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  • 1.
    Andersson, Maria
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Eklund, Mona
    Sandlund, Mikael
    Umeå universitet, Psykiatri.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    Frames for choice and market characteristics - a Swedish case study of community mental health services in change2015In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 5, no 3, p. 227-243, article id 1059772Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and analyse structural frames for choice, as well as characteristics of a free-choice market, implemented in community mental health services in Sweden. Day centres were focused. A case study was conducted. Documents were collected and semi-structured interviews were conducted with twenty-eight agents involved in the implementation process. Content analysis of data showed that users’ freedom of choice was influenced by detailed regulation. Freedom of choice was extended, but it was also substantially reduced. The gain or loss of freedom of choice depended on which aspects of the system were emphasised. Features, which could be interpreted as paternalistic, were once again structurally embedded, despite a system addressing individual freedom of choice. Further, the market did not seem to be adjusted for the average user of community mental health services.

  • 2.
    Andersson, Maria
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Eklund, Mona
    Lunds universitet.
    Sandlund, Mikael
    Umeå universitet, Psykiatri.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    Freedom of choice or cost efficiency?: the implementation of a free-choice market system in community mental health services in Sweden2016In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 2, p. 129-141Article in journal (Refereed)
    Abstract [en]

    This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.

  • 3.
    Andersson, Maria
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    Eklund, Mona
    Lunds Universitet.
    Sandlund, Mikael
    Umeå universitet, Psykiatri.
    The implementation of a Free-choice Market System in Swedish Community Mental Health Services by the Example of Day Centres2014In: Jubilee Congress 50 years WASP World Association of Social Psychiatry, London, November 13-15, 2014., 2014Conference paper (Refereed)
    Abstract [en]

    Marketization in community mental health services is a new phenomenon and might be the most comprehensive reform in the field since the deinstitutionalisation that occurred during the second half of the twentieth century. Historically, mental health services have been characterized by discipline and paternalistic practices.There has been an absence ofwhat is now, due to the new organizational model based on individual freedom of choice, is to be introduced.

     

    The aim of this study was to investigate the implementation of a free-choice market system in community mental health services, using the example of day centres for people with psychiatric disabilities. The study was conducted in a major city that was about to implement a free-choice market system due to a new legislation.

     

    Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top-down political process. The policy intentions of the new Act were in focus when studying the relation between policy and practice during the implementation process. A majority of the policy intentions of the new Act advocated individual autonomy as the market system’s main purpose, only one intention concerned organizational efficiency. Interview data reflected, however, that financial efficiency dominated the agents’ experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, when managers mainly focused on the market as a resource allocator.

  • 4.
    Fjellfeldt, Maria
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Eklund, Mona
    Sandlund, Mikael
    Umeå universitet, Psykiatri.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    Implementation of choice from participants' perspectives: a study of community mental healthcare reform in Sweden2016In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, no 2, p. 116-133Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.

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