Translating Coercion Policy into Inter-Organisational Collaboration–the Implementation of Compulsory Community Care for People with Mental Illness

Abstract

In 2008, compulsory community care (CCC) for people with severe mental illness was introduced in Sweden. CCC requires co-operation between psychiatric and social services, thus further complicating the longstanding difficulties with service coordination in the mental health field.This article investigates what happens when a new policy is introduced that assumes complex co-operation of two organisations bestowed with high degrees of discretion. The process of institutionalisation will be analysed in terms of how an idea is translated and materialised on local levels. This has been investigated by interviewing key informants within psychiatric and social services at three different locations.The implementation was perceived as relatively successful and occurred without major conflict. The main effect of the new legislation was improvement in the coordination of services, where designing a template form for a coordinated care plan was central. The inter-organisational discussions about service coordination that arose had a spill-over effect on services for other patient groups.In essence, respondents describe CCC as a pedagogical reform to promote the coordination of services, rather than a reform to increase coercive powers over patients. This raises concerns about the legitimacy of the reform.

Tvingad till autonomi

“…Vi har undersökt införandet av den här helt nya konstruktionen i svensk rätt och kontrasterat den svenska policyprocessen mot motsvarande processer i andra länder genom att studera förarbeten, politiska debatter, debatter i massmedier och fackmedier samt intervjuer med nyckelpersoner (Sjöström, Zetterberg & Markström 2011). Vidare har vi intervjuat personal inom kommunens socialtjänst och landstingets psykiatri för att undersöka hur öppen psykiatrisk tvångsvård implementerats på lokal nivå i Sverige (Zetterberg, Markström & Sjöström 2016). Vi har också studerat domstolsbeslut rörande öppen psykiatrisk tvångsvård i Sverige utifrån två perspektiv: rättssäkerhet och social kontroll (Zetterberg, Sjöström & Markström 2014).…”

Developing a research tool to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals

“…For example, in Norway, compulsory community care (CCC) has existed since 1961 and was expanded in 1999 Mental Health Act to include implementation without a prior hospital stay (Sjöström et al., 2011). CCC was first introduced in Sweden in 2008 and can only be initiated upon discharge from hospital‐based compulsory care (Zetterberg et al., 2016).…”

Legitimating collaboration, collaborating to legitimate: Justification work in “holistic” services for long-term unemployed persons

“…Second, contestability is further increased when collaborative services break with existing practices and regulations as well as professional norms and ideas. This break makes the consent and support from the employees involved a challenging prerequisite for successful implementation (Lægreid and Rykkja, 2014; Zetterberg et al , 2016), Consequently, legitimacy must be established, reproduced, and assembled with existing institutions and practices.…”