Amra Šabić, Vera Grebenc

Amra Šabić

In recent times, the concept of health promotion has become increasingly present in Slovene political and social life. Through various promotional and preventive activities, a healthy lifestyle reinforces the image of health and the healthy body, which is seen in the Slovene context as being an objective of life and not a source of life. The author underlines the dilemmas arising from divergent conceptual descriptions and interpretations with regard to mental health promotion, particularly with regard to political dualism in much medical discourse. The close links between health promotion and prevention are analysed, and the implications of applying mental health promotion approaches in the field of addiction, an area in which the dominant medical discourse continues to emphasise abstinence as the primary objective of health interventions in this field. This is reinforced by the sensationalistic and stigmatising coverage by the media which reinforces the negative image of drug users. The author then describes how the concept of harm reduction has been gaining in importance, and draws attention to the social consequences of this approach. She examines the prohibition model, which is currently the dominant model in most European countries. Finally, she underlines the need for training professionals working in the field of promotion and prevention and discusses the implications of the recently published guidelines for training professionals working in the field of drugs, developed during the international project PROMISE (Promoting Mental Health Minimising Mental Illness and Integrating through Education).

Vera Grebenc

The article explains the implications and process of applying, in the area of mental health promotion, the ethics of social work and current concepts and principles of social work practice. The set of ten quality criteria for designing training for social workers is discussed and commented through the perspective of social work. Health promotion as an idea and as a political strategy often takes its own ethical and moral principles for granted. Public health workers often take it for granted that their activities are morally and ethically impeccable. Those who play a role in health promotion need to recognize the need to articulate their practice and the meaning of this practice with regard to both the human rights agenda and people’s everyday life. Social work as a profession traditionally sees its role as striving for social justice. Equal access to all the determinants of health is at the very heart of the social work profession. In social work, we cannot understand health promotion only as changing attitudes and behaviour but rather as changing social and life conditions. Social work itself has developed a number of strategies and methods of identify ways of strengthening people’s and communities’ capabilities, resources and aspirations so as to create the conditions necessary to exercise their health rights. Mental health promotion involves social workers finding ways of escaping from their supervision roles and seeing themselves as facilitators of good mental health and well-being. However, this goal requires close scrutiny with regard to our professional position in a changing society. The PROMISE quality criteria for training social workers should also be understood as a set of ethical principles to be incorporated at each step of our everyday practice and thus necessarily introduced into all levels of training for social work professionals.

Ksenija da Silva, Gaja Zager Kocjan

Traditionally, suicide and depression (SD) have been viewed from a treatment point of view, i.e. what are the best steps to treat a suicidal or a depressed patient. These are usually related to the pharmacological treatment of depression. With the implementation of the European Green Paper on Mental Health (2005), and the development of Mental Health Pact (2008), the strategic importance of mental health promotion (MHP) and illness reduction as keystones of Europe-wide mental health policy and practice has never been greater. PROMISE (Promoting Mental Health Minimising Mental Illness and Integration through Education) is an international project, with the specific aim of developing and disseminating comprehensive training guidelines and model programmes for professionals working in health and social care. The present article describes the role of the University of Primorska: adapting the guidelines with regard to SD prevention and developing and implementing a model training programme in SD prevention. Added value was supplied through collaboration with European level health and social service professional bodies, university networks, civil society organizations and non-traditional actors to identify the needs of organisations that provide training in MHP. The project also took into account different countries’ policy and legislation on MHP as well as best practice models; liaising with national governmental and non-governmental organisations working in the area of SD; developing effective working relationships with the local mental health service users and organisations.

Ksenija da Silva

The main aim of the PROMISE project was to develop and disseminate comprehensive training guidelines and model programmes on mental health promotion for professionals working in social and health care, in the areas of 1) healthy living for mental health service users; 2) alcohol and drug use; and 3) suicide and depression. Following an initial analysis of policy, legislation and literature reviews in the area of mental health promotion in different countries, added value was supplied through collaborating with European level health and social service professional bodies, university networks, civil society organizations and non-traditional actors, such as users and their representative organisations to identify the needs of professional bodies that provide training in mental health promotion in the area of suicide and depression. The article addresses the principle topics in the field of suicide and depression which were emphasised as most crucial from users’ and professionals’ points of view.

