No description available.

No description available.

No description available.

Western researchers conducting studies with Somali refugee participants have identified Somali-specific idioms of psychological distress as well as high rates of Western psychological disorders such as depression and post-traumatic stress disorder (PTSD) in this refugee group. Methodological limitations of these previous studies, however, have limited the validity of the conclusions drawn. These limitations include the use of Western psychometric instruments and diagnostic nosologies, limited information about the methodological procedures undertaken, the apparently unqualified use of terms such as mental illness, madness and craziness in interview schedules, minimal exploration of psychosomatic idioms of distress, and limited applicability of some of the research findings to Somali women.. The current research primarily aimed to address these methodological short-comings and build on the findings of previous studies that have explored Somali conceptions of distress. Two additional objectives were to (i) identify protective and resilience factors which may decrease vulnerability to experiencing psychological distress in Somali women, (ii) gauge non-Somali health professionals' understanding of (a) the nature of distress and suffering experienced by Somali women, and (b) effective treatment modalities to ameliorate this distress. The analytical style employed in all three studies of this thesis was thematic. In the first study, ten Hamilton (New Zealand) based Somali women were interviewed. Particular areas of interest explored in the first study included psychological, physical and spiritual conceptions of distress, the symptoms of key idioms of distress, and the way in which these are managed/treated at the individual, community, and family levels. The findings of Study 1 identified spirit (jinn) possession as a form of distress known by at least some members of the local Somali community. Jinn appeared to be an explanation for both milder forms of distress akin to depression and anxiety, as well as more severe forms of distress similar to psychosis. Treatment for jinn possession tended to focus on Koran readings in conjunction with family and community-based support. Generally participants considered there was a very limited role for mental health professionals and Western psychiatric medication in the extraction of jinn. Faith was considered a key protective factor against experiencing non-spiritual forms of distress such as stress, worry, anxiety and depression. Although war trauma was acknowledged to have an adverse impact on the psychological functioning of Somali women it was not considered to impact on a woman's ability to manage her day-to-day responsibilities. The impact of having family in refugee camps in Africa was, however, identified as a common and very distressing issue impacting on many Somali women. The only way of alleviating the distress associated with this stressor, according to participants, was reunification. Interviewees stated that Western interventions for distress were rarely pursued by Somali as they were not considered efficacious. Given there is evidence that Somali communities residing in various cities in New Zealand are at various stages of acculturation, it was considered important to ascertain how valid the results from Study 1 were considered to be by women from other Somali communities. Six focus groups were conducted with a total of 27 Somali women recruited from three New Zealand cities. The findings of Study 2 identified numerous culturally specific forms of distress reported by participants. These states were qalbijab, boofis, murug, welwel and jinn. These Somali idioms of distress were akin to some Western psychological disorders, particularly the depression and anxiety spectrums. Treatment for Somali forms of suffering were reported to focus on Koran readings, in addition to family and community support. Generally, participants in Study 2 considered there was a very limited role for general practitioners (GPs) and mental health professionals in assisting Somali to deal with psychological and spiritual distress. Consistent with the findings of Study 1, faith was considered the most important protective factor, family separation was described as one of the most significant stressors, and war related trauma was suggested to cause significant distress only if the sufferer had family still in Africa. Study 3 explored non-Somali health practitioners' understanding of Somali idioms of distress, as well as their perspectives about how to best treat Somali presenting with psychological distress. A total of 18 mainstream mental health practitioners, general health practitioners (both GPs and primary care nurses), and specialist refugee mental health practitioners took part in this research. Few practitioners mentioned spirit possession as an aetiology for distress and none mentioned other Somali-specific forms of distress. The psychosocial stressors identified as contributing to the psychological distress of Somali women were relatively consistent across the three groups of practitioners and also consistent with the stressors identified by participants in Studies 1 and 2 (e.g., family separation, social isolation, financial concerns). Interviewees did not consider PTSD to be a common psychological disorder amongst Somali women living in New Zealand. Advocacy work and assistance with day-to-day concerns were suggested by many participants as more efficacious for the amelioration of psychosocial stressors than medication-based treatment. Generally, participants in Study 3 were supportive of traditional forms of healing being used as the treatment of choice by Somali clients. The findings of the current thesis suggest that there are clear parallels between Somali idioms of distress and those of Western cultures. However, the data indicate that equating Somali idioms with Western diagnostic labels would be rejected by Somali. Regardless of the similarity of symptom profile of some of the Somali states to Western states, the manner in which these states are conceptualised, understood and treated is markedly different. The findings of all three studies suggested that Somali tend to opt for their own traditional interventions to treat psychological and spiritual forms of distress rather than engage with Western mental health services. Numerous barriers including long waiting lists, mental health practitioners' apparent lack of knowledge/expertise working cross-culturally and poor treatment outcomes were provided for Somali not engaging with such services. The stigma attached to having a mental illness was also considered a barrier to engaging with mental health services. With respect to improving service provision for non-Western clients, an intermediate service that sits between primary and secondary health care agencies is recommended as an effective means of meeting the needs of non-Western clients experiencing psychosocial stressors and mild to moderate psychological distress. It is imperative, however, that any such service involves key stakeholders from the community groups it would serve, in the design, development, and implementation of interventions.

