire. The data for the third sub-study were obtained from documents concerning the need for and the use and functionality of services produced and evaluated by the key groups of actors. The data sets were evaluated way using the multiple constituency method in co-operative evaluation sessions, which were video-taped. The data for the fourth sub-study consisted of tape-recorded interviews of the study subjects. Multiple constituency evaluation and content analysis were used as research methods. As evaluated by comprehensive school and senior secondary school teachers, both the incidence and the severity of students' conduct and emotional disorders have increased over the past few years. Special school students with conduct disorders and mental health problems were referred for examinations and treatment into the treatment chain of child and adolescent psychiatry similarly to other school-aged children and adolescents. Special schools had a constant need for child and adolescent psychiatric services, but there were no direct connections with specialized health care. At all schools, efforts were made by teachers and parents to help students with the assistance of school health care and social work professionals. Whenever students failed to get the requisite help from specialized health care, their problems remained the family's responsibility. The parents in these situations felt that they had been left alone, without understanding what this was all about and without knowing where to go for help. Nevertheless, the data also included many positive experiences of fluent co-operation and easy availability of help for the student. The findings showed that there is a lot of expertise and sincere desire to work for the benefit of children and adolescents. The lack of coordination of the entire treatment chain did, however, wear down the self-esteem of the students in need of help as well as the meagre resources of their parents and the help-providing key actors. It was also suggested that the key groups participating in the treatment chain should be provided joint training and mentoring. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli saada tietoa peruskoulu- ja lukioikäisten lasten ja nuorten psykiatrisen erikoissairaanhoidon palvelujen tarpeesta, käytöstä ja toimivuudesta. Tutkimuksessa kuvataan ja arvioidaan erityisoppilaan psykiatrisen hoitoketjun tarvetta ja toimintaa. Tutkimusaineisto kerättiin Oulun läänin peruskouluista ja lukioista vuosien 1998–2002 aikana. Ensimmäisessä vaiheessa mukana oli 112 (82 %) koulua, joissa oppilaita oli yhteensä 18 532. Toisessa vaiheessa tutkimusta jatkettiin 37 (97 %) erityiskoululta saadulla aineistolla. Näissä erityiskouluissa oppilaita oli yhteensä 1276. Kolmannessa vaiheessa psykiatrisen hoitoketjun tarvetta ja toimintaa arvioitiin monitahoisesti kolmella erityiskoululla. Viimeisessä vaiheessa tutkimukseen osallistui myös psykiatrisessa hoidossa olleita oppilaita ja heidän vanhempiaan. Ensimmäisen ja toisen osatutkimuksen aineistot kerättiin kyselylomakkeella. Kolmannen osatutkimuksen aineisto saatiin palvelujen tarvetta, käyttöä ja toimintaa koskevista avainryhmien tuottamista ja arvioimista kirjallisista aineistoista. Aineistot arvioitiin monitahoisesti yhteisissä arviointitilanteissa, jotka videoitiin. Neljännen osatutkimuksen aineisto koostuu tutkittavien haastatteluista, jotka nauhoitettiin. Tutkimusmetodeina käytettiin monitahoarviointia ja sisällönanalyysia. Peruskoulun ja lukion opettajien näkökulman mukaan oppilaiden käytös- ja tunne-elämän häiriöt olivat sekä lisääntyneet että vaikeutuneet viime vuosina. Käytös- ja mielenterveysongelmista kärsivät erityiskoulujen oppilaat ohjautuivat tutkimuksiin ja hoitoon lasten ja nuorten psykiatriseen hoitoketjuun, kuten muutkin kouluikäiset lapset ja nuoret. Erityiskouluilla oli jatkuva tarve saada lasten ja nuorten psykiatrisia palveluja, mutta suoraa yhteyttä erikoissairaanhoitoon ei ole ollut. Yleis- ja erityisopetuksessa oppilaita yritettiin auttaa opettajien ja vanhempien voimavarojen mukaan sekä kouluterveydenhuollon että sosiaalitoimen asiantuntijoiden avustamana. Jos oppilaalle ei saatu tarvittavaa apua erikoissairaanhoidosta, ongelmat jäivät perheen vastuulle. Näissä tilanteissa vanhemmat kokivat jääneensä yksin ymmärtämättä, mistä on kysymys ja mistä apua voi etsiä. Tutkimustulokset antavat päätöksentekijöille, koulujen johtajille ja opettajille sekä sosiaali- ja terveydenhuollon käytännön toimintaa koordinoiville asiantuntijoille tärkeää tietoa erityisoppilaan psykiatristen palvelujen tarpeesta ja moniammatillisen hoitoketjun toiminnasta.

