Thesis (M. A. (Clinical Psychology)) --University of Limpopo, 2018 / Studies by the World Health Organisation have shown that mental illness is an international health concern across the globe, with one in four people (25%) suffering from mental disorders in both developed and developing countries. In many African countries traditional health practitioners are the health care providers of choice for individuals, families and communities. The aim of this study was to explore methods used by Shona speaking traditional health practitioners in the prevention of mental illness in Bulawayo, Zimbabwe. A qualitative research design was used in the present study. Ten Shona speaking traditional health practitioners (male=9; female=1) were selected through purposive sampling and requested to participate in the study. Data was collected using semi-structured interviews and analysed through thematic content analysis. It was found that traditional healers tend to commonly understand and conceptualise mental illness in terms of the causes instead attaching nosological labels to these conditions. The findings of the study also show that most of the traditional health practitioners interviewed had similar methods of preventing mental illness both in families and individuals. Culture was found to be central in shaping how the traditional health practitioners understand and prevent mental illness. Ancestors were found to be pivotal in specifically determining the methods to prevent mental illness for each client. The study is concluded by recommending closer collaboration between the dominant Western health care system and traditional healing in order to improve mental health care provision in Zimbabwe.

archives@tulane.edu / Research has shown that populations with mental illness tend to have higher rates of obesity, diabetes, and other chronic conditions. This can be due in part to the medication treatment as anti-psychotic and anti-depressant medications have been shown to be major contributors to elevated rates of obesity, diabetes, dyslipidemia, and metabolic disorders that have the potential to lead to cardiovascular disease. Existing literature has identified many barriers that contribute to low preventive care utilization and screenings for metabolic risk factors. Consequently, national policy initiatives, such as the 2010 Affordable Care Act’s (ACA) Medicaid expansion, have aimed to improve access to care impacting adults with mental illness and expand coverage for more preventive and mental health services. Thus, this project: (1) examined longitudinal trends in diabetes preventive screenings and healthcare utilization associated with the 2016 Louisiana Medicaid expansion for a traditionally enrolled Severe Mentally Ill (SMI) Medicaid insured population, (2) assessed differences in racial and other socio-demographic characteristics associated with receiving diabetes preventive care and utilizing health care services amongst a traditionally enrolled SMI Medicaid insured population, and (3) assessed if Medicaid expansion was associated with better access to care and increased utilization of preventive care for diabetes-related complications in adults with diabetes and depression. To address these aims, adults ages 18 to 64 were analyzed through two data sources. The first is Louisiana Medicaid claims data; a longitudinal assessment of screening rates over a five-year period was used in an interrupted time series analysis to look at the change in screening rates for preventive care services and health care utilization before and after expansion for adults with SMI. Next, we used multivariable logit regression modeling, to examine the likelihood of receiving preventive care and utilizing health care services based on sociodemographic characteristics. Results from these analyses showed there was a total of 53,926 adults with a diagnosed SMI who had continuous enrollment in Medicaid between January 1st, 2014 – December 31st, 2018. Medicaid expansion was associated with significant increases in ED utilization and average inpatient length of stay for traditionally enrolled SMI adults. Racial differences in the likelihood of going to the ED were also apparent as blacks were more likely to go to the ED and for reasons that could have been prevented. For the third aim, data were extracted from the Behavioral Risk Factor Surveillance System survey for the years 2010 to 2017 for all adults with a self-reported diagnoses of depression and diabetes by a health professional. A retrospective cross-sectional study design using difference-in-differences analysis assessed relationship between Medicaid expansion and access to care and preventive care utilization for Medicaid eligible respondents in expansion states, compared to Medicaid eligible respondents in non-expansion states. Medicaid expansion significantly increased insurance coverage and the likelihood of having a personal doctor for eligible respondents in expansion states. / 1 / Alisha Monnette

Many large urban juvenile probation departments have begun to utilize mental health courts to meet the demands of the increasing number of individuals who have mental health issues that end up in the juvenile justice system. Diversion programs are designed to keep youth in the community and out of the juvenile justice system, but it is not clear whether these programs keep individuals from re-offending. Therefore, this study was conducted to determine whether diversion programs used in the mental health courts are helping to decrease recidivism for juveniles identified with mental illness. This study was also aimed at identifying how mental illnesses affect successful completion of programming. The theory of therapeutic jurisprudence was used as the theoretical foundation to help guide this quantitative, quasi-experimental study and answer the research questions. The data utilized was from a large urban juvenile probation department, which uses the mental health court as a diversion program. Data was collected from 2009 to 2017 on both youth who participated in the program and those who chose not to participate in the program. Chi-square and logistic regression were used to analyze the data. Based on the chi-square, recidivism rates were significantly impacted by participation in the mental health court. The data presented demonstrated mental health court is effective at reducing recidivism. The potential is there for positive social change in the treatment of youth with mental illness both in the community and the juvenile justice system.

