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No. of bitstreams: 1 Dissertacao completa Mauricio Giubilei.pdf: 155857 bytes, checksum: eec715b4a732d4c696eef25d77658ae6 (MD5) Previous issue date: 2006-09-11 / Coordenacao de Aperfeicoamento de Pessoal de Nïvel Superior / Aims The authors tried to identify de-hospitalized mentally ill patients living in shelters or homes and then quantify and stratify them as to their destinations residence and behavior specially towards other residents in Elderly Homes The de-hospitalizations took place by the end of the 80s with changes to the Mental Health policy the creation of Paulo Delgado law and the consequent deactivation of psychiatric beds in Brazil mainly in Minas Gerais state Methods Two questionnaires were made one for the Elderly Homes and the other for their residents The survey only began after a Term of Consent was signed authorizing the participation in this study The first questionnaire consisted of questions regarding care homes themselves their managers main religion budget source number of employees and their specific duties Main types of covenants public or private endowments for specific and complementary assistance as well as the number of beds for elderly and mentally ill residents were also evaluated The Ministry of Health regulations regarding mentally ill patients were unknown to their managers As to the boards of directors they found it acceptable to have both mentally ill and elderly persons in the same environment However they were careful to explain the discomfort of this sociability Psychiatric support or specific hospitals were acknowledged The questionnaire consisted of residents data sociofamiliar factors psychiatric and psychological diagnostics medication and dosages Those residents coming from hospitals number of specialized psychiatric confinements and their behavior adjustments were also considered 520 residents in 11 homes located in 10 cities in the southwest region of Minas Gerais were evaluated Results Gender distribution was the same Average age was 22 to 100 years old (65,60 ± 14,39) Ages between 51 and 70 years old corresponded to 48,65% while in 82.49% of residents the ages were between 51 and 90 years Caucasian was 70.60% Regarding the laboring capacity 67.90% was between none and little Of all residents evaluated 72.90% had never had a psychiatric hospitalization and 10.40% had been hospitalized more than five times The results show that 20.00% of all residents suffer from dementia 19.80% were chronic psychotics and 13.30% schizophrenics 21.70% were mentally ills and 12.70% was the percentage of healthy residents The remaining residents presented other neuropsychiatric diagnostics 3,70% (19) were de-hospitalized from Psychiatric Hospital In general 15.30% had inadequate behaviors which interferes in their daily life and 64.40% make daily use of psychotropic medication against 35.60% who uses with non-psychotropic drugs or only and nothing at all Of the psychotropic medications used haloperidol is the main in 35.20% followed by diazepam 34.00% Biperideno 23.00% followed by Phenobarbital 21.50% and amitriptyline 14.90% Conclusion The study concluded that the number of psychiatric patients de-hospitalized and transferred to Elderly Homes was little in the evaluated area However a significant number of patients with chronic characteristics who alternated between Elderly Homes and Psychiatric Hospitals were identified Most of the Elderly Homes avoided residents with some sort of mental disorder especially schizophrenic ones Other chronic psychiatric patients with light symptoms and lack of monetary and family support were accepted in as a matter of philanthropy and humanity / Objetivo Através das mudanças na Política de Saúde Mental a partir da Lei Paulo Delgado e sua conseqüente diminuição de leitos psiquiátricos os autores buscaram por evidencia quantificar e estratificar doentes mentais de custódia desospitalizados seus destinos e habitações especialmente nas Casas de Acolhimento de Idosos em cidades do sudoeste mineiro Os comportamentos destes pacientes e dos outros condôminos suas capacidades psíquicas e funcionais número de internações psiquiátricas as medicações administradas foram avaliados e estratificados Método Após os diretores dessas casas autorizarem a realização deste estudo dois questionários foram aplicados um a elas e outro aos seus moradores O primeiro identificou uma a uma seus representantes dados econômicos operacionais quantidade de colaboradores e suas funções No segundo cada condômino foi identificado e obteve-se seu diagnóstico social econômico familiar psiquiátrico psicológico e seu tratamento após assinar um Termo de Consentimento Livre e Esclarecido anuindo o nosso exame Todos seus 520 moradores doentes