Albert B. Odro, Lawrence K. Dadzie, Daniela Collins, Roland Lodoiska, Peter Ryan

This paper places in a European context recent research work carried out at Middlesex University, London, UK for the PROMISE DG Sanco European project. The work at Middlesex sought to critically review a new mental health nursing curriculum being introduced at the university, using the ten quality criteria for training social and health care professionals in mental health promotion. Each of fourteen nursing modules in this new curriculum was individually reviewed and judgements were made as to what extent each of the 10 PROMISE Guidelines quality criteria were present or absent in these modules. It was found that half of the modules contained references to the principles of mental health promotion, but that this was not followed through in terms of identifying and developing core skills necessary to implement mental health promotion. There was little reference for example to advocacy. It was concluded that mental health promotion is still not seen as a core essential skill component in professional mental health nursing in the UK.

Marie Moineville, Emmanuelle Jouet, Tim Greacen

Richard Plette

Metka Kuhar, Barbara Kobal Tomc

Polona Dremelj

The main sources of assistance and support in the families in Slovenia are examined. For analysis, two empirical studies were used: a study of time consumption, conducted by Statistical office of Slovenia (2000), and a study on social support networks of Slovenian residents (2002). The data shows that people in need mostly rely on family and kin and that support between family members is still based on the traditional gendered division of household labour. Two problems arise from these findings: the problem of families which are facing the lack of social support sources in family and the problem of women who perform the majority of household tasks and are also the main sources of social support for adult individuals in the family. The article offers some solutions to these problems in the framework of family centres which can be, on the one hand, seen as the area for strengthening the social support networks of families and, on the other hand, as an important source of social support for families.

Tatjana Rakar, Ružica Boškić, Metka Kuhar

Family centres as a form of family help programmes are an important measure of the welfare state in the promotion of family friendly environment for the reconciliation of work and family life and for equal opportunities policies. Existing welfare systems, such as the conservative-corporatist, social-democratic, liberal, catholic and former state-socialist types are based on different hierarchies of spheres (such as the market, state, civil society and community) from which we obtain resources for social protection and welfare. The consequences of these differences in the hierarchies are the different levels of decommodification and defamiliarisation in society. As a consequence, the role of family centres also differs among different welfare systems. On the basis of comparative analysis of the characteristics of family centres in chosen countries the article shows that the welfare system and its defamiliarisation level have an important influence on the development and the role of family centres.

Barbara Kobal Tomc, Tamara Narat, Vid Žiberna

In the article, family centres in Slovenia, which were subsidized by Ministry of labour, family and social affairs, are described and analysed. On the basis of the results of the analysis, the article compares family centres in Slovenia with trends and models operating in the EU region. The analysis contains different aspects of activities of family centres, such as regional distribution, structure of financial resources, work methods, analysis of target population. Special focus is given to the question how did the family centres organizations adapt to the current definition of family centres (positive experiences are observed as well as problems and difficulties, confronted by workers in family centres, such as lack of suitable infrastructure, inadequate financial resources). On the basis of standardised model of evaluation of social protection programmes and current characteristics of the open call of Ministry of labour, family and social affairs, the article presents a proposal of evaluation model. The proposal combines the existing form of family centres programmes with the possible form, which this programmes might get in the future, if they would adapt to the family centres in other European countries. Systematic evaluation of the programmes is essential for comprehending the effectiveness and contribution of programmes to the quality of life of families of children.