No description available.

Stigma proves to be a serious barrier for individuals living with mental illness, and research has shown that the media heavily contribute to and support damaging stereotypes about individuals with mental illness. This study examined how current films feed into fears about mental illness, especially the stereotype that individuals with serious mental illness are violent. A population of films released from 1990--2010 containing a character with schizophrenia or a related disorder was compiled and 30 films were randomly selected for viewing from this list. The films were scored for acts of violence committed by characters with and without mental illness, and the acts of violence were coded for severity. This study found that characters with mental illness committed significantly more acts of violence than characters without mental illness did. The significance of these findings along with recurring themes found in the movies are discussed in this paper.

Careful review of the literature found prison programs having a positive impact on post-release outcomes in employment and lowered recidivism rates. Most of the literature reviewed found negative effects of mental illness on post-release success. This study expands the literature on prison programming and mental illness by examining the dynamics between mental illness, program completion, and post-release success. Furthermore, this research can be linked to Hirschi's social bond theory, which created a framework to view the relationship between prison programming and increased ties to conventional society through commitment, attachment, and involvement. This study examines the impact of mental illness and prison vocational and educational programming on reentry outcomes (employment rates, length of employment, enrollment in and completion of school, and recidivism) and the relationship between mental illness and program completion. Additionally, the study examines the interactions of mental illness and prison programming on reentry outcomes. The sample consists of male offenders released onto parole in the State of Iowa (N=3426). Vocational training had positive significant effects on employment rates and full-time employment. An additional analysis found a significant indirect relationship between vocational training and recidivism through employment. Mental illness had a negative significant impact on completion of vocational programming, GED classes, and employment outcomes. Furthermore, it was found that having a mental illness significantly increased the likelihood of recidivism. The interaction of mental illness and programming on reentry outcomes did not have a significant impact. However, the interaction of mental illness and vocational programming had a positive significant impact on full-time employment in the opposite direction of prediction. The results inform social work practice and policy on the benefits of prison programming and the negative impact of mental illness on participation in programs and reentry outcomes.

Through a post-colonial narrative turn, scholars created space for alternative illness narratives to be performed; narratives that reflected the fragmented and unpredictable ways of ailing bodies, and allowed for multiple and diverse identities to be constructed. However, even with this post-colonial turn, illness narratives in U.S. culture often depict situations in which individuals overcome their illnesses, and death is somehow avoided (Langellier & Peterson, 2004), which present potential constraints for what narratives individuals at the end-of-life (EOL) are able to tell and what identities they are able to construct. Using post-colonial narrative theory (Frank, 1995) as a framework, I engaged in a thematic narrative analysis of 16 hospice patient narratives, to understand whether narratives and identity constructions are constrained for dying individuals as they attempt to make sense of the end-of-life. Patients constructed the five identities of the experienced individual, the believer, the ailing individual, the good dier, and the individual who is still living, through several themes. Ideals of both post-colonialism and modernism were present in identity constructions, suggesting some acceptance of alternative narratives for individuals at the EOL. However, notably a new type of colonization emerged as patients' identity constructions and themes reflected elements of ars moriendi or the good death (Faust, 2008). Specifically, it appears that end-of-life narratives must reflect that the individual nearing the end-of-life is doing so in a culturally acceptable way which involves acceptance, sacrificial or selfless qualities, dying gladly, and dying not alone. This nuanced type of colonization suggests that specific illness situations might present unique narrative colonization. I end by offering practical implications for health care providers and family. Specifically, these findings might inform traditional practitioners and encourage them to broaden the clinical definition of the good death, with an understanding that elements such as esteem and emotional support or empowerment might be paramount for some patients' good deaths. Additionally, these findings offer awareness to family members regarding cultural expectations of the good death, so that they might consider whether they are adding pressure to their loved ones to achieve such a death.

