Abstract
A freedom-of-choice reform within mental health day center services was evaluated. The reform aimed to (1) facilitate users’ change between units and (2) increase the availability of service providers. Seventy-eight users responded to questionnaires about the reform, empowerment, social network, engagement and satisfaction and were followed-up after 15 months. Fifty-four percent knew about the reform. A majority stated the reform meant nothing to them; ~25 % had a negative and ~20 % a positive opinion. Satisfaction with the services had decreased after 15 months. Empowerment decreased for a more intensively followed subgroup. No positive consequences of the reform could thus be discerned.
Similar content being viewed by others
References
Andersson, M., Eklund, M., Sandlund, M., & Markström, U. (in press). Freedom of choice or cost efficiency? The implementation of a free-choice market system in community mental health services in Sweden. Scandinavian Journal of Disability Research.
Argentzell, E., Leufstadius, C., & Eklund, M. (2012). Factors influencing subjective perceptions of everyday occupations: comparing day centre attendees with non-attendees. Scandinavian Journal of Occupational Therapy, 19, 68–77.
Argentzell, E., Leufstadius, C., & Eklund, M. (2014). Social interaction among people with psychiatric disabilities—Does attending a day centre matter? International Journal of Social Psychiatry, 60, 519–527.
Bejerholm, U., & Eklund, M. (2004). Time-use and occupational performance among persons with schizophrenia. Occupational Therapy in Mental Health, 20(1), 27–47.
Bengtsson-Tops, A. (2004). Mastery in patients with schizophrenia living in the community: relationship to sociodemographic and clinical characteristics, needs for care and support, and social network. Journal of Psychiatric and Mental Health Nursing, 11, 298–304.
Bredgaard, T., & Larsen, F. (2008). Quasi markets in employment policy: Do they deliver on promises? Social Policy and Society, 7, 341–352.
Catty, J., Burns, T., Comas, A., & Poole, Z. (2007). Day centers for severe mental illness. Cochrane Database of Systematic Reviews 2007, Issue 1, Art. No.: CD001710. DOI: 10.1002/14651858.CD001710.pub2.
Eklund, M. (1997). Therapeutic factors in occupational group therapy identified by patients discharged from a psychiatric day center and their significant others. Occupational Therapy International, 4, 198–212.
Eklund, M., Bengtsson-Tops, A., & Lindstedt, H. (2007). Construct and discriminant validity and dimensionality of the Interview Schedule for Social Interaction (ISSI) in three psychiatric samples. Nordic Journal of Psychiatry, 61, 182–188.
Eklund, M., & Erlandsson, L. K. (2013). Quality of life and client satisfaction as outcomes of the Redesigning Daily Occupations (ReDO) programme for women with stress-related disorders: A comparative study. Work, 46, 51–58.
Eklund, M., & Sandlund, M. (2012). The life situation of people with persistent mental illness visiting day centers: A comparative study. Community Mental Health Journal, 48, 592–597.
Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.
Finn, D. (2009). The “welfare market” and the flexible new deal: Lessons from other countries. Local Economy, 24, 38–45.
Friedman, M., & Friedman, R.D. (1990). Free to choose : A personal statement (1st Harvest/HBJ ed.). San Diego: Harcourt Brace Jovanovich.
Hansson, L., & Bjorkman, T. (2005). Empowerment in people with a mental illness: reliability and validity of the Swedish version of an empowerment scale. Scandinavian Journal of Caring Sciences, 19, 32–38.
Henderson, S., Duncan-Jones, P., Byrne, D. G., & Scott, R. (1980). Measuring social relationships. The Interview Schedule for Social Interaction. Psychological Medicine, 10, 723–734.
Jolley, G., Freeman, T., Baum, F., Hurley, C., Lawless, A., Bentley, M., et al. (2014). Health policy in South Australia 2003–10: primary health care workforce perceptions of the impact of policy change on health promotion. Health Promotion Journal of Australia, 25, 116–124.
Krippendorff, K. (2013). Content analysis: An introduction to its methodology (3rd ed.). Los Angeles: SAGE.
Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197–207.
Leufstadius, C., Eklund, M., & Erlandsson, L. K. (2009). Meaningfulness in work – Experiences among employed individuals with persistent mental illness. Work, 34, 21–32.
Lindqvist, R., Markström, U., & Rosenberg, D. (2010). Psykiska funktionshinder i samhället. Aktörer, insatser, reformer [Psychiatric disabilities in society. Actors, interventions, reforms]. Malmö: Gleerups.
Markström, U. (2003). Den svenska psykiatrireformen. Bland brukare, eldsjälar och byråkrater [The Swedish mental health reform. Among users, enthusiasts and bureaucrats]. Umeå: Boréa förlag.
National Board of Health and Welfare. (2011). Nationella riktlinjer för psykosociala insatser vid schizofreni och schizofreniliknande tillstånd —stöd för styrning och lednin. [National guidelines for psychosocial interventions for schizophrenia and related disorder —support for management and leadership]. Stockholm: National Board of Health and Welfare.
Perri 6. (2003). Giving consumers of British public services more choice: What can be learned from recent history? Journal of Social Policy, 32, 239–270.
Rebeiro, K. L., & Cook, J. V. (1999). Opportunity, not prescription: an exploratory study of the experience of occupational engagement. Canadian Journal of Occupational Therapy, 66, 176–187.
Rogers, E. S., Chamberlin, J., Ellison, M. L., & Crean, T. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48, 1042–1047.
Rogers, E. S., Ralph, R. O., & Salzer, M. S. (2010). Validating the empowerment scale with a multisite sample of consumers of mental health services. Psychiatric Services, 61, 933–936.
Spall, P., McDonald, C., & Zetlin, D. (2005). Fixing the system? The experience of service users of the quasi-market in disability services in Australia. Health and Social Care in the Community, 13, 56–63.
Struyven, L., & Steurs, G. (2005). Design and redesign of a quasi-market for the reintegration of jobseekers: Empirical evidence from Australia and the Netherlands. Journal of European Social Policy, 15, 211–229.
Swedish Governmental Reports. (2008). Lag (2008:962) om valfrihetssystem [Law (2008:962) about freedom of choice systems]. Stockholm: Swedish Governmental Reports.
Tjörnstrand, C., Bejerholm, U., & Eklund, M. (2011). Participation in day centres for people with psychiatric disabilities: Characteristics of occupations. Scandinavian Journal of Occupational Therapy, 18, 243–253.
Tjörnstrand, C., Bejerholm, U., & Eklund, M. (2013a). Participation in day centres for people with psychiatric disabilities – A focus on occupational engagement. British Journal of Occupational Therapy, 73, 144–150.
Tjörnstrand, C., Bejerholm, U., & Eklund, M. (2013b). Psychometric testing of a self-report measure of engagement in productive occupations. Canadian Journal of Occupational Therapy, 80, 101–110.
Tjörnstrand, C., Bejerholm, U., & Eklund, M. (2014). Factors influencing occupational engagement in day centres for people with psychiatric disabilities. Community Mental Health Journal. doi:10.1007/s10597-014-9765-0.
Undén, A. L., & Orth-Gomer, K. (1989). Development of a social support instrument for use in population surveys. Social Science and Medicine, 29, 1387–1392.
WHO. (1993). The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization.
Acknowledgments
We gratefully acknowledge that this study was financed by the Swedish Council for Health, Working Life and Welfare, grant number 2010-1042.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eklund, M., Markström, U. Outcomes of a Freedom of Choice Reform in Community Mental Health Day Center Services. Adm Policy Ment Health 42, 664–671 (2015). https://doi.org/10.1007/s10488-014-0601-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-014-0601-1