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芬兰心理健康家访整合中的社区融合应对措施。

Tackling community integration in mental health home visit integration in Finland.

作者信息

Raitakari Suvi, Haahtela Riikka, Juhila Kirsi

机构信息

School of Social Sciences and Humanities, University of Tampere, Tampere, Finland.

出版信息

Health Soc Care Community. 2016 Sep;24(5):e53-62. doi: 10.1111/hsc.12246. Epub 2015 May 5.

Abstract

Integration - and its synonym inclusion - is emphasised in the western welfare states and in the European Union in particular. Integration is also a central topic in the social sciences and in current mental health and homelessness research and practice. As mental healthcare has shifted from psychiatric hospitals to the community, it has inevitably become involved with housing and integration issues. This article explores how community integration is understood and tackled in mental health floating support services (FSSs) and, more precisely, in service user-practitioner home visit interaction. The aim, through shedding light on how the idea of integration is present and discussed in front-line mental health practices, is to offer a 'template' on how we might, in a systematic and reflective way, develop community integration research and practice. The analysis is based on ethnomethodological and micro-sociological interaction research. The research settings are two FSSs located in a large Finnish city. The data contain 24 audio-recorded and transcribed home visits conducted in 2011 and 2012 with 16 different service users. The study shows how the participants in service user-practitioner interaction give meaning to community integration and make decisions about how it should (or should not) be enhanced in each individual case. This activity is called community integration work in action. Community integration work in action is based on various dimensions of integration: getting out of the house, participating in group activities and getting along with those involved in one's life and working life. Additionally, the analysis demonstrates how community integration work is accomplished by discursive devices (resistance, positioning, excuses and justifications, delicacy and advice-giving). The article concludes that community integration is about interaction: it is not only service users' individual challenge but also a social challenge, our challenge.

摘要

融合——及其同义词包容——在西方福利国家尤其是欧盟中受到强调。融合也是社会科学以及当前心理健康与无家可归研究及实践中的核心主题。随着精神卫生保健从精神病院转向社区,它不可避免地涉及到住房和融合问题。本文探讨了在心理健康流动支持服务(FSSs)中,更确切地说是在服务使用者与从业者的家访互动中,社区融合是如何被理解和处理的。目的是通过揭示融合理念在一线心理健康实践中的呈现和讨论方式,提供一个关于我们如何以系统且反思性的方式开展社区融合研究与实践的“模板”。该分析基于常人方法论和微观社会学互动研究。研究场所是芬兰一个大城市的两个FSSs。数据包含2011年和2012年对16位不同服务使用者进行的24次家访的录音和文字记录。研究表明了服务使用者与从业者互动中的参与者如何赋予社区融合意义,以及如何就每个具体案例中应(或不应)如何加强社区融合做出决策。这种活动被称为实际行动中的社区融合工作。实际行动中的社区融合工作基于融合的各个维度:走出家门、参与团体活动以及与生活和工作中涉及的人友好相处。此外,分析还展示了社区融合工作是如何通过话语手段(抵制、定位、借口与辩解、微妙处理和给予建议)来完成的。文章得出结论,社区融合关乎互动:它不仅是服务使用者的个人挑战,也是一项社会挑战,是我们的挑战。

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