Abstract Purpose: The study aims to establish a summary of the main characteristics of gender, age, types of crimes and previous criminal records of the offenders sentenced to forensic-psychiatric care in the time period 1995 to 2018 in Sweden and to compare them with offenders sentenced to imprisonment for the same types of crime types in the same time period in Sweden as well as to link different types of crimes to mental illness. Furthermore, the study attempts to find correlations between the group sentenced to forensic-psychiatric care and different types of crimes. Method: Using official statistical data from BRÅ, serious crimes, age, gender and criminal records for all individuals sentenced to forensic-psychiatric care during 1995 to 2018 are described together. This group was compared to all individuals which were convicted to prison in the same period. Furthermore, correlations between types of crimes and the group of individuals sentenced to forensic-psychiatric care were examined in order to find any statistical difference between the two groups. Result: A few differences between the groups were found. The individuals in the forensic-psychiatric care group did not differentiate much in age, and also had similar criminal records, unlike the prison- group. Additionally, a meaningfully higher amount of women was prevalent in the forensic psychiatric care-group compared to the prison-group. A small correlation between individuals sentenced to forensic psychiatric treatment and arson were confirmed as well as stronger correlations with offenders sentenced to FPT and crimes of theft, vehicle theft, arson and homicide were found. Conclusion: These findings provide data for future research as well as potential support for courts to identify more suitable treatment for offenders with a mental illness. Additionally, the findings in this paper presents the health care system and social services with opportunities to analyse and prevent trajectories into more serious offending in particular regards to individuals who are young and/or have a mental disorder.

Introduktion: Psykisk ohälsa är ett växande folkhälsoproblem och antalet som vårdas under tvång ökar. Både sjuksköterskor och närstående till tvångsvårdade patienter belyser vikten av kommunikation i vården för att minska tvångsåtgärder. Syfte: Syftet var att undersöka patientens upplevelse av psykiatrisk tvångsvård samt tvångsåtgärder i slutenvård, med fokus på kommunikation. Metod: Allmän litteraturöversikt med beskrivande design. 12 kvalitativa artiklar har kvalitetsgranskats med hjälp av SBU:s granskningsmall, sedan analyserats med hjälp av en etablerad analysmetod och sammanställts i resultatet. Resultat: Tre teman identifierades: kommunikativ relation, tillgång till information och överenstämmelse med patientrollen. De flesta patienter upplevde att de inte fick tillräckligt med information gällande tvångsinläggningen och eventuella tvångsåtgärder som de utsatts för. Det resulterade i en förvirring och osäkerhet hos patienterna och tillsammans med bristande, eller ensidig, kommunikation var de faktorer som gjorde att patienterna hade svårt att acceptera tvångsvården. De som upplevde en god kommunikativ relation belyste vikten av tillit och att få bli sedd och hörd; de kände en känsla av tacksamhet och trygghet när de fick den information de behövde, och kunde lättare acceptera tvångsvården. Patienterna upplevde att de behövde överensstämma med patientrollen för att undvika negativa konsekvenser och få det hjälp de behövde genom att avsubjektifiera sig själva.  Slutsats: Brist på kommunikativ relation och adekvat information till patienter gör att dessa har svårare att acceptera tvångsvården och tvångsåtgärderna. Tillit är av yttersta vikt för att känna sig trygg och kunna anförtro sig till vårdpersonalen. Sjuksköterskan kan göra skillnad i patientens upplevelse av tvångsvård genom att lyssna, finnas till hands, kommunicera och ge personcentrerad information samt vård. / Introduction: Mental illness is a growing public health problem and the number of involuntarily admitted people is increasing. Both nurses and relatives of patients in compulsory care highlight the importance of communication to reduce coercive measures. Aim: The aim of the study was to investigate patients’ experience of compulsory psychiatric care and coercive measures in inpatient care, with a focus on communication. Method: General literature review with a descriptive design. Twelve qualitative articles have been quality reviewed using SBU’s review template, then analyzed using an established analysis method and compiled in the result.  