Ružica Boškić, Tatjana Rakar, Metka Kuhar, Mateja Nagode

In the article, the needs of the families as perceived by the parents, are related to the supply of the family centres as support institutions for assistance to families in meeting their needs. The activities the family centres offer are defined by the state and reflected by the definitions of family centres in the criteria for co-financing of these institutions by public calls. The needs of the modern family have been defined in two researches carried out in Slovenia on the topic in the past two years: The needs of the families for support services (2010) and The needs of the families with the preadolescent children in Slovenia (2010). The analysis shows a significant correlation between the state conceptualization of family centers and family needs. This is especially important for the two most important needs – need for socialising, networking, and the need for occasional child care. However, some of the family centres' activities, such as providing information, could be further strengthened in the future. In addition, we propose that the conceptualization of family centers focuses on the needs of families (not at the same time on the couples who do not yet have children) and that certain substantial requirements are more precisely defined.

Tamara Narat, Metka Kuhar, Nadja Kovač

The article addresses the perception of Slovene municipalities of their role in ensuring the quality of life of families with children, their knowledge about activities of family centres according to the current definition set by Ministry of Labour, Family and Social Affairs, and their attitude towards these centres. The main focus of the article is given to the analysis of municipalities’ perspective towards establishment of family centres based on the models operating abroad – for non-Slovene centres it is caracteristique that they provide the place that enables socializing and integration, and that they are strongly embedded in local communities. Here particularly the needs and interests of municipalities and their role in potential implementation of family centres are being investigated. The article is based on the analysis of representative sample of representatives of 141 municipalities and on the analysis of 10 semi-structured interviews among selected municipalities. The obtained results show that municipalities support the idea of family centres – they recognize the possibility for integration and upgrading the existing institutions that offer these kind of services. Concerning the implementation of family centres, analysed data implicates that the majority of municipalities are prepared to take an active role in this field in cooperation with the government.

Mojca Urek

Mirjana Ule

Our views on health and illness are an integral part of our worldview. These include our understanding of the bodily signs of illnesses, as well as the social role of a patient. Not only can we be physically healthy or sick, but we can also feel healthy or sick. In the article the established medical view of illness, which is limited to the physical symptoms, is contrasted with the social model, which includes the self-evaluation of health and mood. The research of the public opinion on the self-evaluation of health is presented. In addition, the consequences of social inequalities on the health and well-being of individuals are emphasized.

Irena Eržen

Medical social workers provide support and help to patients and their relatives or caretakers in dealing with different social distress during medical treatment. With their specific knowledge and skills they complement the medical treatment of the patient. For solving patients' social difficulties it is important to know and respect their needs and wishes. Medical social worker must constantly adapt her activities to changes of patient’s health or to other circumstances. The profession of social workers in health care is specific, requiring a lot of flexibility and patience, both from a professional point of view and from the point of view of teamwork. The problem is, that medical social workers in Slovenia still haven’t formed and written down standards and criteria. But only the national legal framework of social work in health care could guarantee patients the same multidisciplinary treatment and equal access and maximum quality of service. On the other hand, with precise standards and criteria, medical social workers could get the appropriate degree of autonomy and security, especially when overburdened with work.

Zalka Drglin

Medicalization of motherhood in the very beginning – in pregnancy, childbirth, postpartum – is typical for the second half of the twentieth century. What are the promising ways to achieve empowerment of mothers/women? An analysis of the selected testimony of the childbirth experience reveals complex issues regarding contemporary relationships among birthing women and health care professionals, midwives especially. Midwifery is tied to deeper understanding of the birthing process as intersection of nature and culture and of the basic needs of women and babies in perinatal period. Midwifery as profession, processes of professionalization of support, care and compassion and problematical images of midwives, are carefully analysed. The focus is on the actual task: it is essential to conceptualise midwifery as contemporary caring profession and to provide circumstances for its realisation in maternity care practices.

