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Alain Topor. Foto: Eva Dalin

Alain Topor

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Arbetar vid Institutionen för socialt arbete
Telefon 08-16 12 18
E-post alain.topor@socarb.su.se
Besöksadress Sveavägen 160, Sveaplan
Rum 747
Postadress Institutionen för socialt arbete 106 91 Stockholm

Forskning

Min forskning handlar om sociala faktorers och relationers betydelse för uppkomsten av och återhämtning från allvarliga psykiska problem (funktionsnedsättning/störningar).

För närvarande leder jag en uppföljningsstudie av människor med en psykosdiagnos.

1501 personer följs upp med registerdata från socialtjänstens och psykiatrins verksamhetsregister, Brottsförebyggande Rådets-, Dödsorsaks-, Nationella slutenvårds- och Statistiska centralbyråns register. Data från registren har kompletterats med kliniska data på ett urval personer samt med regelbundna intervjuer med 19 personer under tre års tid. Forskargruppen i studien inkluderar Per Bülow, Anne Denhov, Sara Holmqvist, Maria Mattsson samt Claes-Göran Stefansson.

Delstudier inom Uppföljningsstudien är:

Hur går det? En unik studie som följer de 1501 personerna genom de olika registren för att undersöka dels vilka insatser de får och dels vilka följder dessa insatser får.

Brott och straff: Vilka brott begås av människor med allvarliga psykiska problem och vilka påföljder får de? Har det verkligen skett en transinstitutionalisering från psykiatriska institutioner till fångvårdsanstalter?

Money and madness: Privatekonomins betydelse för återhämtningsprocessen samt hur människor med allvarliga psykiska problem klarar av att leva på existensminimum.

Hjälpande professionella: Vilka är de och vad gör de som brukarna uppfattar som hjälpande?

Stjälpande professionella: Vilka är de och vad gör de när de motverkar brukarnas återhämtningsarbete?

Psykos och Suicid: (i samarbete med Suicidforskning och prevention av psykisk ohälsa (NASP)) Studien följer upp dödligheten och självmordsförekomsten bland de 1501 personer i studien.

Att leva med allvarliga psykiska problem i 2000-talets Sverige: Det är ett speciellt, FAS-finansierat, projekt som bygger på material från UPPföljningsstudien. Forskargruppen inkluderar Per Bülow, Gunnel Andersson samt Anne Denhov.

Andra aktuella forskningsprojekt:

Inom ramen för ett anslag för CKVO och i samarbete med Lidingö stad studerar jag socialtjänstpersonalens erfarenhetskunskap relaterad till deras arbete med människor med allvarliga psykiska problem.

På uppdrag från Socialstyrelsen pågår en utvärdering av statens satsning på sysselsättning för människor med allvarliga psykiska funktionsnedsättningar. Forskargruppen inkluderar Katarina Piuva, Martin Åberg samt Marian Bergroth.

Sedan snart tre år följer jag två unga kvinnor med psykosdiagnos med regelbundna trepartssamtal om deras liv och deras erfarenheter av vården, inklusive Försäkringskassan och Arbetsförmedlingen.

Inom ramen för studier om vad som bidrar till återhämtningsprocessen från svåra psykiska problem har jag under senare tid skrivit och medverkat i flera artiklar fokuserade på de professionellas bidrag till återhämtningen.

Handledning

Jag handleder gärna studenter som vill uppsatser om socialtjänstens, psykiatrins och frivilliga organisationers verksamhet och diskurser, samt uppsatser som studerar det psykiatriska fältet från ett brukarperspektiv.

Publikationer

I urval från Stockholms universitets publikationsdatabas
  • 2020. Ninive von Greiff, Lisa Skogens, Alain Topor. Nordic Social Work Research 10 (2), 173-185

    The study focus on how clients with co-occurring problems describe the importance of treatment factors for the recovery process and how these descriptions relates to professional descriptions. 40 client interviews and 15 interviews with professionals were conducted. Three major themes emerge in the results: medication, methods and the professionals.

    The amount of contact with psychiatry and social services that these clients often have through the years can lead to a ‘learned passivity’ towards their own recovery process. Thus, an important task for the professionals is to break through passivity and isolation. This can be done by treating the client like an ‘ordinary fellow human’. Besides the actual professional tasks, small things seem to be important; greeting the person, paying respect when entering some one’s home, etc.