mentais ou não foram avaliados clinicamente e seus diagnósticos estabelecidos segundo a CID-10 Onze dessas casas foram visitadas em dez cidades nessa região definida Resultados A distribuição por sexo foi a mesma e as idades entre 22 a 100 anos Resultou que a predominância foi entre 51 a 70 anos cor de pele branca em 70,60 % e capacidade laborativa inapta em 67,90 % Seis ou mais internações psiquiátricas aconteceram em 10,40% e 20,00% encontravam-se demenciados Psicóticos crônicos e esquizofrênicos respectivamente eram 19,80% e 13,30 % Deficientes mentais encontrados em 21,70% contra 12,70 % de idosos preservados Apenas 3,70% (19) eram egressos de hospitais de custódia No total 15,30 % tinham comportamentos que interferiam no cotidiano dos condôminos Dos que usavam medicamentos regularmente 64,40 % usavam remédios psicotrópicos associados ou não a outros clínicos Destes 35,60% tomavam medicações clínicas ou nenhuma delas Das drogas psiquiátricas prescritas a prevalente foi o haloperidol em 35,20 % seguido do diazepan em 34,00 % o biperideno em 23,00 % fenobarbital em 21,50 % e a amitriptilina em 14,90 % Inexistiram leitos específicos para idosos e doentes mentais Conclusões Este estudo concluiu que o número de egressos de hospitais psiquiátricos de custódia encontrado foi pequeno em relação ao número de doentes mentais moradores dessas casas A capacidade de seus diretores em fazer diagnóstico de perfil de doente mental assim como o faz o psiquiatra inibiu a inclusão de novos condôminos A grande maioria de sua população (87,10%) era portadora de doenças mentais neurológicas neuriátricas entre outras com sintomatologia psiquiátrica Seis ou mais internações psiquiátricas ocorreram em 10,40% inferindo-se que esta alternância entre estas casas e hospitais psiquiátricos foi uma institucionalização contínua em psiquiatria O impacto social apresentou significativo grau de injúria seja ela física ou psíquica demonstrando que essas casas eram inespecíficas e incompletas para que houvesse harmonia entre condôminos de perfis geriátricos e psiquiátricos

Die vorliegende Arbeit befasst sich mit dem wissenschaftlichen Werk der DDR Psychiaterin Christa Kohler (1928 – 2004). Fokussiert werden dabei ihre Habilitationsschrift zu sozialpsychiatrischen Problemen bei Neurosen und Psychosen in der zweiten Lebenshälfte sowie ihr selbstständig erarbeitetes Konzept der „Kommunikativen Psychotherapie“. Die Forschungsarbeit Kohlers wird unter Berücksichtigung von themenrelevanter Literatur, Interviews mit Zeitzeugen und Archivmaterialien analysiert und bewertet. Dabei wird auch die Person Kohlers beleuchtet und ihre Arbeit in den wissenschaftshistorischen Kontext eingeordnet.:Inhaltsverzeichnis 1. MOTIVATION FÜR DAS THEMA 4 2. AUFBAU DER ARBEIT 5 3. HISTORISCHER KONTEXT DES THEMAS 6 4. METHODE 8 5. FACHWISSENSCHAFTLICHE AUSGANGSLAGE 10 5.1 Überblick über die Geschichte der Psychotherapie 10 5.2 Psychotherapie in der DDR 15 5.3 Überblick über die Geschichte der Sozialpsychiatrie 20 5.4 Sozialpsychiatrie in der DDR 22 6. PRIMÄRQUELLEN, ARCHIVALIEN, INTERVIEWS 25 7. FORSCHUNGSFRAGEN 26 8. BIOGRAFISCHES ZUR PSYCHIATERIN CHRISTA KOHLER 28 9. PUBLIKATIONEN 33 9.1 Steinmetz M Himmerich H Steinberg H. Christa Kohlers „Kommunikative Psychotherapie“ – ein integratives Psychotherapiekonzept im biografischen, wissenschaftlichen und historischen Kontext in der Zeitschrift „Fortschritte der Neurologie Psychiatrie“ 33 9.2 Steinmetz M Himmerich H Steinberg H. Eine frühe sozialpsychiatrische Schrift in der DDR. Christa Kohlers Habilitation über Neurosen und Psychosen der zweiten Lebenshälfte 34 10. PROBLEMATISIERUNG DES KONTEXTES WISSENSCHAFT IN DER DDR 35 10.1 Zusammenarbeit mit dem Ministerium für Staatssicherheit (MfS) 35 10.2 Einflussnahme der SED auf die Wissenschaft und den ärztlichen Beruf 35 10.2.1 Staatliche Vorgaben sowie Freiräume psychotherapeutischer Forschung in der DDR 39 11. BEDEUTUNG DER ARBEIT UND AUSBLICK 42 11.1 Bedeutung der Arbeit 42 11.2 Ausblick 43 12. ZUSAMMENFASSENDE THESEN 44 13. LITERATUR 49 14. ABBILDUNGSVERZEICHNIS 55 15. TABELLENVERZEICHNIS 56 16. DANKSAGUNG 57 17. EIDESSTATTLICHE ERKLÄRUNG 58 18. BIBLIOGRAPHISCHE BESCHREIBUNG 59

