The main goal of the Strategy for the Reform of Psychiatric Care, published in 2013 by the Ministry of Health of the Czech republic, was to improve the quality of life of people suffering from mental illness. One of the results of this strategy was the emergence of new mental health centres. These mental health centres are meant to provide individualized social and health care to people with mental illness in order to prevent or minimize their hospitalization. The service is ensured by multidisciplinary teams which include professionals such as psychiatrists, psychologists, psychiatric nurses, and social workers. Case management is supposed to be a dominant form of the service provided. The theoretical part of the thesis describes the historical context of the case management and its recent exploitation in the mental health centres in the Czech republic. The empirical part focuses on a particular multidisciplinary team applying the case management method. Through qualitative research, it aims to identify the different parts of the case management and the constraints and obstacles of its application. The analysis of the data collected brings the definition of the key problem areas the team is facing. The final part of the thesis provides recommendations for further development and proposes steps...

Bakgrund: Självmord är brett representerat över hela världen och berör många miljoner människor direkt eller indirekt. Psykiatriskt sjukdomstillstånd och andra sociala och biologiska tillstånd ligger som grund då en människa tar sitt liv. Omvårdnaden vid självmordsproblematik är central och sjuksköterskors inställning och den vårdrelation som finns mellan sjuksköterska och patient är viktig vid omvårdanden av självmordsnära patienter. Syfte: Syftet med studien var att utifrån sjuksköterskor inom psykiatrisk vård och självmordsnära patienter beskriva omvårdnad som kan vara betydelsefull samt svårigheter som kan föreligga. Metod: Litteraturstudie med 12 artiklar där kvalitativ, kvantitativ och mixad metod användes. Data analyserades med Thomas och Hardens tematiska syntes. Resultat: Resultatet bildade två huvudteman; ”Förutsättningar för att bedriva ändamålsenlig omvårdnad för självmordsnära patienter” och ”Sjuksköterskors känslor – En utmaning vid omvårdnaden av självmordspatienter”. Underteman för respektive huvudteman beskriver ”Observation och säkerhet”, ”Bedömning”, ”Teamarbete”, ”Kommunikation”, ”Kunskap och stöd” samt ”Tid” och för huvudtema två ”Osäkerhet”, ”Sjuksköterskors förhållningssätt: Empati – icke empati” samt ”Medkänsla och sjuksköterskans ingjutande av hopp hos patienten”. Diskussion: Resultatet diskuteras utifrån Joyce Travelbees teoretiska utgångspunkt och belyser den unika människan och den mellanmänskliga relationen, hoppets betydelse för den lidande människan och hur vi förstår andras upplevelser genom tid och kommunikation. / Background: Suicide is widely represented all over the world and affects many millions of people directly or indirectly. Psychiatric disease states and other social and biological conditions lie as a basis when a person takes one’s life. Nursing in suicide problems is central and nurses' attitude and the care relationship between nurse and patient is important in nursing suicidal thinking patients. Aim: The purpose of the study was to describe nursing care that may be significant as well as difficulties that may exist from nurses in psychiatric care and suicidal patients. Method: Literature review with 12 articles using qualitative, quantitative and mixed methodology. Data was analyzed by Thomas and Hardens thematic synthesis. Results: The result formed two main themes; "Prerequisites for proper care for suicidal patients" and "Nursing feelings – A challenge in nursing of suicide patients". Subtopics for the respective main themes describes "Observation and Security", "Assessment", "Teamwork", "Communication", "Knowledge and Support" and "Time" and for the main theme two "Uncertainty", "Nurse’s approach: Empathy - Empathy" and "Compassion and nurse’s initiation of hope for the patient". Discussions: The result is discussed based on Joyce Travelbee's theoretical theory and highlighting the unique human and interpersonal relationship, the significance of the hope for the suffering person, and how we understand the experiences of others through time and communication.

The thesis is based on three months of participant observation in a long-term care facility in 2010 and interviews conducted during next three years. It draws from a perspectives of medical anthropology and anthropology of institutions. The focus is on an ethnography of institution for clients with chronic mental disease, dementia and substance abuse. The thesis is mapping institution's components and actors, their social life and relationships in the institution. The analyses is based upon the concept of total institution by Erving Goffman, and draws from thoughts of Josef Pieper, Martin Buber, Emanuel Lévinas and Michel Foucault. A long-term facility is an institution, which shares clients and some of problems with classical examples of total institutions, but recent reforms aimed to minimalize features of total institutions. Still it does not seem to be a vital institution and new aspects of social situation of staff and clients are recognized. Among new problems is non-existence of therapy for the inhabitants, their marginalization through poor financial situation in an institution, where lot of services are paid and little continuity to other forms of care of more community and ambulant character. Key words: total institution, long-term facility, psychiatric care, medical anthropology,...