    When a social network is missing, the professional can sometime fill this gap, but if this is to promote recovery, it seem important that the professional social network is used as a bridge to other social networks.

    The professionals as a group, including the environment, emerge as important. Accordingly, to be supportive as a group, and be able to act like ‘social role models’, the professionals need to have working alliances also between themselves. The environment can also offer tools that can be used for socialization that interfere with the ‘learned passivity’ and instead includes and respects the client. This, together with the results highlighting the importance of creating safe milieus, confident and secure professionals, puts focus on how the professional work is organized.

  • 2020. Per Bülow (et al.). Community mental health journal

    Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004-2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period.

  • 2020. Jan G. Friesinger (et al.). Sociology of Health and Illness 42 (7), 1742-1758

    Our daily lives and sense of self are partly formed by material surroundings that are often taken for granted. This materiality is also important for people with mental health problems living in supported housing with surroundings consisting of different healthcare services, neighbourhoods, buildings or furniture. In this study, we explored how understandings of tenants are expressed in the materialities of supported housing. We conducted ethnographic fieldwork in seven different supported accommodations in Norway and analysed the resultant field notes, interviews, photographs and documents using Situational Analysis. The analysis showed that supported housing materialities expressed a blurry picture comprising widening and narrowing understandings of tenants, both by others and by themselves. Widening understandings concerned how tenants were living their lives in their own ways in private rooms while maintaining a social life in common areas. Narrowing understandings pertained to understand the tenants based solely on their diagnosis and need for care and control in hospital-like buildings. The following discussion focusses on the ideas that underlie narrowing materialities and on the importance of striving for atmospheres that entail a sense of belonging.

  • 2020. David Matscheck, Amanda Ljungberg, Alain Topor. International Journal of Social Psychiatry 66 (2), 156-162

    Background:

    User involvement, based on respect and carried out through dialogue, has been shown to lead to increased self-respect, self-confidence and positive identity. In Sweden, the Social Service Act requires that interventions be designed and implemented together with the individual concerned. The basic criterion for social support is prolonged severe mental illness (usually at least 6 months), with no criteria for specific diagnosis or institutional history. The most common form of social support is ‘support in daily living’, a community care intervention for people aged 18 years or older who have their own homes and living arrangements.

    Aim:

    This article aims to deepen our understanding of user involvement at the individual level in the provision of an ongoing social work intervention. What elements of user involvement can be found in users’ and support workers’ descriptions of helpful support in daily living?

    Method:

    Qualitative interviews were conducted with 18 users, who had experienced support in daily living as helpful, and 16 interviews with the users’ support workers.

    Results:

    Three major, interconnected themes emerged: Constant dialogue; Framing the flexibility, in relation to formalized intervention plans and regulations; The importance of ‘small things’, decisions concerning daily life.

    Conclusion:

    Both users and support workers described user involvement at the individual, micro-level to be an integral part of helpful support in daily living. It was possible to create a space for dialogue and co-creation in which users were involved in formulating and deciding the contents of their support at an informal level, to influence their own everyday lives. While a formal framework of rules, restrictions and plans surrounds meetings between users and professionals, a facilitating factor may be the absence of too detailed plans and regulations, leaving trust to users and professionals and their capacity to manage most of the choices they have to make.

  • 2020. Gunnhild Ruud Lindvig (et al.). Journal of Psychiatric and Mental Health Nursing

    Introduction: In the aftermath of the deinstitutionalization in western countries, new community-based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community-based institutional supportive housing.

    Aim: To explore how staff members describe their relationships with residents who have identified them as helpful.

    Methods: Qualitative interviews with nine staff members were analysed using thematic analysis.

    Results: Reciprocity was identified as the main theme, and two subthemes were developed: Something influential about the resident and Value for the staff member.

    Discussion: The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested.

    Implications for practice: To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity.

  • 2019. Jan Georg Friesinger (et al.). Health and Place 57, 44-53

    Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.

  • 2019. Alain Topor (et al.). Social Psychiatry and Psychiatric Epidemiology 54 (8), 919-926

    Purpose

    Persons with severe mental health problems (SMHP) point out financial strain as one of their main problems. De-institutionalisation in welfare countries has aimed at normalisation of their living conditions. The aim of the study was to follow the changes in income and source of income during a 10-year period for persons with a first-time psychosis diagnosis (FTPD).

