Dom på overføring til tvungent psykisk helsevern : en kvalitativ studie om erfaringer og utfordringer ansatte innen psykisk helse opplever i forhold til å gi pasienter dømt til tvungent psykisk helsevern et godt tilbud

Abstract

Background: The subject of this study is «Sentencing to compulsory mental health care». The choice of subject is sprung from a desire to gain a better knowledge of the challenges related to providing a good service for patients sentenced to compulsory mental health care (TPH). At the same time the study is seeking a more comprehensive understanding of the already known challenges concerning the collaboration between the first and second line services providing for this group of patients. The study's findings are discussed in light of a dialogical perspective of interaction. Selection and method: Qualitative study using participant observation and focus group interviews. A dialogue seminar was held as a starting point for the participating observation and selection of informants to the focus groups. A hermeneutic-phenomenological analysis inspired by Giorgi is used. Issue and purpose: The study highlights the experiences and challenges employees from the first and second line services experience in relation to giving patients sentenced to compulsory mental health care good service. It also explores whether or not the dialogue seminar contributed to the informants' understanding of the subject, and whether it influenced the further interaction between the first and second line services. The purpose of the study is to gain increased knowledge about the challenges mental health workers are experiencing by giving patients sentenced to TPH good service. We also sought knowledge of whether dialogue seminars can be a beneficial way to increase the understanding of the subject, and improve the interaction between the first and second line services. Results: Many mental health workers have not yet had dealings with this particular patient group. The reason seems to be that the majority of these patients are still hospitalized in psychiatric wards - primarily security or rehabilitation units. The patients are perceived as a kind of «clots in the system», and the interaction is to a large degree characterized by confusion regarding the responsibility and task distribution between the various management levels. Dialogue seminars are described as a useful forum for increasing knowledge, meeting peers and as a contribution to the creation of a common understanding. Conclusion: The study suggests that there is still uncertainty within the mental health field regarding aspects such as security, resources, responsibility and task distribution, legislation and organization. These conditions challenge the health workers in their daily work with this patient group, and affects the interaction between service levels. The findings indicate a link between the challenges informants experience in the collaboration, and the challenges they experience in relation to providing good service to this patient group. The study reveals organizational challenges related to legislation and the design of service provision, and raises the question of whether one should have separate forensic psychiatric units. Keywords: Compulsory mental health care, forensic psychiatry, first line service, second line service, interaction, dialogue, Freire