Denna vetenskapliga essä utgår från författarens personliga erfarenhet som boendestödjare i form av en gestaltning. Syftet med essän är att formulera boendestödjarens praktik utifrån gestaltningen samt med hjälp av Aristoteles Den Nikomachiska etiken samt Donald A. Schöns Educating the Reflective Practitioner reflektera över vilken kunskap som boendestödjare använder samt hur det är möjligt att lära sig densamma. Metoderna består av skrivande, fenomenologiskt tillvägagångssätt gällande gestaltningen och hermeneutiskt utforskande. I essän presenteras en personlig och historisk bakgrund samt ett forskningsurval rörande boendestöd. Därefter diskuterar författaren, utifrån Aristoteles teorier, kring syftet med boendestöd och de kunskapsformer som återfinns i den inledande gestaltningen. Författaren diskuterar vidare hur boendestödjaren lär sig dessa kunskaper med utgångspunkt ur Schöns teorier. Därefter diskuteras instruktioner i ett annat sammanhang, utifrån den konceptuella konstnären Sol LeWitt. Essän avslutas med att författaren bland annat konstaterar att den praktiska kunskapen är centrala inom boendestödsarbetet även om instruktioner kan uppmärksamma författaren om medelvägen. / This scientific essay starts with a literary composition from the author’s personal experience as a community mental health worker. The purpose of the essay is to articulate the practice of the community mental health worker starting with the literary composition and by utilizing Aristotle The Nicomachean Ethics and Donald A. Schön Educating the Reflective Practitioner reflect over what type of knowledge the mental health worker uses and how it is possible to attain that knowledge. The methods consist of writing in addition to a phenomenological procedure regarding the literary composition and hermeneutic exploring. A personal and historical background is presented, along with a selection of research regarding community mental health work. This is followed by the authors discussion, starting with the theory of Aristotle, regarding the purpose of community mental health work and the type of knowledge that is located in the literary composition. The author continues to discuss how the community mental health worker learns this knowledge with starting from the theory of Schön. After that instructions are discussed in another context, from the conceptual artist Sol LeWitt. The essay ends with a conclusion by the author that the practical knowledge is central within the community mental health work even if instructions can make the author attentive on the middle way.

Samverkan inom psykiatri/socialpsykiatri inbegriper organisationer och de professionella roller som utgår ifrån olika lagar och riktlinjer, organisatoriska strukturer samt teoretiska och professionella grunder. Syftet med denna studie är att ge en bild av hur en kommunal socialnämnd och en lokal psykiatrisk verksamhet kan arbeta med en långsiktig strategi för samverkan. Denna fallstudie granskar samverkan mellan psykiatrin och socialtjänsten i en kommun i Stockholms län. Ansatsen är organisationsteoretisk och belyser de strukturer och processer som samverkan innebär. De organisationer som berörs tillhör olika administrativa och politiska sektorer inom landsting respektive kommun och innefattar olika professionella inriktningar såsom läkare, socialsekreterare, sjuksköterskor, psykologer, kuratorer, arbetsterapeuter, boendestödjare, mentalskötare m.fl. Fallstudien omfattar dels en dokumentationsstudie över avtal och rutiner för samverkan, utvärderingar och andra typer av dokumentation samt en intervjustudie av personer med olika professionella roller inom respektive organisation. Resultaten visar att framgångsrik samverkan bygger på klara strukturer utifrån mandat från respektive organisations ledning samt processinriktade faktorer, framför allt behovet av gemensamma "arenor" som stöd till de direkta kontakter som behöver tas i arbetet med individuella patienter och klienter. / Collaboration in the area of mental health involves organizations and professional roles with their basis in differing laws and guidelines, organizational structures and theoretical and professional foundations. The aim of this study is to examine the structures and processes involved in collaboration between the social service and providers of psychiatric care. Drawing on organizational theory concerning the nature of collaboration and factors which can hinder or assist successful collaboration, a case study has been constructed examining collaboration between a local psychiatric clinic in the region of Stockholm and the social service in a local community. The organizations concerned belong to different administrative and political sectors and involve professionals with various specialties such as psychiatrists, social welfare secretaries, nurses, psychologists, counsellors, occupational therapists and others. A study of formal agreements and routines for collaboration, evaluations and other forms of documentation, in combination with an interview study of persons with different professional roles in each respective organization, reveals the importance of a commitment to support collaboration from the management of each organization and the systematic creation and upholdning of meeting places for the various professions in order to support and facilitate cooperation concerning individual clients and patients.