    Methods

    Data were gathered from different registers. Data from persons with FTPD were compared to data on the general population. Two groups with different recovery paths were also compared: one group without contact with the mental health services during the last five consecutive years of the 10-year follow-up, and the other with contact with both 24/7 and community-based services during the same period.

    Results

    SMHP led to poverty, even if the financial effects of SMHP were attenuated by welfare interventions. Even a recovery path associated with work did not resolve the inequalities generated by SMHP.ConclusionsAttention should be paid to the risks of confusing the effects of poverty with symptoms of SMHP and thus pathologizing poverty and its impact on human beings. Adequate interventions should consider to improve the financial situation of persons with SMHP.

  • 2019. Alain Topor, Ninive von Greiff, Lisa Skogens. International Journal of Mental Health and Addiction

    Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.

  • 2019. Jan Georg Friesinger (et al.). Palgrave Communications 5

    Over the last few decades, various housing types for people with mental health problems have been developed for use in the community. These housing types differ in their objectives, staff support and design. In this study, we focus on how fire safety influences the lives of tenants in supported housing. The qualitative study was designed with a multi-sited ethnography approach. Fieldwork was conducted in seven different Norwegian supported housing settings in 2017 with 105 participants (29 tenants, 70 staff, five managers, and one planner). The empirical data consist of field notes, recorded interviews and pictures, which were analyzed with grounded theory and situational analysis. The analysis reconstructed how fire safety was organized and tenants' experiences of it. These experiences could be positive (such as feeling protected) or negative (such as feeling annoyed or under surveillance). The tenants coped differently with these situations, and fire safety sets boundaries for tenants. Overall, fire safety was organized differently in the supported housing settings we looked at comparison to in most of the common housing units in Norway. The influences of fire safety on daily life can be understood as ambiguous and can be interpreted as a normalizing factor in a risk society. Thus, we emphasize the need for appropriate and well-considered fire safety as a public health intervention in supported housing.

  • 2019. Gunnhild Ruud Lindvig (et al.). European Journal of Social Work

    This article explores how professional relationships may be helpful from the perspective of residents in staffed supportive housing for individuals with severe mental health and/or drug problems. Using in-dept interviews, residents were individually asked to describe a helpful relationship with a self-chosen staff member, the content of the help provided by this staff member and how this help influenced their lives. Using thematic analysis, we found that the residents described mutual relationships that resembled friendships and helpful staff members who carried out a variety of doings. Four domains of doings were identified: small human gestures, filling the hours with 'friendship', enabling the residents to take care of their own needs and fighting on behalf of the residents to ensure rights and benefits. To some of the residents, these doings had life-changing impact. We propose that service management within relationship-based practices should be open for friendship resemblance when matching professionals and service users and make room for a diversity of doings rooted in the service users' perceived needs.

  • Artikel Nothing matters
    2019. Tore Dag Bøe, Inger Beate Larsen, Alain Topor. International Journal of Qualitative Studies on Health and Well-being 14 (1)

    Purpose: The aim of this study is to explore the ways in which “small things” may be of importance for people with mental health difficulties.

    Method: Empirical material from three different studies was reanalysed through a phenomenological, dialogical, approach.

    Results: We discovered some paradoxical aspects of small things: i.e., they could be about “something” that was difficult or even impossible to identify. The unidentifiable could be about bodily, sensual experiences that are superficial (i.e., belonging to the surface). The interaction with others highlighted as significant could be about doing something fun, talking nonsense or kidding around, and hence not at all about making sense of something—a kind of important nonsense. We summarize these aspects in three themes: the importance of the unidentifiable, the superficial and nonsense. These aspects can be regarded as small things—even “nothings”—that make it possible “to stay in the world”.

    Conclusion: We elaborate on the findings in relation to the following: Gumbrecht’s critique of the prevailing hermeneutic world-view with its idea that “interpretation is humankind’s exclusive way of relating to the world”, Ingold’s idea that social life is lived in relations of “interfacility” and hence a turn to surfaces is needed for a “restoration of social life”, and Biesta’s idea of existence as “coming into the world in the presence of others”.

  • 2018. Alain Topor, Lisa Skogens, Ninive von Greiff. Advances in Dual Diagnosis 11 (2), 76-87

    Purpose - The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals' perceptions of their contribution to improvement.

    Design/methodology/approach - In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.

    Findings - Recovery processes were dependent of the persons' access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one's self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person's life. Trusting a professional might be a basis for trusting one's self as an agent in one's recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).