Results: Three themes were identified: communicative relationship, access to information and compliance with patient role. Most participants felt they needed to receive more information regarding the involuntary admission and any coercive measures they were subjected to. This resulted in confusion and uncertainty among the patients. The feeling of uncertainty and confusion together with a lack of, or one-sided, communication were factors that made it difficult for the patients to accept the forced care. Those who experienced a good communicative relationship with the caregiver highlighted the importance of trust and being seen and heard. They felt a sense of gratitude and security when they received the information they needed, which made it easier for them to accept compulsory care. The participants felt that they needed to conform to the patient role to avoid negative consequences and get the help they needed by de-subjectifying themselves.  Conclusion: Lack of communicative relationships and adequate patient information makes it more difficult for them to accept compulsory care and coercive measures; trust is of the utmost importance in order to feel safe and confide in the caregivers. Nurses can make a difference in the patients’ experience of compulsory care by listening, being present, communicating and providing person-centered information and care.

Inom en snar framtid kan effektiva behandlingsmetoder mot antisocial personlighetsstörning komma att bli tillgängliga för användning. I denna uppsats driver jag en tes om hur vi på ett etiskt försvarbart sätt skulle kunna använda dessa metoder. Tesen begränsar sig till (1) tvångsbehandling (2) av våldsamma återfallsbrottslingar (3) som diagnostiserats med antisocial personlighetsstörning och psykopati, samt till (4) behandlingsmetoder som klassificeras som kapacitetsförbättringar riktade mot moralisk kompetens. Jag argumenterar för att vi har starka skäl att godta tesen, främst med hänseende på fördelarna det skulle innebära för patienten, potentiella brottsoffer, och samhället i stort. Jag diskuterar också de två allvarligaste invändningarna mot min tes – att behandlingen hotar patientens autonomi, respektive personliga identitet – men konstaterar slutligen att de inte tycks kunna falsifiera tesen.

Orientador: Fernando Andrade Fernandes / Banca: Antonio Milton de Barros / Banca: Marisa Helena D'Arbo Alves de Freitas / Resumo: São deveres do Estado, no contexto do ato do portador de anomalia psíquica que entra em contradição com o ordenamento jurídico pátrio, proteger a sociedade de novas lesões de bens jurídicos penalmente relevantes, proporcionar ao indivíduo adequado tratamento terapêutico, reinseri-lo no convívio social, e, não por último, respeitar e fomentar sua dignidade humana. O presente trabalho investiga as potencialidades da desinternação progressiva na efetivação das finalidades político-criminais das medidas de segurança, finalidades essas que se constituem verdadeira obrigação do Estado Social e Democrático de Direito Material. Ao lado do quadro teórico a respeito de tais finalidades e dos princípios constitucionais aplicáveis à medida de segurança, este trabalho apresenta dados a respeito de sua execução tradicional no Brasil, que apontam para a urgente necessidade de sua reestruturação. O trabalho também expõe dados empíricos relacionados à desinternação progressiva, colhidos no Hospital de Custódia e Tratamento Psiquiátrico II de Franco da Rocha, local em que a experiência inovadora se dá. Revela seus objetivos, características e critérios de funcionamento, assim como desvela os resultados já obtidos e patenteia as imperfeições encontradas. Por fim, evidencia em que medida a desinternação progressiva permite o atingimento das finalidades político-criminais das medidas de segurança e o que deve ser feito para aumentar-lhe a eficácia / Abstract: Protecting the society from attempts against interests protected by criminal legal rules, providing the patients a proper therapeutical treatment, embedding the patients in the social conviviality, and also respecting and promoting their human dignity, are obligations of the Brazilian State considering the mental ill's act against legal rules. This paper investigates the potentiality of progressive disinternment on accomplishing the politic-criminal purposes of the Safety Measures. Such purposes are stablished as real obligations of the actual Democratic Welfare Legal State. Besides theoretics on these purposes and applicable constitucional principles related to Safety Measures, the research presents information about their usual execution in Brazil, whose qualifications bring up the need of urgent reorganization. It also presents empirical data about progressive disinternment, collected from the Franco da Rocha Custody and Psychiatric Treatment Second Hospital, establishment in which this innovative experience occurs. It discloses the objectives, characteristics and operational criteria of this experience as well as it studies the results obtained and points the imperfections revealed. Finally, it highlights how progressive disinternment is able to provide the achievement of the politic-criminal purposes related to the Safety Measures and what should be done in order to increase its effectiveness / Mestre

