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Background: Mental health problems and financial difficulties each increase the risk of social exclusion. However, few large studies representing a broad age range have investigated the combined social effect of having both difficulties. The purpose of this cross-sectional study was to examine associations of mental health problems, financial difficulties, and the combination of both with social exclusion. Methods: This analysis was based on responses from 28,047 adults (age > 18 years) from the general population participating in The Norwegian Counties Public Health Survey 2019. Respondents answered questions about their financial situation, mental health problems, and social exclusion. Social exclusion was measured as a lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded, and feeling isolated. Adjustments for sex and age were made in multivariable logistic regression analyses. Results: Having mental health problems or financial difficulties was associated with various measures of social exclusion (odds ratios [ORs] with 95% confidence intervals [CIs]: 1.33 [1.23–1.43] to 12.63 [10.90–14.64]). However, the odds of social exclusion strongly increased for respondents who reported a combination of mental health problems and financial difficulties compared with those who did not report either (ORs [CIs]: 2.08 [1.90–2.27] to 29.46 [25.32–34.27]). Conclusions: Having the combination of mental health problems and financial difficulties is strongly associated with increased risk for social exclusion, far beyond the effect of either factor alone. [ABSTRACT FROM AUTHOR]

This paper points out some problematic aspects of qualitative research based on interviews and uses examples from mental health. The narrative approach is explored while inquiring if the reality of life here is forced into the formula of a chronological story. The hermeneutic approach, in general, is also examined, and we ask if the reality of life in this scenario becomes caught up in a web of interpretations. Inspired by ideas from Bakhtin and phenomenology, we argue for interview-based research that stays with unresolvedness and constantly question the web of interpretations and narratives that determine our experiences. This also chimes with certain dialogical practices in mental health in which tolerance of uncertainty is the guiding principle. Concludingly, we suggest that interview-based research could be a practice of 'un-resolving' in which researchers, together with the participants, look for cracks, contradictions, and complexities to prevent the qualitative fallacies of well-organized meanings and well-composed stories. [ABSTRACT FROM AUTHOR]

People with severe mental illness face a different 'interventional' landscape compared to some decades ago, when mental hospitals were dominant, in Sweden as well as in the rest of the Western world. The aim of the research reported in this article was to follow men and women diagnosed with psychosis for the first time over a 10-year period, and to explore what interventions they experienced. The interventions, here defined as "spheres", were either community-based or institutional. A third sphere represents no interventions. Based on data from registers and using a time-geographic approach, the individuals were visualised as 10- year trajectories where their transitions between the different spheres were highlighted. The results show a great diversity of trajectories. Two main categories were detected: two-spheres (community-based and no interventions) and three-spheres (adding institutional interventions). One third of the population experienced only community-based interventions, with a higher proportion of men than women. Consequently, more women had institutional experience. Two sub-categories reveal trajectories not being in the interventional sphere in a stepwise manner before the 10th year, and long-term trajectories with interventions in the 10th year. The most common pattern was long-term trajectories, embracing about half of the population, while one-fifth left the institutional sphere before the 5th year. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore how material things might become involved in the recovery process of people with mental health difficulties. Empirical material from three different studies on various aspects concerning mental health issues that each of the authors had conducted was reanalysed through a phenomenological item analysis. We discovered that mundane objects such as a mobile phone, a bench, a door and a key have agency to contribute to peoples' recovery and wellbeing. Things became agents that created contexts that initiated physical, social and emotional movements. By giving attention to materiality we might become aware of the importance of things as agents in living in general and in recovery processes for people with mental health difficulties in particular. [ABSTRACT FROM AUTHOR]

The aim of this study is to present concrete descriptions of the content in the construction of helpful relationships with staff, according to users. Starting with the re-occurring concept of the meaning of “little things” in recovery studies, a literature review was done. A thematic analysis shows that small things play an important role in improving a person’s sense of self. Small things seem to be an invisible but effective parts of a recovery-orientated practice, but they might be defined as unprofessional and their efficacy negated. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.Design/methodology/approach In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.Findings There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.Research limitations/implications The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having “double trouble”.Practical implications The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.Social implications Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.Originality/value By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors. [ABSTRACT FROM AUTHOR]