    Practical implications - Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.

    Originality/value - Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.

  • 2018. Alain Topor (et al.). Psychosis 10 (4), 263-274

    Background: Despite repeated attempts, it has not been possible to reach a consensus on the definition of recovery. In this paper, we use the term institutional recovery and focus on the persons' use of services. Aim: What type of services were used by men and women who were diagnosed for the first time with psychosis? How did different cut-offs of length of follow up influence the findings? Method: Interventions for 386 persons diagnosed for the first time with psychosis were followed up for 10 years. Data were collected from registers covering psychiatric and social work services and prisons. Results: Results varied according to cut-off. Nevertheless, even using the higher cut-off, fifty-five percent of the persons had no stay in 24/7 institutions during the follow-up's last 5 years. More than 40% had only community-based treatment and support. Fifteen percent had no interventions at all. A 2-year cut-off doubled the percentage of persons with no interventions. No statistically significant gender differences were found. Conclusions: Institutional recovery could be a useful recovery measure. However, the results from different studies are dictated by choices made by the research team, which should be clarified and discussed.

  • 2018. Lisa Skogens, Ninive von Greiff, Alain Topor. Advances in Dual Diagnosis 11 (3), 101-113

    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.

  • 2018. Alain Topor, Tore Dag Bøe, Inger Beate Larsen. Community mental health journal 54 (8), 1212-1220

    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.

  • 2017. Amanda Ljungberg, Anne Denhov, Alain Topor. Issues in Mental Health Nursing 38 (7), 578-583

    Background: Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries. Aims: This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users. Method: Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis. Results: Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their experience-based knowledge to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users. Conclusions: Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible.

  • 2017. Inger Beate Larsen, Alain Topor. Health and Place 45, 145-151

    The downsizing of psychiatric hospitals has created a new institutional landscape in the local community to support people with severe mental problems in their daily living. This study explores meeting places in Norway from the users’ perspectives. The users used four metaphors to describe these meeting places: “like a home”, “like a family”, “like a landing ground” and “like a trampoline”. The users have decorated the interiors of the meeting places with hearts made from various materials, and these could be considered as symbols of the places. The metaphors used: the hearts and the rooms and interiors, reflect old ideas about calmness and dignity rather than new ideas based on New Public Management.

  • 2017. Katerina Vrotsou (et al.). Geografiska Annaler. Series B, Human Geography 99 (4), 341-359

    Living conditions for persons with severe mental illness (SMI) in Sweden have changed dramatically in recent decades, mainly due to the closure of mental hospitals in the 1990s and the subsequent development of community-based interventions. Thereby, people with SMI have experienced care interventions in various forms, which vary according to how the treatment is institutionally organised over the years. There is, however, a lack of knowledge concerning what care paths persons with SMI have undergone in this fragmented institutional landscape. In this article we present a time-geography-inspired visualisation method to address this. A set of 437 persons, first diagnosed with psychosis between 2000-2004, were studied over 10 years with regard to their contact with various care institutions. We constructed time-geographic paths of intervention for these individuals and visualised them at an aggregate level. The initial exploration conducted using the proposed visualisation method showed gender and age differences in some respects, but also that the initial periods after the psychosis diagnoses were similar in terms of in-patient care interventions among men and women. The proposed visualisation method is promising and should be further developed for deeper analysis of long-term individual paths of intervention.

  • 2017. Alain Topor, Ingemar Ljungqvist. Community mental health journal 53 (7), 823-831

    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.

  • 2016. Alain Topor, Amanda Ljungberg. American Journal of Psychiatric Rehabilitation 19 (4), 275-293

    The relationship with professionals is an important factor in relation to the outcome of interventions directed to persons with severe mental problems. However, the current knowledge regarding the development of helpful relationships within Individual Placement and Support (IPS) services is limited. The aim of the study was to investigate how participants in IPS services described their relationship with their IPS coach. The article is based on interviews from a Swedish government evaluation of IPS services, thematically analyzed. The results showed that the relationship with the coach is central for the participants' success in the service. The main theme, something different - as a human being highlighted that the conditions for the relationship are different within IPS as compared to traditional services. The other themes were here and now action, closer to wish-fulfilment - impact on the self, and from role to person. The principles of IPS parallel the results from research about helpful relationships and offers good preconditions for the occurrence of such relationships. This can represent a bridge between evidence based methods and research on helpful relationships, and should be possible to implement in the development of evidence based methods as well as of treatment as usual.