Abstract The purpose of this study was to investigate treatment adherence among adolescents receiving mental health care, with a special focus on psychiatric inpatient treatment. Key goals were to derive a general definition of adherence suitable for this purpose and to assess adolescents’ adherence to medication and non-pharmacological treatments. This study had two phases; phase one involved conducting systematic literature reviews, and phase two was based on empirical research in which data were collected by analyzing notes on hospital patients. The aim of the reviews were to review current research evidence into treatment adherence in adolescents and factors relating adherence among adolescents receiving mental health care (original publication n=15 and original publication n=17). Phase two was part of a clinical follow-up project called STUDY-70 conducted at the Department of Psychiatry at Oulu University Hospital in Finland. This phase yielded two further original publications – papers III and IV. Paper III examined adherence among adolescents receiving psychiatric inpatient care (n=72), focusing on both medication and non-pharmacological treatments. Paper IV examined factors affecting treatment adherence among these 72 inpatient adolescents, including family- and clinic-related variables. The systematic reviews demonstrated that many different definitions of adherence have been used in the literature. A concept synthesis was applied to these definitions to establish a basis for empirical research. The main factors that were found to correlate positively with treatment adherence among adolescents were the patients’ own will to be treated and positive sentiments, but family also played an important role. Factors that correlated negatively with adherence included negative feelings, a lack of cooperation with treatment, and adverse mental symptoms. Adolescent who has received special support at school was found to favor treatment adherence, whereas involuntary treatment, self-mutilative behavior and a close maternal relationship were all linked to non-adherence. Treatment adherence is an ongoing process, and achieving high levels of adherence should be an important goal in all treatment processes. It is important for clinical staff to be aware of factors influencing adherence in order to support the provision of effective and high-quality care for adolescents. / Tiivistelmä Tutkimuksen tarkoituksena oli selvittää mielenterveyspalveluita käyttävien nuorien hoitoon sitoutumista ja erityisesti psykiatrisessa osastohoidossa olevan nuoren sitoutumista hoitoon. Keskeisinä tavoitteina oli kuvata hoitoon sitoutumisen määrittelyä ja arvioida nuoren sitoutumista lääke- ja ei-lääkinnälliseen hoitoon. Tutkimus sisälsi kaksi vaihetta: vaihe yksi systemaattiset kirjallisuuskatsaukset sekä vaihe kaksi empiirisen tutkimuksen, jossa tieto kerättiin analysoimalla potilasasiakirjoja. Systemaattisen kirjallisuuskatsauksen tarkoituksena oli selvittää nuoren hoitoon sitoutumista ja siihen yhteydessä olevia tekijöitä (alkuperäisjulkaisu I n=15, alkuperäisjulkaisu II n=17). Vaihe kaksi oli osa Oulun yliopistollisen sairaalan psykiatrian klinikan projektia, STUDY-70, joka tuotti kaksi osajulkaisua. Alkuperäisjulkaisun III tarkoituksena oli tutkia osastohoidossa olevan nuoren sitoutumista lääke- sekä ei lääkinnälliseen hoitoon (n=72). Alkuperäisjulkaisussa IV selvitettiin näiden nuoren sitoutumista hoitoon ja erityinen mielenkiinto tässä tutkimuksessa oli perhe- ja kliinisillä tekijöillä sitoutuminen (n=72). Systemaattisen kirjallisuuskatsauksen perusteella sitoutumisen määrittelyt vaihtelivat. Tästä huolimatta käsitteen määrittelyjen synteesi oli mahdollinen ja se loi pohjan empiiriselle tutkimukselle. Tämän tutkimuksen perusteella nuoren oma tahto ja positiivinen asenne olivat positiivisesti yhteydessä hoitoon sitoutumiseen. Myös perheen toiminta vaikutti hoitoon sitoutumiseen. Nuoren negatiiviset tunteet, yhteistyökyvyttömyys ja mielenterveysoireet vaikuttivat negatiivisesti sitoutumiseen. Lisäksi nuoren saamat erityispalvelut koulussa tukivat osastohoidossa olevan nuoren hoitoon sitoutumista. Vastentahtoinen hoito, viiltely sekä läheinen ja kestävä äitisuhde olivat yhteydessä sitoutumattomuuteen. Hoitoon sitoutuminen on kokonaisvaltainen prosessi ja yksi hoidon tavoitteista, joka voidaan saavuttaa. Hoitoon sitoutumisen edistämiseksi henkilökunnan tulee tiedostaa ne tekijät, jotka vaikuttavat hoitoon sitoutumiseen. Näin voidaan suunnitella ja toteuttaa laadukasta ja vaikuttavaa hoitoa.