The aim of the presented work is to present problematic aspects of the work of peer consultants in the field of mental health care, i.e., in psychiatric hospitals, social services and leisure clubs. The theoretical part will present the context from which the position grows and comes- the concept of mental illness and stigmatization of mental illness, as well as the project of deinstituonalization of the mental health care system. The theoretical part of the work is then concluded with an introduction to the position of the peer consultant. In the practical part I deal with the problematic aspects themselves by the means of semi-structured interviews. Aspects such as the scope of work of the peer consultant, experience with colleagues and clients, requirements for the position, the topic of the future and the work procedure and finally also the issue of the legislative anchoring of this position. Key words: mental illness, stigmatization, peer support, peer mentor, social works, psychiatric care, Centre for mental health care development, deinstitutionalisation

In my thesis I am going to focus on one of the areas of community care for people with mental illness and thus on the area of employment. The main focus of the thesis is on a description of current situation in the provision of the employment support for people with mental illness. The focus is also on the formulation of the specifics of the Employment Support Program for people with mental illness. Another part of my thesis contains empirical investigations focusing on the sustainability and the perspective of the Employment Support Program for people with mental illness. The goal of my thesis is to set up an updated oveview study on the issue of providing employment support for people with metal illness. Powered by TCPDF (www.tcpdf.org)

Le régime juridique des soins psychiatriques sans consentement et les dispositions légales qui l’entourent sont le fruit de la longue évolution de la collectivité à prendre en charge les personnes atteintes de troubles psychiques. Cette maturation, qui témoigne de l’équilibre fragile entre le respect des libertés fondamentales et les impératifs d’ordre public, explique en grande partie la reconnaissance tardive de ces patients vulnérables comme véritables sujets de droit. A travers la loi n°2011-803 du 5 juillet 2011 et la loi n°2013-869 du 27 septembre 2013, le législateur a conservé le système médico-administratif des soins sans consentement qu’il a érigé au XIXe siècle. Néanmoins, via ces deux dernières réformes, il l’a atténué en introduisant un contrôle obligatoire du Juge des libertés et de la détention et a élargi ces prises en charge aux soins ambulatoires. Ce système est caractérisé par une dualité des modalités d’admission : les soins à la demande du représentant de l’Etat (S.D.R.E.) d’une part, et les soins à la demande d’un tiers (S.D.T.) d’autre part. Ces deux blocs sont eux-mêmes subdivisés en une pluralité de mesures, chacune justifiée pour des motifs divers : urgence, absence de tiers, circonstances de fait, existence d’un trouble grave à l’ordre public ou à la sûreté des personnes… Si le régime juridique des soins sans consentement est censé prévoir une prise en charge adaptée à chaque situation particulière, en réalité, ces orientations sont souvent prises pour des raisons d’opportunité et ne correspondent pas toujours à la réalité. Les contentieux issus de ce régime juridique d’exception témoignent des nombreuses atteintes aux droits subies par les patients qui en font l’objet. Pour ces raisons, un toilettage de fond peut être envisagé. Il passerait par la fusion des deux blocs d’admission en un seul, par le prononcé des mesures par le juge et par un renforcement de la protection des droits et des libertés, dispositions qui devront s’entourer de garanties plus effectives et de contrôles plus appuyés. / The legal regime of the psychiatric care without consent, and the relevant legal provisions that surround it, are the direct consequence of the long-term development of the society in managing the mentally disabled people. This process of maturing, which reflects the delicate balance between the respect for fundamental freedoms and the imperatives of public order, mainly explains the rather belated recognition of these vulnerable patients as real subjects of rights. Through the law n°2011-803 of 5 July 2011 and the law n°2013-869 of 27 September 2013, the legislator maintained the model of care and medical administrative system without consent, dating from the nineteenth century. Nevertheless, through these last two reforms, the system has been attenuated by the introduction of a mandatory control of the liberty and custody judge and expanded these medical cares at the ambulatory. This system is characterised by its own duality in terms of admission rules: the request for care on demand of the representative of State (S.D.R.E.) on the one hand, and of a third party (S.D.T.) on the other hand. These two sets of procedures themselves are subdivided in a plurality of actions, each one justified on various purposes: urgency, absence of a third party, factual circumstances, existence of a serious public disorder or threat to the safety of individuals… Even if the legal regime for the medical care without consent is supposed to provide an appropriate care for each and every specific situations, often these policies are actually set for opportunistic reasons and do not always match reality. The disputes resulting from this exception legal regime demonstrate the many human rights violations suffered by the concerned patients. For these reasons, some tidying up can be envisaged. The latter would involve the merging of the two sets of procedures, the issuance of measures by the judge himself and a strengthening of the protection of civil rights and freedoms, provisions which will have to be surrounded by more effective safeguards and stronger controls.