  • 2016. Alain Topor (et al.). Community mental health journal 52 (6), 731-737

    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.

  • 2016. Per Bülow (et al.). Issues in Mental Health Nursing 37 (11), 820-828

    Psychotropic drugs, particularly antipsychotic types, are a cornerstone of the treatment of people with psychosis. Despite numerous studies showing that drug treatment with psychotropic drugs initially alleviates psychiatric symptoms, the proportion of people with mental health problems and symptoms that do not follow doctors' prescriptions, thus exhibiting so-called non-adherence, is considerable. Non-adherence is predominantly seen as a clinical feature and as a patient characteristic that is especially due to patients' poor understanding that they are ill. There is also a widespread notion that non-adherence is of great disadvantage to the patient. This article is based on interviews with 19 persons diagnosed with psychosis. It challenges the notion of patients being either adherent or non-adherent to the doctor's orders. The findings show that persons with psychosis are active agents when it comes to adjusting medication. The interviewees created their own strategies to gain power over treatment with psychotropic drugs. The most common strategies were to adjust the doses or take breaks of varying lengths from the medication. These deviations from prescriptions were important to conceal, not only from their own psychiatrists, but from all psychiatric staff.

  • 2016. Ingemar Ljungqvist (et al.). Community mental health journal 52 (7), 842-850

    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.

  • 2016. Ottar Ness (et al.). Advances in Dual Diagnosis 9 (4), 130-138

    Purpose - The importance of collaboration in the mental health field is a well established theoretical principle, but there has so far been less attention to its practical implications from a parents' perspective. The purpose of this paper is to describe parents' experiences of collaboration with mental health practitioners. Design/methodology/approach - This was a qualitative study based on thematic analysis of multi-stage focus group discussions with ten parents of young adults with co-occurring mental health and substance use problems. Findings - The authors identified three major themes related to family member's experiences of collaborative practices: negotiating partnerships, incomprehensible services and being the young adult's advocate. Research limitations/implications - A potential limitation of this study is that the parents who agreed to take part in this study were all part of the population who really want to be involved in their relative's care; other family members who did not take part may have different feelings. It would be interesting to interview the siblings and partners of young adults with mental health and substance abuse problems. A last limitation is that only family parents participated in these focus group discussions; it would be interesting to invite service users and practitioners to elicit information about similarities and differences in their experiences of collaborative practices. Practical implications - This study emphasises that parents should be seen as unique individuals as well as families. Parents are persons in different contexts. This creates different needs in their collaboration with the professionals. Parents want to be invited to contribute with their experiences and knowledge, being a collaborative partner in the service provision, and not a burden for their young adults, or to the professionals. Social implications - This study emphasises that it may be important to understand the complex situations of each family parent, supporting their loved ones and at the same time living lives of their own. Families are in demanding and stressful situations often over many years. They want to be invited to contribute with their experiences and knowledge, being a collaborative partner in the service provision, and not a burden for their young adults, or to the professionals. Originality/value - The importance of collaboration is well established in in the mental health field. However, there has been less attention to what collaboration with parents might involve in practice. This paper describes the collaborative experiences of parents of young adults (18-28 years) with co-occurring mental health and substance use problems.

  • 2016. Amanda Ljungberg, Anne Denhov, Alain Topor. Journal of Mental Health 25 (3), 267-277

    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.

  • 2016. Alain Topor, Ingemar Ljungqvist, Eva-Lena Strandberg. Psychosis 8 (4), 336-345

    Background: The relationship between severe mental illness, poverty and social isolation has been explored in a number of studies.Aim: The purpose of the study was to explore the relationship between financial strain and social isolation.Methods: Sixteen persons with severe mental illness were interviewed about their experience of having a severe mental illness, living in poverty and the effect these circumstances had on their social relationships. The interviews were analysed according to thematic analysis.Results: The overarching theme was the cost of having friends; it consisted of five categories: the loss of friends; making do without friends; dependence on friends and family; supported socialisation; and money as an aid to recovery. The participants experienced a connection between their financial circumstances, their social relationships and their lack of initiative in maintaining and developing a social network.Conclusions: The results underline the importance of considering the person in his/her social context in order to avoid the risk of interpreting rational strategies for coping as psychiatric symptoms.