Darja Zaviršek

Like in other countries, in Slovenia too, the number of people who are in need of an assisted reproductive technology is increasing. Nevertheless, the discourse in the area is dominated by the medical model and social workers are almost non-existent. Social workers would be needed to support people during their reproductive choices and during the process of assisted reproductive technology. The article gives an overview over the current global processes of assisted reproductive technology and emphasises the issues of the donation of the gametes by the third party. It also analyses the ethical concerns about the child’s right to know about his or her genetic history and the ethical dilemmas about the right of the parents to tell. The ethnographic material is based on the analysis of Slovenian internet forums of people who use assisted reproductive technology.

Zlata Ličer

Psycho-social counselling in the field of the rights to family planning, to artificial termination of pregnancy and to procedures of artificial insemination with biomedical assistance, which are all basic human rights, are described. In broader terms, the counselling involves protection of the reproductive health of women during periods of pregnancy and after childbirth. It is also an indicator of commitment of social policies to function according to principles of equality, social justice and solidarity. The aim of the paper is to present the significance of interdisciplinary cooperation which enables realization of every woman's right to freely decide to have children and to have available universal support to her and her family members during period of pregnancy and childbirth.

Maja Šimaga Saje

The article analyses discursive construction of menopause and aims to examine the ways in which menopause is represented. Through six semi-structured individual interviews the study hears from women how they approach the menopausal experience, which social and cultural factors influence it and who were the major sources of information about menopause. Discoursive analysis of women's menopause experiences has shown that predominant medical discourse on menopause is combined with managerial discourse, denial discourse and the feminist-emancipatory discourse. A patchwork of different discourses provides an opportunity for different positions, which can give meaning to women’s experience of menopause. Those positions enable that experience of menopause becomes more embedded in the social context and more positive (or at least neutral) then in the dominant medical discourse.

Renata Šribar

The paper is focused on the constructions of genders in popular medical discourse in printed news and online information media. It leads to the basic conclusion that an illness or a health problem itself is engendered on the level of a syndrome. As the most characteristic and transparent construction of an illness from genders perspective the breast cancer is thematized; the naming itself (in Slovene language) is denoting the exclusion of men, which is in contradiction with the quantitative data related to the phenomenon. At the same time the cultural meaning of women's breasts is being confirmed. Applying the semiotics and criticism of ideology in the analysis of numerous cases the author argues that illnesses, which relate to reproductive anatomy and physiology, are echoed most in the media public – introducing the »natural« associative logic of sexual character, which conveys, just like genders, discriminatory meanings. Besides, gender biased and sexualized is also the understanding of pain and the instance of care in interpersonal relations related to illnesses and health problems.

Emmanuelle Jouet, Olivier Las Vergnas, Luigi Flora

Alongside the movement of patients’ participation within the health system, the knowledge drawn from the experience of illness has also changed the patients’ roles in many aspects. The importance of chronic illness has stimulated the development of patients’ education about their illness in order to support them in their symptoms management and to improve their life quality. Several ideal typical roles of patients are nowadays in relation with health professionals: those who consider that their illness brought them experiential knowledge that could be useful to the health system and the society. They are acting with their peers (peer-support), in educational settings (user-trainers, user-researchers), in hospitals (peer-educators). Meanwhile, several organizations lead by ill people and their relatives, have also experienced new relationship with knowledge production, particularly in the case of not academically well known syndromes. This new kind of empowerment of patients as medical knowledge producers can be compared to other new situations in which non-scientists are involved in research processes, such as popular epidemiology or scientific leisure club. All those situations transgress the division of people into those able or unable to deal with scientific issues. Besides, those situations offer an opportunity to try to clarify the idea of “lay scientific” knowledge, which is a main question for “science and citizens” programmes.

Jane Shears, Shula Ramon

Peer support in mental health services – the reciprocal sharing of the experience of mental health distress – is an innovative new way of working which, through an emerging evidence base, is becoming gradually embedded into health and social care services in the UK. The article focuses on the genesis of peer support in mental health services, demonstrating a different pathway from examples given in general health services. It describes the modalities and delivery of peer support reflecting the different situational contexts in which the activity takes place. The emphasis on the need for training peer supporters to carry out this function is explored together with the existing, yet insufficient, evidence base in both intervention and cost effective terms. The article concludes with a discussion on the interrelationship between the unique and ambiguous components that the concept of peer support raises.