The problem with which this study is concerned is the delineation of current practices in therapeutic recreation in psychiatric treatment centers in Texas, The programs of the forty-two hospitals responding to the survey questionnaire were evaluated in terms of the National Therapeutic Recreation Society's "Standards for Therapeutic Recreation in Psychiatric Facilities." It was determined that, while the use of recreation in psychiatric rehabilitation is widespread, many programs are not administratively independent., A close association between recreation and occupational therapy was found. Extensive recreation facilities and activities were reported. Use of community resources was widespread, but follow-up and leisure counseling services were rare. Most personnel had no recreation training. The evaluation showed limited compliance with the standards.

Made available in DSpace on 2016-03-22T17:26:32Z (GMT). No. of bitstreams: 1 mariane.pdf: 698501 bytes, checksum: abf01a8f2f50d6b1dfa772fc147ff533 (MD5) Previous issue date: 2011-02-28 / Objective: Asses the prevalence of depression and associated factors as well as the history of psychological or psychiatric treatment in individuals older than 14 years seeking care in primary care Method: We conducted a cross-sectional study in three Basic Health Units are linked to the Catholic University of Pelotas. The presence of depression was assessed using the Mini International Neuropsychiatric Interview (MINI). In addition, we assessed the factors associated with major depressive episode, substance abuse, anxiety disorders, suicide risk and a history of psychological / psychiatric treatment. Results: Among the 1069 primary care patients evaluated, the prevalence of depression was 24%, however, only 29% had consulted a psychologist or psychiatrist, while 21.5% have been or are currently psychotherapeutic treatment. For adults with depression, perceptions of psychiatric disorder was present among 36.8%, the remainder reported not suffer or have suffered at some time in life for such problems. Were hospitalized for psychiatric problems 40% of individuals with depression and 39.4% used psychotropic drugs in the month preceding the interview. Conclusion: The prevalence of depression is high, however, few receive adequate treatment. For this reason should be inserted in mental health care in primary care through diagnostic evaluations and proposals brief psychoterapy for mental disorders / Objetivo: Verificar a prevalência de depressão e fatores associados bem como o histórico de tratamento psicológico e psiquiátrico em indivíduos com idade superior a 14 anos que buscaram atendimento na atenção primária. Método: Foi realizado um estudo transversal nas três Unidades Básicas de Saúde vinculadas a Universidade Católica de Pelotas. A presença de depressão foi avaliada através do Mini International Neuropsychiatric Interview (MINI). Além disso, foram avaliados os fatores associados ao episódio depressivo maior: uso de substâncias psicoativas, transtornos de ansiedade, risco de suicídio e histórico de tratamento psicológico/psiquiátrico. Resultados: Entre os 1069 pacientes da atenção primária avaliados, a prevalência de depressão foi de 23,9%, entretanto, apenas 29% já consultaram com psicólogo ou psiquiatra, enquanto 21,5% fizeram ou fazem atualmente tratamento psicoterapêutico. Para os adultos com depressão, a percepção do transtorno psiquiátrico esteve presente em 36,8% dos entrevistados. Foram hospitalizados por problemas psiquiátricos 40% dos indivíduos com depressão e 39,4% utilizaram psicofármacos no mês anterior a entrevista. Conclusão: A prevalência de depressão é elevada, entretanto, poucos recebem tratamento adequado. Por isso devem ser inseridos cuidados em saúde mental na atenção primária através de avaliações diagnósticas assim como propostas breves de psicoterapia para os transtornos mentais