  • 2015. Alain Topor. Psykisk helse, 240-248
  • Artikel Going beyond
    2015. Alain Topor, Anne Denhov. Psychosis 7 (3), 228-236

    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.

  • 2015. Alain Topor. Det sociales betydning för mennesker med sindslidelse
  • 2015. Amanda Ljungberg, Anne Denhov, Alain Topor. Psychiatric quarterly 86 (4), 471-495

    Relationships with professionals have been shown to be helpful to persons with severe mental illness (SMI) in relation to a variety of services. In this article, we aimed to synthesize the available qualitative research to acquire a deepened understanding of what helpful relationships with professionals consists of, from the perspective of persons with SMI. To do this, we created a meta-ethnography of 21 studies, through which ten themes and an overarching interpretation were created. The findings show that helpful relationships with professionals are relationships where the persons with SMI get to spend time with professionals that they know and trust, who gives them access to resources, support, collaboration and valued interpersonal processes, which are allowed to transgress the boundaries of the professional relationship. The overarching interpretation shows that the relationship that persons with SMI form with professionals is a professional relationship as well as an interpersonal relationship. Both these dimensions entail actions and processes that can be helpful to persons with SMI. Therefore, it is important to recognize and acknowledge both the functional roles of service user and service provider, as well as the roles of two persons interacting with each other, in a manner that may go beyond the purview of the traditional professionalism. Furthermore, the helpful components of this relationship are determined by the individual preferences, needs and wishes of persons with SMI.

  • 2014. Alain Topor, Amanda Ljungberg.
  • 2014. Alain Topor.
  • 2014. Alain Topor. Tidskrift for Psykisk Helsearbeid 11 (1), 75-85
  • 2014. Alain Topor (et al.). Psychosis 6 (2), 117-127

    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 diffi- culties. 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.

  • 2014. Alain Topor. Tre decennier med socialtjänstlagen
  • 2013. Alain Topor. Hjälpande möten i vård och omvärld, 68-91
  • 2013. Marit Borg (et al.). Qualitative Social Work 12 (3), 323-339

    Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work - finding meaning and a focus; 2) helpful roles and contexts - to be much more than a person with an illness; 3) making work possible - the role of supportive relationships and supportive medications, and 4) the costs of working too much - finding a meaningful and healthy balance.

  • 2012. Alain Topor, Anne Denhov. American Journal of Psychiatric Rehabilitation 15 (3), 239-254

    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 experienceand evidence-based practice.

  • 2012. Katarina Piuva (et al.).
  • 2012. Alain Topor (et al.). Psychosis 4 (3), 246-257

    Background: The de-, re- and trans-institutionalization of psychiatric care has resulted in a number of changes in the interventions available to persons with severe mental disorders. Aims: This article describes the design of a naturalistic follow-up study of persons with a psychosis diagnosis, the characteristics of the study population, and the interventions they received prior to study participation from various agencies in and outside of mental healthcare. Method: data from various registers, such as psychiatric and social services case registers, criminal records, and the cause of death register have been collected and analyzed. Results: Under the period 1997-2004, 42% were in contact only with out-patient care, 58% were in contact with the social services, and 2% had served prison sentences. Conclusions: Studies need to include interventions that are provided beyond the scope of psychiatric services in order to assess the extent of the existing support network and the long-term outcomes for persons with a psychosis diagnosis. The lack of a gender perspective in psychiatric research also needs to be addressed.

  • 2012. Anne Denhov, Alain Topor. International Journal of Social Psychiatry 58 (4), 417-424

    Background: The quality of the relationship between professional and user is one of the important factors in the recovery process. However, more knowledge is needed concerning the components of helping relationships and characteristics of the helping professional. The aim of this study was to explore users’ experiences of helping relationships with professionals.

    Data and methods: This was a grounded theory analysis of 71 qualitative interviews to explore users’ experience of helping relationships and their components, in psychiatric care in Sweden.

    Discussion: Within the three main categories – interpersonal continuity, emotional climate and social interaction – two core themes were found that described vital components of helping relationships: a non-stigmatizing attitude on the part of the professionals and their willingness to do something beyond established routines.

    Conclusions: The focus in psychiatric treatment research needs to be broadened. In addition to research on the outcome of particular methods and interventions, the common factors also need to be investigated, above all, what is the effect of the quality of the relationship between user and professional. Greater attention needs to be paid, as well, to how helping respective obstructive relationships in psychiatric services arise, are maintained or are modified.

