A proverbial double-edged sword

The notion of family and carer involvement appears throughout European mental health policy and guidelines. However, it has been noted that carer involvement policy may derive from a responsibilization agenda rather than from evidence that it genuinely supports re- covery. We review qualitative research on family life with depression from the perspective of people with depression. Studies were included if they elicited accounts from adults with a professional diagnosis of depression. Nineteen studies were included which incorporated the experiences of 493 adults with depression. A metasynthesis of findings from these stu- dies is discussed within three themes: family issues and depression interact; family support as a double-edged sword; benefits and limitations of psychosocial interventions. Findings reveal a complex inter-relationship between family roles, relationship dynamics, gender, culture and attitudes towards depression. Family involvement in primary care and medical settings can be a double-edged sword and the perceived benefit may depend on the extent to which family perspectives on treatment fit with the depressed person’s understanding of their depression as medical or psychosocial. Psychosocial interventions for individual cli- ents have several limitations in terms of improving family relationships while family-based group interventions may be more beneficial, depending on the engagement of the family and the partner in particular. The review findings emphasise the complexity of family life with depression indicating that the requirement for ‘carer involvement’ as simplified in cur- rent policies and guidelines is naïve policy at best and that family or couple psychosocial interventions may often be more appropriate

Who gets involved with what? A discourse analysis of gender and caregiving in everyday family life with depression

The recent process of deinstitutionalization of the psychiatric treatment system, in both Denmark and other European countries, has relied heavily on the involvement in treatment and recovery of cohabitant relatives of diagnosed people. However, political objectives regarding depression and involvement rely on a limited body of knowledge about people’s ways of managing illness-related problems in everyday life. Drawing on a discursive notion of gender laid out by Raewyn Connell, the aim of the article is to elucidate how the involvement of relatives is guided by an extra- individual rationale about gender and caregiving, and how this gendered discourse might frame different challenges and burdens, depending on the gender of the diagnosed person and the cohabitant relative. Drawn from a larger, multisited field study on involvement processes in Danish psychiatry, the article is based on field notes and 21 interviews with seven heterosexual couples. The analysis shows that gender works as a decisive premise for the division of caregiving labour among the couples, and clarifies how the couples’ gendered institution is disrupted after the onset of depression. The article argues that gender-blind involvement strategies could produce divergent treatment outcomes and varying social effects in relation to couples’ everyday family lives.

A Case Study of Casework Tinkering

Citizens with complex problems are often in touch with different welfare services and administrative systems in order to receive the help, they need. Sometimes these services overlap and sometimes they conflict. The lack of ready-made services to match the complex, multiple, and often shifting needs of citizens with complex problems presents a challenge to caseworkers in the welfare system. In this article, we zoom in on the management of a single user´s case, in order to examine in detail how caseworkers nevertheless make casework ‘work’. We employ the concept of ‘tinkering’ to highlight the ad hoc and experimental way in which caseworkers work towards adjusting services to the unique case of such citizens. Tinkering has previously been used in studies of human-technology relations, among others in studies of care-work in the welfare system. In this paper, we employ the concept to capture and describe a style of working that, although not a formally recognized method, might be recognizable to many caseworkers in the welfare system. We show how tinkering involves the negotiation of three topics of concern, namely the availability of services, the potentials of services to be adjusted to the particular problems of the citizen, and finally, the potential for interpreting these problems and the citizen’s needs in a way that they match the service. We further demonstrate that casework tinkering involves both short-term and long-term negotiation of services. Firstly, tinkering is involved in the continual adjustment and tailoring of services to the immediate needs of the citizen, but secondly, it also speaks to a more proactive process of working towards a more long-term goal

Introduktion: Stoffer

I dette nummer af Tidsskrift for Forskning i Sygdom og Samfund sætter vi fokus på stoffer og stofbrug og forskellige sociale, kulturelle, ideologiske og/eller professionelle betydninger, funktioner og formål, stoffer kan have i forhold til sundhed og sygdom

A proverbial double-edged sword: A qualitative metasynthesis of family involvement in depression from the perspective of people with depression

The notion of family and carer involvement appears throughout European mental health policy and guidelines. However, it has been noted that carer involvement policy may derive from a responsibilization agenda rather than from evidence that it genuinely supports re- covery. We review qualitative research on family life with depression from the perspective of people with depression. Studies were included if they elicited accounts from adults with a professional diagnosis of depression. Nineteen studies were included which incorporated the experiences of 493 adults with depression. A metasynthesis of findings from these stu- dies is discussed within three themes: family issues and depression interact; family support as a double-edged sword; benefits and limitations of psychosocial interventions. Findings reveal a complex inter-relationship between family roles, relationship dynamics, gender, culture and attitudes towards depression. Family involvement in primary care and medical settings can be a double-edged sword and the perceived benefit may depend on the extent to which family perspectives on treatment fit with the depressed person’s understanding of their depression as medical or psychosocial. Psychosocial interventions for individual cli- ents have several limitations in terms of improving family relationships while family-based group interventions may be more beneficial, depending on the engagement of the family and the partner in particular. The review findings emphasise the complexity of family life with depression indicating that the requirement for ‘carer involvement’ as simplified in cur- rent policies and guidelines is naïve policy at best and that family or couple psychosocial interventions may often be more appropriate

Psykisk Sundhedsarbejde og Politik

Psykisk Sundhedsarbejde og Politi

Reform eller stabilitet?