Huntington disease (HD) is a degenerative neurological disease that typically onsets in midlife. It leads to progressively severe impairment in cognitive, behavioral, and motor function and premature death. Persons who test positive for the HD gene expansion know they will develop the disease. Research indicates changes are detectable several years before onset. Thus, HD has a long prodromal period (prHD). While researchers are aware of changes, little is known whether persons with prHD or their companions notice changes, or how they make sense of and cope with them. Leventhal and colleagues developed the Common Sense Model of Illness Representation (CSM) to describe how people make sense of illness. According to the CSM, people notice somatic changes, form illness representations, select coping procedures and evaluate them, and reappraise illness representations in an iterative process. The CSM has been used to explore illness representations in a variety of illnesses, including diagnosed HD. The authors of the model state it is also applicable in anticipated illness but this assertion has not been adequately tested. The purpose of this thesis was to use the CSM to explore and describe illness representations in persons with prHD and their companions. The results of this exploration are presented in three papers. The first paper, presented in Chapter 2, was a preliminary study based on interview data from 8 persons and 7 companions. Results of this analysis indicated persons with prHD and companions noticed and made attributions for changes, suggesting they formed illness representations. However, they were unsure whether some changes were related to HD. Results were considered preliminary because participants were not directly asked to make attributions. Data were also limited to changes in work function and the sample size was small. In the next two papers, 23 couples were interviewed. The purpose of the second paper, presented in Chapter 3, was to explore illness representations in persons with prHD and their companions and evaluate the usefulness of the CSM in anticipated illness using prHD as a model. Results supported preliminary findings: Participants noticed changes, made attributions, used coping strategies and evaluated them. Again, they unsure whether some changes were related to HD. Other elements of the CSM were partially supported by the data. The third paper, presented in Chapter 4, used quantitative and qualitative methods to explore coping in persons with prHD and companions. Participants were asked open-ended questions about how they coped with changes and were also verbally administered the Brief COPE scale. Both quantitative and qualitative data showed participants used active coping, acceptance, planning, and social support. Participants rarely used denial or substance abuse. Persons with prHD used more coping strategies than companions. Three major themes from the qualitative interview were identified: trying to fix it, can't fix it, and not broken yet. Qualitative interviews revealed some coping strategies that the Brief COPE did not measure. Findings from these papers may inform interventions to help people with prHD and companions cope with changes. Persons with prHD and companions might benefit from knowing what changes might be related to HD in order to cope more effectively.