  • 2011. Alain Topor, Anne Denhov. PSykiatri som socialt arbete, 138-155
  • 2011. Alain Topor. Tidskrift för Psykisk Helsearbeid 8 (4), 303-313

    An increasing number of policy documents are recommending that the recovery perspective be used as a guiding principle in the development of psychiatric care. The recovery perspective also implies a formalized user involvement in the planning and managing of treatment interventions. The present article questions whether it is possible to integrate this perspective in psychiatry’s current practice and body of knowledge. Three aspects are investigated: What are mental disorders? Who are the users? What factors contribute to the recovery process? Psychiatry’s belief in chronic illnesses that follow a given course of development is contrasted with the view of mental problems as being related to life events and that recovery is a likely course of development. The dominant view in psychiatry is that the patient is irrational and incapable of interpersonal relationships. Results in recovery research place the user in his or her social context and show that managing of symptoms and stigma is possible. Where psychiatry focuses on specific treatment interventions, the users themselves point at a variety of helping factors where interpersonal relationships play a central role. An integration of users’ experience-based knowledge in the arena of psychiatry would deeply transform its current knowledge and practice.

  • 2011. Alain Topor (et al.). International Journal of Social Psychiatry 57 (1), 90-99

    Background: Recent literature on recovery describes the process as deeply personal and unique to each individual. While there are aspects of recovery that are unique to each individual, this article argues that focusing solely on these overlooks the fact that recovery unfolds within a social and interpersonal context.

    Materials: Drawing from qualitative data, this article describes aspects of recovery that involve the contributions of others, the social environment and society.

    Discussion: These aspects of recovery include relationships, adequate material conditions and responsive services and supports.

    Conclusion: The authors consider the implications of these social factors for transforming psychiatric research and theory as well as for recovery-orientated practice

  • Kapitel Återhämtning.
    2011. Alain Topor. Psykiatri som socialt arbete, 1-18
  • 2010. Alain Topor, Simonetta Di Girolamo. Journal of Mental Health 19 (6), 553-561

    Background:

     

    People who have been diagnosed with schizophrenia are regarded as being no longer

    capable of making rational choices.

     

     

    Method:

     

    Fifteen users with psychosis diagnosis participated to 10 focus group sessions about different

    aspects of everyday life. The discussions were tape recorded and the transcript analyzed using a

    grounded theory inspired methodology. A core category that emerged was making choices in crises

    situations.

     

     

    Results:

     

    Users have to choose whether or not they want help, to whom to turn for help, and how to

    describe their problems so as to get the kind of help they seek. The choices were based on past

    experiences in connection with the choices available. They were constantly making quality judgements

    of the care workers they came into contact with. Experiencing a sense of comradeship emerged as a

    vital criterion.

     

     

    Conclusions:

     

    The ability to make rational choices often existed parallel with hallucinations and

    delusions. This ability could form the basis for a true collaboration between users and professionals.

    The findings of this study indicate that such collaboration is possible, but that it requires a

    reassessment of our traditional knowledge base.

  • 2010. Alain Topor, Simonetta Di Girolamo. Journal of Mental Health 19 (6), 553-561

    Background: People who have been diagnosed with schizophrenia are regarded as being no longer capable of making rational choices.

    Method: Fifteen users with psychosis diagnosis participated to 10 focus group sessions about different aspects of everyday life. The discussions were tape recorded and the transcript analyzed using a grounded theory inspired methodology. A core category that emerged was making choices in crises situations.

    Results: Users have to choose whether or not they want help, to whom to turn for help, and how to describe their problems so as to get the kind of help they seek. The choices were based on past experiences in connection with the choices available. They were constantly making quality judgements of the care workers they came into contact with. Experiencing a sense of comradeship emerged as a vital criterion.

    Conclusions: The ability to make rational choices often existed parallel with hallucinations and delusions. This ability could form the basis for a true collaboration between users and professionals. The findings of this study indicate that such collaboration is possible, but that it requires a reassessment of our traditional knowledge base.

  • 2009. Alain Topor, S Di Girolamo. Medforskning
  • 2009. Ulla-Karin Schön, Alain Topor. International Journal of Social Psychiatry 4 (55), 336-347

    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.