Petra Videmšek

Until recently, the research was reserved for experts rather than for those that have lived personal experience (mental health difficulties, handicap, ethnic minorities etc.). Only academics were entitled to be familiar with methodology and research methods. The article is based on literature and research overview in the field of inclusion of experts with personal experience with mental health difficulties into research in the role of researchers. It shows that inclusion of experts by experience into research raised an important question of knowledge construction in social work practice, which has been for a long time “owned” by those with more power. The voice of important others (professionals, relatives) was, in contrast with the voice of service users, deemed as valid and credible, and only important others were recognised as those knowing the truth about users’ experience. That was pointed out by many foreign and Slovene national studies, emphasising the importance of knowledge and experience of users. By including experts by experience into research in the role of researchers, the social work practice stops being a mere obligation fulfilment and starts encompassing a wider social frame, taking account of structural and social mechanisms of inclusion. Without that, social work practice would still be based on imaginary presumtions that are far away from reality of users.

Damijana Stržinar

The author presents social work with adolescents with mental disorders and mental distress at the Unit for Adolescent Psychiatry in The centre for the mental health of Psychiatric Hospital Ljubljana. The specifics of the social work with adolescents in psychiatric treatment is described. Specific attention is given to the role of social workers in a multidisciplinary team. At the definition of the helping process she uses concepts such as: person in environment, ecosistem perspective, bio-psycho-social model of treatment, holistic treatment, working relationship, defining a problem, integrated treatment. In a case study of practical work with adolescent, helping process is evident. Adolescents must not be treated just individually, since they are in a developmental period in which they still heavily depend on their environment: parents, peers, school. Social worker must connect and mobilize helping resources of everyone involved: patient, family, peer group, school.

Stanislava Ristić Kovačič

Hospital social work in Slovene health care sector is neither formally recognized nor has its proper standards and norms. Tasks and duties carried out by a social worker at the Clinical Institute of Clinical Neurophysiology are much more extensive in their contents than tasks and duties of social workers in health care sector. The nature of work derives from medical viewpoint, because the amyotrophic lateral sclerosis (ALS) disease requires that everything is provided quickly, economically and with the least effort for patient and its family. In a master’s degree the survey that estimates contents of a social worker’s tasks and duties in the Group for the treatment of people suffering from ALS was conducted. It was important to ascertain how much of the contents pertain to activities of social work and how much to activities of a coordinator.

Lilijana Šprah

Affective disorders present a widespread public health problem as they are among the most frequently diagnosed psychiatric disorders. Clinical practice in the therapy of affective disorders, including depressive and bipolar disorders, has showed that pharmacological treatment as a stand-alone therapy proved as less efficient in the long term, compared to those treatments involving any form of adjunctive psychosocial interventions. Functional remediation has been convincingly shown as effective in schizophrenia treatment, and thus it has been considered as increasingly relevant to treatment of depressive and bipolar affective disorders. Functional remediation in persons with affective disorders comprises apart from maintenance treatment also psychoeducational intervention and cognitive remediation, i.e. cognitive skills training. Its aim is to restore the ability to carry out everyday activities in individuals, to help them reintegrate into society as well as to improve occupational outcome and to prevent affective recurrences. The programme of functional remediation is implemented by an interdisciplinary team of professionals from different occupations: psychiatrists, psychologists, social workers and nurses. The article summarises research outcomes, theoretical underpinnings of functional remediation of persons with depressive and bipolar affective disorders and some current implementation aspects.

Tanja Kotnik Grčar

Simona Muhič

Jolanda Stevanović

Brigita Žajdela

Anja Kaurič, Alenka Stolc Jež, Klavidja Širaj Mažgon

Nataša Urankar

Petra Videmšek, Nika Cigoj Kuzma

Tanja Petelinek

Jelka Zorn