Support provided by non-professional family members is generally believed to be beneficial to the recovery of critically ill patients. Nursing researchers have conducted a number of studies about the experiences of critically ill patients and the needs of their families. However, few have investigated the experiences and interactions of both this group of patients and their main informal carers (principal lay support persons) simultaneously. This study has sought to rectify this situation by capturing and undertaking a theoretical analysis of the perceptions and experiences of both critically ill patients and their principal lay support persons. As a result a substantive theory has been developed through the use of grounded theory method in the Study. This theory identifies and explains the actions and interactions between critically ill patients and their principal lay support persons who participated in the Study, whom the researcher observed and interviewed during the data collection period. Data were collected during the critically ill participant¡¦s hospitalisation and three months following his/her discharge from hospital. Implications of the study concern nursing practice as well as outcomes of the Study as these are described and explained through the substantive theory developed from it. Testing of this theory in the context of critically ill patients and their lay support persons provides opportunities for further research, as does the overall phenomenon of lay person support for critically ill patients. Grounded theory was the method used in the Study. Data for the Study were collected by participant observation of, and face-to-face interviews with patients who had a critical illness and their principal lay support persons. Two interviews were conducted with each of these participants. Patients and their principal lay support persons were initially interviewed separately to obtain information about their individual perspectives of what support meant to them during an episode of critical illness. A second interview was conducted three months later to facilitate the researcher¡¦s understanding of both patients¡¦ and principal lay support persons¡¦ experiences during the recovery process. A total of sixteen (16) interviews were conducted in this study from eleven (11) participants before data saturation occurred. The data collected were analysed by constant comparative analysis integral to the grounded theory approach. Data analysis was also facilitated by a computer-aided qualitative data analysis software NUD*IST 4 (Non-numerical Unstructured Data Indexing, Searching, and Theorizing Version 4). This software aided the analysis to the extent that it provided an efficient data management system. Three categories, 1) being-there-with, 2) independing, and 3) coping were discovered from the data. Being-there-with is an essential and mutual need between the patients and their principal lay support persons during the episode of critical illness and later recovery. Independing on the other hand is the process through which these patients experiment with regaining their independence. It involves their experiences of making decisions and re-building confidence. Coping is the process whereby the principal lay support persons and patients manage their stress during the critical illness and later recovery. During the coping process, there is an uncertainty in principal lay support persons about their loved ones¡¦ situation. They experience ¡¥coping with each day as it comes¡¦ and ¡¥learn to adjust¡¦ to the stress arising from the changing and unpredictable condition of the patients. Being-there-with is also a major coping strategy for both the principal lay support persons and patients to manage their stress. The three categories of being-there-with, independing, and coping arising from this Study provided the basis from which to identify its core category, ¡¥mutually being-there-with each other¡¦, and to theorize the core process that represents the substantive theory about experiences and interactions of principal lay support persons and their loved ones during a critical illness situation. The core process that represents the developed substantive theory is ¡¥surviving a critical illness through mutually being-there-with each other¡¦. This theory explains the complex, dynamic, and interactive nature of principal lay person support which both patients and principal lay support persons experienced during an episode of critical illness and later recovery. An understanding of this dynamic, complex and interdependent relationship between patients and lay support persons will better enable nurses to consider both these parties as the focus of their care. Furthermore, because the substantive theory emerging from this Study captures the process of patients¡¦ and lay support persons¡¦ recovery from an episode of critical illness it provides a conceptual map of how this process may progress. In this Study the theory enables nurses to gauge both patients¡¦ and lay support persons¡¦ progress along the road to recovery and to consider this in their plan of care. Several implications for nursing practice emerged from this study. These relate to the needs of critically ill patients and their principal lay support persons during the process of being critically ill and recovering which they experienced together. Because this Study identified the importance to both patients and principal lay support persons being-there-with each other, a key implication of the study is the need for intensive care units to adopt flexible visiting hours to maximise opportunities for this to occur. Nevertheless, at the same time nurses need to be vigilant that flexible visiting does not prove onerous and overtire patients or their principal lay support persons. A further implication of the Study for nursing practice closely related to its finding of the importance of the core category ¡¥mutually being-there-with each other¡¦ to patients and their lay support persons in the context of critical illness and recovery, is the need for nurses (and other health professionals) to be willing to care for both parties as an inseparable dyadic unit. This Study also has implications relating to the care of critically ill patients following their discharge home. The experience of participants in this Study revealed the importance of careful discharge planning, post-ICU follow-up, and continuity of care in the community to enhance recovery of the patients and to address the special needs of their principal lay support persons. From a researcher¡¦s perspective the process of recruitment for this study demonstrated that recruitment of vulnerable populations (like ICU patients) is a challenge to the researcher in terms of ethical considerations, particularly when the researcher is attempting to meet the expectation of primary selection for theoretical sampling in grounded theory method. Suggestions are made in this thesis about how to tackle this challenge in future studies. At the conclusion of the Study, a number of suggestions for further research are made relating to the findings. These include the recommendation that the substantive theory developed in this Study be tested with a larger population. It is also suggested that a longitudinal follow-up study, which extends beyond a three months recovery period, be conducted to further understand the experiences and support needs of post-ICU patients and their principal lay support persons. In addition, more research is required to identify best practice regarding discharge planning, post-ICU follow-up care, and continuity of care in the community for critically ill patients and their principal lay carers. / PhD Doctorate

The management of acute psychosis is a constant challenge to the health care system, with only a limited amount of research providing data for allied health care practitioners. Despite anecdotal data indicating that music therapy may be an effective intervention, there have been few studies to date which provide any rigorous empirical evidence. This project aimed to test several hypotheses. The study has shown that music therapy is a valuable therapeutic adjunct to standard ward programs for the management of an acute psychotic episode resulting in shorter hospital stays, considerable cost savings and significant improvement in symptomatology as judged by the standardized measures employed. In addition, EFG testing while listening to self-chosen music demonstrated a reduction in dysfunctional brain wave activity. This project has highlighted the importance of music therapy in allied mental health care and opens up the need for further research into the management of such a large disease burden in Australia. / Doctor of Philosophy (PhD)