Artiklens formål er at identificere, analysere og diskutere udviklingen af velfærdsrationa- lerne i de nationale politikker, der i perioden 2009-2019 er offentliggjort som politiske bud på at styre og forandre det psykiatriske område i Danmark. I lyset af Bacchis tilgang til analyse af politiske velfærdsrationaler undersøges de tre elementer, som tilsammen kon- stituerer rationalerne i politikkerne i perioden: 1) De generiske måder hvorpå målgrup- pen beskrives i perioden, 2) de politiske redskaber der foreslås til at forandre og håndtere målgruppen i perioden og 3) de begrundelser der bruges i politikkerne til at legitimere indsatserne gennem perioden. Målgruppen repræsenteres som risikable, syge, sårbare, om- kostningsfulde og i særlige tilfælde farlige og komplekse. Repræsentationen danner grund- lag for en betoning af civilsamfundets ansvar, frivillighed recovery og forebyggelse, mens fremstillingen af de farlige og komplekse lægger op til øget brug af tvang. Velfærdsrationa- lerne i perioden afspejler, at majoriteten af målgruppen frivilligt forventes at påtage sig rollen som risikabel, sårbar og psykisk syg og deltage i de beskrevne tiltag for ikke at belaste velfærdsstaten. Trods en politisk ambition om en omfattende reform af det psykiatriske område, der imødekommer udfordringer som stigmatisering, umyndiggørelse og ulighed i sundhed, reflekterer politikkerne i stigende grad, at staten er villig til at fratage hele eller dele af ikke-frivilligt-deltagende og farlige personers selvbestemmelse igennem perioden. Derved repræsenterer politikkernes velfærdsrationaler ikke et bud på en radikal ændring af psykiatriens struktur, organisering og funktion. I stedet har de sidste ti års velfærdspolitik- ker stabiliseret paradigmet i det eksisterende system, snarere end at radikalt reformere det

Quality-of-life measurement in depression trials: A consumerist relic

Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and ‘choice’ a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the ‘affective fallacy’ (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare

Den sociale konstruktion af pårørendeinddragelse i behandlingspsykiatrien – et ph.d. forsvar: – et ph.d. forsvar

This article accounts for the insights drawn from the defense of a PhD thesis, aiming to clarify the underpinnings of health political and clinical involvement efforts directed to- wards families in which a person has been diagnosed with depression. By posing the following questions, the research issue involves a clarification of political, clinical and every- day-oriented understandings of involvement that largely have remained implicit in existing research literature on involvement: How is involvement of relatives understood and prac- ticed in health political and clinical contexts in Denmark? And how is involvement understood and practiced among persons diagnosed with depression and their relatives in their everyday life? The study was designed as a multisited field study that shed light on the transformation of the understanding of involvement between three interconnected empirical fields. Discourse analysis of the empirical materials drawn from these fields showed, how the hegemonic understanding of involvement of relatives in psychiatric treatment and practice does not have much to do with the ways that involvement is articulated among the seven families participating in the study. Conclusively, the dominant political-clinical understanding of involvement of relatives signals a prevention- and deinstitutionalization strategy that constitutes a range of consequences and paradoxes. In order to develop practices that avoid these issues, the article calls for more specific analysis and efforts that take into account the social and gendered context of involvement.Denne artikel bygger på forsvaret af en ph.d. afhandling, der havde til formål at anskueliggøre grundlaget for sundhedspolitiske og kliniske pårørendeinddragelsesindsatser i forbindelse med behandling af personer diagnosticeret med unipolar depression. Ved at stille følgende spørgsmål, drejer projektet sig om at undersøge de politiske, kliniske og dagligdagsorienterede forudsætninger, som danner baggrund for pårørendeinddragelse, da de i væsentlige træk har været underbelyst i litteraturen om inddragelse i depressionsramte familier: Hvordan forstås og praktiseres pårørendeinddragelse i sundhedspolitiske og behandlingspsykiatriske sammenhænge i Danmark, og hvordan forstås og praktiseres pårørendeinddragelse blandt pårørende og personer diagnosticeret med depression i deres hverdag? Produktionen af studiets empiri hviler på et flerstedsetnografisk feltarbejde, som synliggør forandringen af de måder inddragelse italesættes og praktiseres på tværs af tre forbundne, empiriske felter. Diskursanalyser af empirien viser, hvordan den fremherskende forståelse af pårørendeind- dragelse i klinisk psykiatrisk praksis ikke har meget at gøre med de måder pårørendeind- dragelse kommer til udtryk iblandt undersøgelsens syv, deltagende familier. Denne artikel konkluderer, at den herskende politisk-kliniske diskurs om pårørendeinddragelse signalerer en forholdsvist ensartet målsætning om deinstitutionalisering og forebyggelse, som kan frembringe en række problemer og paradokser. For at kunne udvikle praksisformer, som undgår disse typer af problemstillinger, lægger artiklen op til at designe mere specifikke analyser, som i højere grad kan tage inddragelsens sociale og kønnede kontekst i betragtning