During a 9-month period, 100 persons with SMI were given approx. 73 USD per month above their normal income. Sixteen of the subjects were interviewed. The interviews were analysed according to the methods of thematic analysis. The money was used for personal pleasure and to re-establish reciprocal relations to others. The ways in which different individuals used the money at their disposal impacted their sense of self through experiences of mastery, agency, reciprocity, recognition and security. The findings underline the importance of including social circumstances in our understanding of mental health problems, their trajectories and the recovery process. [ABSTRACT FROM AUTHOR]

Several studies have indicated a co-occurrence between mental problems, a bad economy, and social isolation. Medical treatments focus on reducing the extent of psychiatric problems. Recent research, however, has highlighted the possible effects of social initiatives. The aim of this study was to examine the relation between severe mental illness, economic status, and social relations. Method: a financial contribution per month was granted to 100 individuals with severe mental illnesses for a 9-month period. Assessments of the subjects were made before the start of the intervention and after 7 months' duration. A comparison group including treatment as usual only was followed using the same instruments. Significant improvements were found for depression and anxiety, social networks, and sense of self. No differences in functional level were found. Social initiatives may have treatment and other beneficial effects and should be integrated into working contextually with persons with severe mental illnesses. [ABSTRACT FROM AUTHOR]

During the last decades services to people with severe mental health problems have gone through important changes. Terms as de-, trans-, reinstitutionalisation and dehospitalisation has been used. The objective of the study was to collected data about the changes in a welfare society about the new institutional landscape after the mental hospital area. Data about interventions from social welfare agencies, psychiatric care, and prisons were collected from local and national register as well as data about cause of death and socio-economic status for 1355 persons treated with a diagnosis of psychosis in a Stockholm area 2004-2008. Psychiatric in-patient care and prisons are marginalized. Different interventions in open care touched a very large number of persons. Social welfare agencies play an increasing role in this context. The total institutions have been replaced by a network of micro-institutions sometimes offering help but also control. [ABSTRACT FROM AUTHOR]

Background: The relationship with professionals has proved to be important with regard to outcome for persons with severe mental illness (SMI). The understanding of non-helpful relationships is important complementary knowledge to that regarding helpful relationships. Aim: To review the available qualitative research providing knowledge of non-helpful relationships from the perspective of persons with SMI. Method: A review of qualitative studies, based on an earlier systematic search, analyzed through thematic analysis. Results: The main themes were "non-helpful professionals", "organization versus relation" and "the consequences of non-helpful relationships with professionals". Examples of professionals described as non-helpful were pessimistic and uncaring professionals who were paternalistic and disrespectful. Discontinuity, insufficient time and coercion were some of the contextual factors described as non-helpful. These sorts of relationships were non-helpful because they hindered helpful relationships from developing and contributed to further suffering, instilling hopelessness and hindering personal growth. Conclusions: Non-helpful relationships with professionals can be understood as impersonal relationships that contain no space for negotiation of the relationship nor of the support and treatment provided through it. It is important that organizations provide professionals with favorable conditions to negotiate the organizational framework and to treat persons with SMI as whole human beings. [ABSTRACT FROM AUTHOR]

People with severe mental illness (SMI) are often described as lonely and socially incapable – an inability resulting from the mental illness. The aim of this article is to explore experiences of being alone among persons with SMI. The article is based on interviews with 19 persons diagnosed with psychosis who were interviewed between four and nine times over a period of three years. The findings show that experiences of being alone can be identified bytwoconcepts: aloneness and loneliness. The persons in the study appeared as socially able and active in relation to their social lives. However, a social agent does not operate in a void but in interaction with specific living conditions; the experiences of aloneness and loneliness may be viewed as the result of the interplay between the individual and the social and material environment. [ABSTRACT FROM PUBLISHER]

Background: Establishing a working alliance has been found to be of great importance for the outcome of professional interventions for people diagnosed with severe mental illnesses.Aim: The aim of the present study was to analyse the concrete actions of helpful professionals in establishing a working alliance.Method: Interviews with 58 persons diagnosed with severe mental illness who were in a recovery process or had recovered were analysed using Grounded Theory.Results: The core category that emerged from the analysis was termed ‘going beyond’. It was constituted on three subcategories: challenging the rationality of the institutions, restoring the professional as a person and restoring the user as a person.Conclusion: Users’ experience-based knowledge about helpful professionals calls into question the traditional view of professional roles. [ABSTRACT FROM AUTHOR]