The subject of this diploma thesis is the involvement of users of psychiatric care in the process of planning and realization of psychiatric care reform at the macro level of policy making. The aim of the research is to describe and understand this involvement. In the research are describer possibilities of participation in the phases of involvement, its form, purpose, formal regulation of opportunities, expectations of respondents, perceived power and barriers in involvement. The data was collected during interviews with key actors and studies of relevant documents. The results relate to the theoretical concepts of coproduction, patient-oriented care, strategic and human rights documents (the Convention on the Human Rights of People with Disabilities). The element of power is described through the typology of Sherry Arnstein's participation ladder. Evidence of interviews indicates elements of tokenism and disadvantages. There is a low (one-person) representation of users in reform bodies, lack of time for discussion in consultative bodies, lack of information and lack of capacity (people, time, resources) for greater development of patient organizations. Respondents have identified barriers as the socio-economic situation, lack of capacity for macro-level involvement, mental health constraints or...

Emotionsreglering har de senaste åren fått alltmer uppmärksamhet och stöd som en faktor associerat med substansbruk. Däremot finns till författarnas vetskap ingen tidigare forskning som undersökt sambandet mellan emotionsreglering och substansbruk i ett rättspsykiatriskt urval. Syftet med denna studie var att beskriva substansbruket och utforska associationer mellan emotionsreglering och substansbruk i ett rättspsykiatriskt urval. Deltagarna (N = 98; 13 % kvinnor) rekryterades från en kohort av rättspsykiatriska patienter i Sverige från 2016-11-01 till 2020-11-30.  Data samlades in genom journalgranskningar, självskattningar och kompletterades med semistrukturerade intervjuer. För att beskriva substansbruk i gruppen användes deskriptiv statistik. Vidare användes instrumentet Difficulties in Emotional Regulation Scale (DERS) för att undersöka deltagarnas svårigheter med emotionsreglering. Som mått på substansbruk använde författarna debutålder av substanskonsumtion och antalet testade substanser. För att utforska sambandet mellan emotionsreglering och substansbruk användes korrelationsmatriser.  Resultatet visade att 64,3 % av deltagarna någon gång hade diagnostiserats med substansbrukssyndrom. Vidare hade 79.5 % av urvalet någon gång använt cannabis och hade i större utsträckning använt andra substanser jämfört med en generell svensk population. Studien fann inga signifikanta samband mellan emotionsreglering och substansbruk, vilket går emot tidigare forskning. Det motsägelsefulla resultatet kan bero på metodologiska skillnader och/eller att deltagarna hade andra gemensamma och inflytelserika erfarenheter i relation till emotionsreglering som påverkade resultatet. / Emotional regulation has in recent years gained more attention and support as a factor associated with substance use. However, to the authors knowledge, no research has examined the association between emotional regulation and substance use in a forensic psychiatric sample. The aims of this study were to describe substance use and examine associations between emotional regulation and substance use in a sample of forensic psychiatric patients. Participants (N = 98; 13% female) were recruited from a cohort of forensic psychiatric patients in Sweden from 2016-11-01 to 2020-11-30.  Data were collected through file information, self-reports and complemented with semi-structured interviews. The study used descriptive data to report the use of substances within the sample. Furthermore, the study used the instrument Difficulties in Emotional Regulation Scale (DERS) to examine the participants' emotional dysregulation. To measure substance use, the authors used age of onset of substance consumption and the number of substances tested as variables. Correlational matrices were used to explore the association between emotional regulation and substance use.  The results showed that 64.3% of the participants had at some point been diagnosed with SUD. Furthermore, 79.5 % of the sample had at some point used cannabis and had to a large extent used other substances. No significant associations were found between emotional regulation and substance use. The result goes against previous research, methodological differences may cause this contradiction. Another possible explanation is that the participants had other common and influential experiences in relation to emotional regulation that influenced the result.

En empruntant une démarche prospective, l’objectif de cette contribution est de mettre en lumière l’existence d’une évolution de la condition juridique des personnes privées de liberté du fait d’une décision administrative. Si pendant longtemps l’obligation de préserver l’ordre public a été présentée comme conférant de nombreuses prérogatives à l’administration, elle doit désormais être décrite comme une mission de service public devant s’accomplir conformément à un modèle de comportement, sans toutefois que l’on puisse aujourd’hui évoquer l’existence de véritables sujétions à la charge de l’administration. Si cette évolution a été rendue possible, c’est en grande partie grâce à de «nouveaux contre-pouvoirs» qui ont contribué au renforcement de leur protection en participant plus ou moins directement à l’identification des obligations que toute administration qui prend en charge une personne privée de liberté devrait respecter et en concourant à leur défense. / By taking a prospective approach, the main of this work is to highlight the existence of an evolution of the legal status of persons deprived of their liberty for an administrative decision. Though the obligation to preserve public order has long been introduced as granting the administration many prerogatives, it must from now on to be equally described as a public-service mission that should be accomplished in accordance with a particular behavior model, without however, always mentioning the presence of actual constraints at the expense of the administration because of the numerous shortcomings currently affecting the protection system. Presumably, if this improvement has been made possible, it is in mainly due to “this new opposing-force concept” that has contributed to strengthening theirs protection especially by participating in the identification of the obligations that should be respected by all administrations which have to take care of a person deprived of liberty.