Fra idé til virkelighet! Implementering og bruk av individuelle planer i psykisk helsevern - en kvalitativ studie

Abstract

Aim of the study. ‘Individual plan’ (IP) is a master-plan intended to increase user-participation and provide better coordination of measures for patients in need of extensive and long-term health-care services. The aim of this study, which makes the basis of my doctoral thesis, is to explore and describe what hampers and promotes the use of ‘individual plan’ in a population of youths/young adults with longstanding and complex mental health problems.<br><br>

Background. IP is a legalised tool within all Norwegian health- and social-services. IP is built on the patient’s own goals, needs and resources. It assumes an appointed service provider coordinating the services involved. IP is one of Norway’s answers to the more internationally known models for integrated care. Norwegian Health Authorities used a dissemination strategy, which implied that managers within health and social care could choose their own way of implementing IP in their organisation.<br><br>

Methodology. The study is based on in-depth interviews. The data material consists of interviews with 22 managers from different clinics and organisational levels within mental health care, representatives of 24 IP-processes where either the patient (19), a relative (7) or both where interviewed, as well as their coordinators (19) and six representatives of user-organisations. The patients and relatives were interviewed twice, two years apart. The analysis was primarily made according to Systematic Text Condensation and content analyses.<br><br>

Findings. The findings are based on analyses of how implementation processes were described, how the managers reflected upon the usefulness of IP as a tool, what kind of practical implementation strategies that were chosen, the manager’s own role in this, characteristics of the organisational culture as well as conditions related to administration, time and resources. The patients and relatives found the following themes important in the process of making and using an IP: To participate and have influence, get information and gain competence, have a suitable responsibility, and feel respect and mutuality in relations with the service-providers. In cases where IP seemed to work as intended, the process seemed to have an empowering potential. In these cases there were some parallels to efficacy variables in therapy, like the importance of alliance and mutual definitions of goals to work for. IP as a tool seemed to be most suited for patients with diagnostically clarified, mental health problems, even if these were complex. The coordinators looked at themselves and the patients as having a balanced relationship, marked by mutuality and participation in those well-functioning cases. Whether the coordinator and the patient liked each other, and whether the service providers were flexible and available were seen as another important aspect. The analyses also showed that an IP was not an useful tool in 14 out of 24 cases. In these cases the use of IP did not help to clear out organisational and economic questions when there were organisational barriers like unclear responsibility for decisions or lack of resources.<br><br>

Discussion. The findings are discussed within a frame of implementation theory, organizational theory, health promotion theory, especially related to empowerment and user-participation. Whether the findings fit with existing knowledge about case management, assertive community treatment team and integrated care models in general is also discussed.