In psychiatry, it is assumed that the social conditions of everyday life do not in themselves affect the severity of an individual’s mental ill health. Rather, the illness is the cause of problems that the individual meets in daily life. However, recent studies indicate that social factors can explain behavior that has ordinarily been regarded as symptoms of mental illness. The aim of the present study is to investigate how people with a psychosis diagnosis manage their economic difficulties. Nineteen persons with a psychosis diagnosis were interviewed on several occasions in the course of a follow-up study. The interviews were analyzed according to Grounded Theory. The present study shows that the persons had developed different rational ways of coping with economic strain: reducing their expenses, increasing their incomes or borrowing money and acquiring debts. Living under poverty negatively affects their possibility to acquire and maintain a social network and their sense of the self. The study contributes to our knowledge of the nature of psychosis and its relationship to the social context. [ABSTRACT FROM AUTHOR]

Research has shown the importance of the relationship between professionals and users for the outcome of interventions in psychiatry. The aim of this study is to analyze time as one factor in the development of working alliances. Fifty-eight persons in recovery from diagnosis of severe mental illness were interviewed about helping factors in their recovery process. Two aspects of time were considered to be of importance for the construction of working alliances: the quantity of time, that is, getting more time than expected during, between, and after the sessions; and the quality of time, that is, having undisturbed and focused time, the experience of being in the professional thoughts between the sessions and timing in one's life. Those experiences give the person a sense of being a real-life person and not an abstract patient, and this lays the groundwork for establishing a working alliance. The management of time is an important factor in the creation of a working alliance and should be given greater attention in the development of experience- and evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: Recovery research often describes recovery from mental illness as a complex individual process. In this article a social perspective on recovery is developed. Aims: To ascertain which factors people regard as decisive to their own recovery and what makes them beneficial. Methods: In-depth interviews were conducted with 58 persons in Sweden who had recovered from severe mental illness. Interviews were qualitatively analyzed using grounded theory. Results: Three dimensions of contributing recovery factors were identified. Social relationships emerged as the core category throughout these dimensions. Conclusions: The results show that recovery processes are social processes in which social relationships play a key role. [ABSTRACT FROM AUTHOR]

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We analyzed informant narratives in terms of the benefits of spending time within various community arenas, including service user organizations, advocacy agencies, the bowling alley, and universities. Themes contributing to recovery from severe mental illness included the understanding and acceptance infromants both gave and received from others, spiritual fulfillment, and even experiences of anger as mechanisms of empowerment to counter social discrimination and neglect. Involvement across various community arenas and the themes it elicited relative to recovery were understood in terms of developing more durable and advantageous understandings of the self. [ABSTRACT FROM AUTHOR]

As they began the journey of recovery from psychosis, informants described the importance of making their own initial decision to get well and maintain their physical and mental health. Developing a sense of self-control in their lives by managing their symptoms, determining how they spend their time, developing their own ways of defending themselves from stigma and social demands, and listening to their own needs and experiences were crucial to developing a sense of independence and agency. Informants described aiding their own recovery by allowing and encouraging new and different identities beyond their status as mental patients and apart from the person they were before the illness. Developing this new identity often enabled them to feel strong and to derive meaning from the difficult experiences of their illness. As in much of the informants' descriptions of their recovery processes, this development of identity and sense of purpose and independence often occurred beyond the scope of the mental health system and its professionals. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to provide an example from phenomenological research of moving from rich descriptive interview data to coherent revelatory descriptions employing empathic bridges within the narrative structure of storytelling. We used transcribed data from two interviews concerning recovery from severe mental illness: one with an American woman in her early thirties, and the other with a Swedish man in his mid-thirties. Five investigators analyzed the transcribed data into individual first-person narrative descriptions according to existing empirical phenomenological methods including an independent reading, identification of themes relevant to processes of recovery from severe mental illness, temporal ordering of themes meaningfully reflecting the sequence of the recounted events, and consensus development. Our findings support the use of empathic bridges as a methodological tool with the narrative structure of firstperson storytelling, as well as the viability and importance of employing this tool to better understand processes of recovery for persons with severe mental illness. [ABSTRACT FROM AUTHOR]