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Gunnel Andersson CollinsForskare

Om mig

Jag är socionom och docent vid Institutionen för socialt arbete, Stockholms universitet. Min forskning har i huvudsak omfattat personer med allvarliga psykiska problem/psykiska funktionshinder, deras vardagsliv samt samhällets stödinsatser, med särskilt intresse riktat mot socialtjänstens insats boendestöd. Efter disputationen (2009) med avhandlingen "Vardagsliv och boendestöd" har jag ingått i olika forskningsprojekt, dels vid FoU Södertörn och dels vid Stockholms universitet. När det gäller boendestöd har jag i ett flertal studier uppmärksammat vad som kännetecknar ett stödjande boendestöd, ofta med ett s k brukarperspektiv. I vardagslivsstudierna har jag intresserat mig för såväl individernas erfarenheter av det "levda livet" som vardagens mer övergripande strukturer och i detta sammanhang använt mig av begreppen "samhällsorganiserat" och "individorganiserat" vardagsliv. Tillsammans med en forskargrupp vid institutionen har jag även studerat "hur det går" för personer som diagnosticerats med psykos, i ett tio-årsperspektiv. Det senare bygger på registerstudier medan de tidigare studierna mestadels utgörs av kvalitativa ansatser såsom intervjuer, deltagande observationer och dagböcker. Ett sammanbindande tema genom mina forskningsprojekt har varit det tidsgeografiska tankesättet, dess metoder och visualiseringsmöjligheter.

Forskningsprojekt

Publikationer

I urval från Stockholms universitets publikationsdatabas

  • The Stockholm Follow-up Study of Users Diagnosed with Psychosis (SUPP)

    2021. Per Bülow (et al.). Community mental health journal 57 (6), 1121-1129

    Artikel

    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.

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  • A diversity of patterns

    2020. Gunnel Andersson (et al.). Moravian Geographical Reports 28 (4), 283-298

    Artikel

    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.

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  • A longitudinal study of men and women diagnosed with psychosis: trajectories revealing interventions in a time-geographic framework

    2019. Gunnel Andersson (et al.). GeoJournal

    Artikel

    The living conditions for persons with severe mental illness have undergone substantial change in Sweden as well as in the rest of the Western world due to the downsizing of inpatient care and the development of community-based interventions. However, there is a lack of knowledge concerning the “trajectories of interventions” in this new, fragmented, institutional landscape. The aim of the study was to explore types of interventions and when they occur in a 10-year follow-up of 437 women and men diagnosed with psychosis for the first time. Based on registers and using a timegeographic visualization method, the results showed a great diversity of trajectories and differences between sexes. The aggregate picture revealed that over the 10-year period there were considerable periods with no interventions for both men and women. Furthermore, institutional interventions more commonly occurred among women but appeared for longer periods among men. Community-based interventions declined among women and increased among men during the period.

    Läs mer om A longitudinal study of men and women diagnosed with psychosis: trajectories revealing interventions in a time-geographic framework

  • Boendestöd – innebörder och effekter

    2019. Gunnel Andersson, Hjördis Gustafsson. Socialvetenskaplig tidskrift 26 (1), 65-85

    Artikel

    Social support in independent living for persons with psychiatric disabilities – meanings and impactsSocial support in independent living is the most common social intervention for persons with psychiatric disabilities in Sweden. This article investigates what constitutes supportive social support, its meanings and impacts in respect of context, interaction and time. The article emanates from a reanalysis of the results of three user-oriented studies. In total, 56 persons with experience of this type of social support were interviewed. The analytical framework derives from theories of social interaction. The findings reveal that supporting social support is a complex social intervention conveyed through ”the doing”, the talking and the company of the support worker. The findings also show that the restraints of everyday life are allayed or abrogated due to the support: the undoable becomes doable. Finally there are impacts on the psychosocial situation: it contributes to increased well-being and improved psychiatric conditions.

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  • Recovery and economy; salary and allowances

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

    Artikel

    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.

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  • Children with disabilities in Swedish child welfare – a differentiating and disabling practice

    2019. Kristina Engwall (et al.). European Journal of Social Work 22 (6), 1025-1037

    Artikel

    Research shows that children with disabilities are victims of violence and abuse to a higher extent than other children and thus need support from social services. In Sweden, cooperation between two different social services units is required to support children with disabilities in socially vulnerable families. In this study, we have examined the intersection between children and disability in a Swedish social services context from the perspective of childhood studies and disability studies. The reasoning of the two units including the child perspective emerged during focus group interviews based on two vignettes. The results show two different rationalities, which has consequences for the disabled child. In spite of a social policy where the ‘best interests of the child’ are meant to prevail and disabilities are meant to be interpreted as barriers in society, children with disabilities seem to be reduced to individuals who are lacking in ability and competency and who are profoundly victimised by power structures that favour the adult perspective in social services.

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  • Institutional recovery

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

    Artikel

    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.

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  • A time-geographic approach for visualizing the paths of intervention for persons with severe mental illness

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

    Artikel

    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.

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  • What makes supportive relationships supportive? The social climate in supported housing for people with psychiatric disabilities

    2016. Gunnel Andersson. Social Work in Mental Health 14 (5), 509-529

    Artikel

    The link between social support, well-being, and mental health has been established in numerous studies in a variety of disciplines since the 1970s. A specific type of support is professional social support for people with psychiatric disabilities living in the community. This study emphasizes the relationship between the professional and the person with psychiatric disability in supported housing. The results show that a supportive relationship involves a social climate with the following components: interest in the individuality, care/concern, and respect for the integrity of the individual. The results also indicate that the social climate has a crucial influence on perceived support, as exemplified by supportive and unsupportive types of relationship.

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  • Experience of Psychotropic Medication - An Interview Study of Persons with Psychosis

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

    Artikel

    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.

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  • After the Asylum? The New Institutional Landscape

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

    Artikel

    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.

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  • Aloneness and loneliness – persons with severe mental illness and experiences of being alone

    2015. Gunnel Andersson (et al.). Scandinavian Journal of Disability Research 17 (4), 353-365

    Artikel

    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 by two concepts: 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.

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  • Standardized knowledge, the IBIC and knowledge-based social services

    2023. Gunnel Andersson, Kristina Engwall. Nordic Social Work Research

    Artikel

    This article discusses the contribution of standardized methods to knowledge-based social services. The point of departure for the study is the Swedish assessment method the Individual’s Needs in Focus (IBIC). How does the IBIC, based on the terminology of the ICF, contribute to standardized documentation and to a focus on the needs of the individual? The study is based on 80 social service investigations, from four different Swedish municipalities, concerning daily living support interventions, as well as 13 interviews with case officers. Our analysis exposes major flaws in terms of clarity and uniformity. The client’s needs may be seemingly randomly assigned to a particular life domain; environmental factors and personal factors have no specified content, and the assessment of the degree to which functioning is limited is subjective. As a standardized method, the IBIC fails in the fundamental requirement of providing a basis for comparison – the headings do not necessarily coincide with the content. From a social perspective, one can also question why, according to the IBIC, needs are centred to functions, supposedly improved by practice/learning. Overall, this also jeopardizes its value relative to goal fulfilment at both individual and aggregated levels. We argue that one reason why it is difficult to apply the IBIC is that its construction does not align with the premise of social work. The IBIC constructs an approach to knowledge that tends to place a high premium on the simple and well-defined, rather than the holistic and complex.

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