Augustin Navrátil This thesis addresses the life and work of Augustin Navrátil (1928-2003), a Roman- -Catholic activist from the Moravian township of Lutopecny near Kroměříž. A. Navrátil has not been subject of a complex publication yet, although he is the author of the largest petition demanding religious - and with that going hand in hand also civic - liberties in socialist Czechoslovakia (1988, 600 000 signatures). Followingly, this is the first attempt to biographically outline the personality and motivations of this farmer, politician (member of the party Lidova strana), man who signed Charta 77 but also a husband and father of nine children. The aim is to cover his life from his birth, over his family background to the beginnings and heights of his social engagement. The text will mainly deal with 22 open letters in which he drew attention to various illegal practices and actions of the Communist power, as well as with the three petitions he authored (1978, 1985 a 1988) and the samizdat (self-published) journal Křesťanské obzory (Christian horizons), which he published with a group of others from June 1988 to July 1990. In contrast to most Czech dissidents, he was never sentenced to a prison term for his activities, but he had to involuntarily undergo repeated psychiatric treatment. He was...

Made available in DSpace on 2014-06-11T19:24:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-07-08Bitstream added on 2014-06-13T18:20:25Z : No. of bitstreams: 1 cia_m_me_fran.pdf: 1413817 bytes, checksum: 68d44c988b7aaa47e3e45e2c8e0562ec (MD5) / São deveres do Estado, no contexto do ato do portador de anomalia psíquica que entra em contradição com o ordenamento jurídico pátrio, proteger a sociedade de novas lesões de bens jurídicos penalmente relevantes, proporcionar ao indivíduo adequado tratamento terapêutico, reinseri-lo no convívio social, e, não por último, respeitar e fomentar sua dignidade humana. O presente trabalho investiga as potencialidades da desinternação progressiva na efetivação das finalidades político-criminais das medidas de segurança, finalidades essas que se constituem verdadeira obrigação do Estado Social e Democrático de Direito Material. Ao lado do quadro teórico a respeito de tais finalidades e dos princípios constitucionais aplicáveis à medida de segurança, este trabalho apresenta dados a respeito de sua execução tradicional no Brasil, que apontam para a urgente necessidade de sua reestruturação. O trabalho também expõe dados empíricos relacionados à desinternação progressiva, colhidos no Hospital de Custódia e Tratamento Psiquiátrico II de Franco da Rocha, local em que a experiência inovadora se dá. Revela seus objetivos, características e critérios de funcionamento, assim como desvela os resultados já obtidos e patenteia as imperfeições encontradas. Por fim, evidencia em que medida a desinternação progressiva permite o atingimento das finalidades político-criminais das medidas de segurança e o que deve ser feito para aumentar-lhe a eficácia / Protecting the society from attempts against interests protected by criminal legal rules, providing the patients a proper therapeutical treatment, embedding the patients in the social conviviality, and also respecting and promoting their human dignity, are obligations of the Brazilian State considering the mental ill’s act against legal rules. This paper investigates the potentiality of progressive disinternment on accomplishing the politic-criminal purposes of the Safety Measures. Such purposes are stablished as real obligations of the actual Democratic Welfare Legal State. Besides theoretics on these purposes and applicable constitucional principles related to Safety Measures, the research presents information about their usual execution in Brazil, whose qualifications bring up the need of urgent reorganization. It also presents empirical data about progressive disinternment, collected from the Franco da Rocha Custody and Psychiatric Treatment Second Hospital, establishment in which this innovative experience occurs. It discloses the objectives, characteristics and operational criteria of this experience as well as it studies the results obtained and points the imperfections revealed. Finally, it highlights how progressive disinternment is able to provide the achievement of the politic-criminal purposes related to the Safety Measures and what should be done in order to increase its effectiveness