Developing an integrated psychiatry and social service: a Swedish perspective

The speech will be about what hindrances and facilitating factors can be observed in the process of developing integrated services for persons with severe mental illnesses. The limits of governmental authorities’ abilities to make services providers to co-operate and practice evidence based methods are highlighted. Evidence exists that point to that an integrated approach is more efficient compared to separate service options. The examples are drawn from Sweden, a nation where services mainly are parts of the public sector. The presentation is based on several years of experiences from health systems research and a couple of assignments as an expert in governmental committees to develop services within the psychiatric field. The mission to implement ‘new methods’ and new organisational structures in the practice of social and psychiatric services is difficult, in fact much more cumbersome as it may seem at first glance, given the fact that the services are publicly funded and run. The local authorities have a high degree of autonomy; the professionals are in many cases unwilling to accept changes in their practices. The governmental policy is imprecise in itself, and the strategies to implement the policy are weak in the sense of legislation and directives. Strategies actually utilised during the last decades are the production of series of governmental commissions’ reports, short-sighted funding for projects, and the production of ‘general advice for good practice’. However, there are reasons for good hope as well. A couple of examples of co-operation and integration of services will be mentioned and analysed.