Previous studies show that elderly people with mental illness tend not to have their needs met due to lack of interaction between authorities (Grundberg, Hansson, Religa & Hillerås 2016). The purpose of this study is therefore to investigate what care managers in social psychiatry and elderly care experience affect their work and collaboration between them. In this way, we want to create a deeper understanding of how work and collaboration affect the care of older people with mental illness. This qualitative study is based on semi-structured interviews with six care managers. We have used a thematic analysis to analyze our empirical material. Through transcription and reading of the empirical material, we have highlighted quotations that have identified repetitions, similarities and differences that have since shaped themes. Furthermore, the material was analyzed based on theories of collaboration (Danermark & Kullberg 1999; Grape 2015) and Lipsky's street level bureaucracy. Our study shows that care managers feel that collaboration is a prerequisite for being able to meet the needs of elderly people with mental illness, but opinions differ on whether the support needs of the target group are actually met. Collaboration between social psychiatry and elderly care is generally perceived to work well, even though our results show some contradictions to this claim. Finally, the study shows that collaboration and social work is influenced by various factors such as proximity and distance, as well as laws and guidelines and knowledge about these. These factors affect the care manager's room for manoeuvre and professional identity, which is also perceived to affect the possibilities for collaboration. Collaboration, room for manoeuvre and professional identity seem to be related and through interaction all parts form a whole.

Denna studie syftar till att öka förståelsen för hur boendestödjarna beskriver sitt vardagsarbete med brukarnas återhämtning på två boenden med särskild service inom Socialpsykiatriska utförarenheten i Skärholmens Stadsdelsförvaltning. Vi har intervjuat åtta boendestödjare. Valet av respondenter har gjorts utifrån ett kvoturval, fyra boendestödjare från Frösätra samt fyra från Solholmen. Vi har gjort semi-strukturerade intervjuer med samtliga boendestödjarna och utformat en intervjuguide. Intervjuguiden berör fenomen hur personalen på boendena beskriver begreppet återhämtning, hur de arbetar med återhämtning, hur återhämtning nås samt hur personal beskriver sin roll. Resultatet av studien påvisar att återhämtning innebär att den enskilde har möjligheten att återhämta sig från det kaotiska tillståndet samt att den enskilde tar makten över sitt liv. Återhämtning innebär utveckling och att den enskilde är självständig trots att en del av symptomen är varaktiga. Arbetet med återhämtning handlar om att lita på den enskildes förmåga och inte ge upp hoppet. Att se människan bakom symtomen och sjukdomen och därefter lyfta fram det friska. Återhämtning nås genom att den enskilde själv medverkar i sin egen återhämtning, är aktiv och villig att åstadkomma en förändring. / This study aims to increase understanding of how housing supporters describe their everyday work with the users' recovery at two sheltered housing, in Social Psychiatry perform purity of Skärholmens District Administration. We interviewed eight housing supporters. The selection of respondents was made based on a quota sample, four housing supporters from Frösätra and four from Solholmen. We did semi-structured interviews with all housing supporters and designed an interview guide. The interview guide affects phenomena such as how staff describes the concept of recovery and work on recovery. How the recovery is accessed and how staff describes their role. The results of this study demonstrated that recovery means that the individual has the ability to recover from the chaotic state, and that the individual will take charge of their lives. Recovery involves the development that the individual is autonomous although some symptoms are lasting. The work of recovery is about trusting the individual capacity and to not give up hope, to see the person behind the symptoms and the disease and highlight the healthy. Recovery achieved by the individual themselves take part in their own recovery, are active and want to make a change.

Syftet med denna studie är att undersöka socialsekreterares och hälso- och sjukvårdskuratorers upplevelser av samverkan mellan rättspsykiatri och socialtjänst vid utslussning av rättspsykiatriska klienter, sett ur ett maktperspektiv. Studiens empiri grundar sig på åtta semi-strukturerade intervjuer, fyra med varje yrkesgrupp, som sedan analyserats med hjälp av en tematisk analys. Studiens slutsats visar på att samverkan mellan socialtjänst och rättspsykiatri påverkas av organisatoriska, ekonomiska och mellanmänskliga faktorer som är svåra att påverka. Studien bekräftar även tidigare samverkansforskning som visar på svårigheter i samverkan när aktörer har olika förutsättningar, uppdrag och mål. Slutsatserna i denna studie leder oss till att förstå intervjupersonernas upplevelser av samverkan mellan rättspsykiatri och socialtjänst. Dessa går att förstås genom: värdet av kompromisser, förståelsen för varandras villkor och behov, upplevelsen av bristande mandat, maktlöshet samt rollförvirring. / The aim of this study is to examine social workers and health care counsellors experiences of cooperation between forensic psychiatry and social services during discharge of forensic psychiatric clients, seen from a power perspective. The study's empiricism is based on eight semi-structured interviews, four with each professional group, which were analyzed using a thematic analysis. The study's conclusions show that collaboration between social services and forensic psychiatry is affected by organizational, financial and inter personal factors that are difficult to affect. The study confirms previous collaboration research that shows difficulties in collaboration when actors have different conditions, assignments and goals. The conclusions of this study lead us to understand that the interviewees experiences of collaboration between forensic psychiatry and social services can be understood through: the value of compromise, the understanding of each other's conditions and needs, the experience of a lack of mandate, powerlessness and role confusion.