Browsing by Subject "deinstitutionalisaatio"

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  • Hyppölä, Oona-Maaria; Hyppölä, Anniina (Helsingin yliopisto, 2018)
    The 2010s have witnessed increasing political and public concern over child and family-related issues in Russia, with child welfare and family policy being elevated to the top of the state’s political agenda. The Russian conservative government has prioritised the protection of traditional family values and family as the mainstay of Russian society and thereupon introduced major policy and welfare reform programmes, one of which works towards deinstitutionalising the country’s entire child welfare system. Building upon the idea of every child’s right to a family, this child welfare reform aims at dismantling the existing system of institutional care for children, replacing placements in institutions with community and home-based, family-like forms of alternative care, including foster care. Service provider responsibilities are hence, being transferred from the state to private and third sector stakeholders operating in the field of child and family welfare. Among these agents providing alternative care are the so-called Children’s Villages. These Villages, as the name suggests, are largely NGO-run communities of foster families, caring for children left without parental care in a non-institutional setting. This thesis takes a range of Russian Children’s Villages as its case study in an attempt to investigate foster parents’ perceptions of parenting and thus shed light on the present-day development of the alternative care system in Russia. The aim is to bridge together bottom-up narratives and top-down political ideology via qualitative analysis of micro-level constructions of parenthood and government-promoted ideas on family. The ongoing process of deinstitutionalisation of child welfare in Russia provides the larger political context for our inquiry that fosters a social constructionist approach and, through thematic content analysis, seeks to answer the following research questions: How do foster parents perceive parenthood/parenting in the context of Russian Children’s Villages? How do their perceptions intersect with government-promoted ideas on family? The primary data consist of focus group and expert interviews with foster parents and child welfare professionals conducted on site in six Children’s Villages in Russia in 2017. The altogether nine interviews, with a total of 58 respondents have been conducted by two other researchers in the ‘A Child’s Right to a Family: Deinstitutionalisation of Child Welfare in Putin’s Russia’ research project that our thesis is also part of. Our findings suggest that parenting takes multiple, concurrent and reciprocal forms, whereby it is largely a cyclical process and a jointly constructed and negotiated experience in the social context of the Children’s Villages. The Villages and the individuals therein are not merely care deliverers assuming service provision responsibilities from the public sector, but they carry considerable innovate potential and valuable ideas on family and parenting vis-à-vis the desired development of systems of alternative care in today’s Russia. Yet, the political arena in Russia remains ambivalent, enabling and coercive at the same time, introducing policies that are often either contradictory or incompatible. Alongside ambitious liberal tendencies and reformist programmes we may observe illiberal and restrictive political and legislative processes that undermine the sustainable fruition of the more progressive reforms amid structures that hold onto authoritarian traditions. While the traditional value base of the conservative government fails to fully embrace the plurality of family systems in modern Russia, the family structures in the Children’s Villages demonstrate that family diversity is very much a contemporary reality in Russian society – and foster families one of its emerging forms.
  • Alanko, Anna (Helsingin yliopisto, 2017)
    The study investigates policy level attempts to improve mental health care. It analyses the rationale of the proposals to improve Finnish mental health policy between 1964–2016. Such proposals have been presented in policy documents such as committee reports, working group memorandums, government bills and project reports. The most prominent examples of the improvement proposals are reducing psychiatric hospital care, increasing outpatient treatment, increasing the possibilities for mental health services users to work, emphasising the autonomy of the service users, and increasing the equal position of mental health care service users and other citizens. The study seeks to find out what has been in the focus in reforming mental health care, how the people using mental health services have been perceived, and finally, what has been left unproblematised. Since the late 1970s, Finnish mental health care has been subject to continuous reforms. A key feature of these reforms has been psychiatric dehospitalisation, i.e. reducing psychiatric hospital care. Dehospitalisation is a trend with complex origins, which became global after the Second World War and reached Finland by the mid-1970s. Dehospitalisation stems from various and conflicting origins, such as citizens’ rights movements, the development of the psychiatric profession, the economic interests of the state, as well as from pharmaceutical development. Dehospitalisation and mental health policy in general are deeply connected with welfare policy, but it the relationship is not straightforward. In Finland dehospitalisation was planned as part of an expansive welfare policy, but its’ implementation has sometimes recalled austerity politics. Another phenomenon that affects mental health policy is the expansion of mental health care: the simultaneous increase in the provision, demand, methods and areas of jurisdiction of mental health care. The dissertation shows that in the reform initiatives set forth in the policy documents, similar suggestions are given in different contexts. In the analysed policy documents, dehospitalisation has been proposed as a solution to almost any problems perceived in mental health care. Dehospitalisation also seems to have materialised, as the number of psychiatric hospital beds is now many times lower than it was in the beginning of the period. Along with the diminishing number of hospital beds, new residential care facilities have been established which seem to be as institutionalising as the previous psychiatric hospitals. Also increasing the amount of outpatient treatment has materialised, but it seems that the services are used by a new group of citizens with milder problems. During the period between the 1960s and the early 1990s, those with a serious mental health problem were considered the core focus group of mental health policy, independently of whether they were within the labour market. Moreover, providing sheltered work for those with serious problems was considered a method of rehabilitation. After the mid-1990s the emphasis on paid work has increased. Those who are able to work in the labour market are the new focus group the mental health policy. The pursuit of mental health care service users’ increased autonomy is ideologically connected to the aim of dehospitalisation. However in the latter phases of the period, after the mid-1990s, the improvement suggestions start to assume the autonomy of the service users instead of seeking ways of supporting it. The changing understanding of autonomy also reflects to the notion of ‘user expertise’. This recently emerged way of thinking lifts the expertise of people having experience with their own mental health problems. However the emphasis on ‘expertise with experience’ fails to take into account that there is a high demand for professional mental health services. In the conclusions I argue that as a whole the well-meaning improvement proposals fail to problematise many structural factors contributing to the unequal provision of mental health care. Instead of achieving the revolving goal of increasing the equality of mental health care service users, the rationale has left room for excluding even further those with the most serious problems.