  • 2009. Alain Topor, Simonetta Di Girolamo. Psychiatrie française 40 (4), 99-107
  • 2009. Alain Topor. Psykiatri för baspersonal
  • 2008. M. Mattsson (et al.). Social Psychiatry and Psychiatric Epidemiology 43 (12), 947-952

    Despite much effort to positively affect long-term outcome in psychosis and schizophrenia many patients are still facing a poor outcome with persistent psychotic symptoms and decline in social functioning. The aim of this study was to examine the relationship between financial strain and social network and five-year outcome of first episode psychosis (FEP). FEP patients were divided into recovered (n = 52) and non-recovered (n = 19). Each person was matched according to age and gender with four persons (n = 284) from a longitudinal population-based study. All persons had answered an extensive questionnaire including social network, quantitative and qualitative, financial strain and mental health. Linear regression analysis showed that both financial strain and social network were associated, and had a unique contribution, to outcome. The results indicate that FEP patients might benefit from interventions that reduce financial strain thus facilitating daily life and cultural and social activities.

  • 2008. Alain Topor, Simonetta Di Girolamo. Psychiatrie française 39 (4), 108-113
  • 2008. Larry Davidson (et al.). Canadian journal of psychiatry 53 (3), 137-144

    This article offers examples of the ways in which qualitative methods have informed, and may inform, mental health policy in Canada and beyond. Three initial uses of these methods are identified: to generate hypotheses to be tested by other means; to explore the subjective experiences and everyday lives of people with mental illnesses; and to investigate processes of recovery and the active role of the individual in recovery. Given the recent focus in mental health policy in Canada, the United States, and around the world on transforming mental health systems to promote recovery and the emphasis recovery places on the individual's own first-hand perspective, we argue that qualitative methods will become increasingly useful as psychiatry shifts away from symptom reduction to enabling people to live satisfying, hopeful, and meaningful lives in the community.

  • Avhandling (Dok) Managing the contradictions
    2001. Alain Topor, Anders Bergmark, John Strauss.

    One of the assumptions made when mental problems are defined as a medical problem is that certain problems, certain diagnoses, are chronic. Nevertheless, a substantial number of follow-up studies have shown that the course of development in patients with these diagnoses is neither uniform nor chronic. The aim of this dissertation is to summarise the state of the art in the knowledge about recovery from severe mental disorders and to examine in depth which factors people who have recovered regard as having helped them in their recovery, and in which ways. These two aims have resulted in two separate but complementary presentations of results. The review of the state of the art, which focuses on the diagnosis schizophrenia, shows that some two-thirds of the patients who received this diagnosis have recovered, either totally or socially. The variation in the percentage of persons who have recovered is explained in the study by such factors as fluctuations in national and local unemployment rates, in definitions of the diagnoses and in access to psychiatric care. On the other hand, the introduction of various treatment interventions seems to have had no noticeable effect on the recovery rate, although it has affected the relapse frequency. There is still a long way to go towards understanding the recovery process and how it can be facilitated. The interview study with persons who have been treated for severe mental disorders and recovered show the patients themselves to be a crucial factor in their own recovery. Throughout the whole course of the disorder, they struggle to find ways to manage both their symptoms and the factors that cause them. What appears to others as symptoms might instead be theperson’s unsuccessful attempts to manage existential problems. Entering into and maintaining relationships with other people is another crucial factor in recovery work. Professionals from a variety of backgrounds as well as family members and other laypersons can contribute to recovery, first and foremost in that they represent continuity between diverse facets of the person’s life; they engage with the person in his/her full complexity, not as someone reduced to a diagnosis and a given patient role, nor by denying the fact of the person’s suffering. Still another factor in recovery work is material conditions which impact on the person’s possibility to regain an identity as a full member of the community. Lastly, the descriptions that the respondents give of their recovery practice have certain constructed meanings in common. These meanings can be categorised as medical, therapeutic, spiritual and interactional. In many of the life stories collected in this study, several of these categories of meaning appear in unison, co-existing in one and the same life story. There is a recurrent theme running through these practice stories of recovery: that people in their everyday lives are not reducible to their problems, but at the same time these problems must not be denied. That people have both weaknesses and strengths, sometimes existing within the same spheres of life and occurring simultaneously; but that in relationships with other people they are given scope to manage and live with these contradictions is of central importance for recovery practice.

Visa alla publikationer av Alain Topor vid Stockholms universitet

Senast uppdaterad: 23 februari 2021

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