Although numerous studies have documented the consequences of victimization on psychological distress, few have directly examined potential moderators of this association. Using data from the Welfare, Children, and Families project (1999-2001), a probability sample of 2,402 low-income women with children living in low-income neighborhoods in Boston, Chicago, and San Antonio, I predict psychological distress with measures of physical assault and sexual coercion before age 18 and psychological aggression, sexual coercion, and minor and severe physical assault in the past year. I also test the moderating influence of alcohol consumption. Cross-sectional results suggest that the effects of sexual coercion before age 18 and severe physical assault in the past year are moderated or exacerbated by alcohol consumption. Longitudinal results indicate that alcohol consumption exacerbates the effects of psychological aggression and minor physical assault in the past year on changes in psychological distress over time.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2004. / Includes bibliographical references.

Thesis (M.S.)--Colorado State University, 1985. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [37]-39).

Thesis (M.A.)--Central Connecticut State University, 2000. / Thesis advisor: Charles Mate-Kole. " ... in partial fulfillment of the requirements for the degree of Master of Arts [in Psychology]." Includes bibliographical references (leaves 41-45).

<p> The dynamic mental health landscape has placed undue strain on hospitals, providers, and the community at large, resulting in gross inequities in access to care for underserved populations. This business plan proposes the establishment of a Los Angeles area non-profit community mental health clinic, embedded with a mission to accept adult patients suffering from co-occurring mental health and chronic medical conditions, regardless of insurance status and ability to pay. Under the Patient Centered Medical Home model, the aim of the Clinic will be to treat patients holistically by incorporating an interdisciplinary team of clinicians to ensure optimal health outcomes. While this plan acknowledges the challenges in serving indigent populations, the Clinic will contract with Medi-Cal and commit to continuous fundraising efforts to remain financially sustainable in order to improve the health of vulnerable Angelenos.</p>

The thesis grew out of the recognition that there is a dearth of information on the users of mental health services. It set out to describe the characteristics of users across a range of health settings and to consider the role of such characteristics in the mental health referral process. The early phases of this research project were strongly influenced by a model of the referral process developed by Goldberg & Huxley (1980). They conceptualized users of health care existing on 5 levels ranging from people living in the community to users in hospital. Hypothetical filters are said to operate between each level to govern who is referred on to the next level of services. This research project borrowed the notion of filters and their arrangement of services in a referral sequence. However, the focus of this research is on the characteristics of users, and not the detail of the filters per se. What is described is the effect of the referral process not the mechanism. This thesis also moves substantially beyond the five settings in the Goldberg & Huxley model to produce a uniquely comprehensive analysis of the users of all the main mental health care providers in one health district. The research project uses a wholly quantitative methodology. The challenge has been to design a range of compatible survey forms to collect data in seven separate study settings, to collate information on over one thousand one hundred users, to describe the user profiles in each study and to develop a comparative analysis of users across a range of settings. The emphasis throughout has been to align the research with contemporary developments in health care policy, and as the project has progressed, to make a practical contribution to the important debate about information systems in mental health service planning. The thesis has been divided into four parts. Part I introduces and sets the context of the research, and describes the methodology. In seven chapters, Part II of the thesis reports the .findings of each of the seven study settings. Part III of the thesis reports the demographic and utilization characteristics comparatively across all the study settings. The conclusions of the thesis are reported in Part IV of the thesis, where the theoretical, research and policy implications are discussed.The research project makes a contribution to knowledge on 4levels. Firstly, it identifies and describes the characteristics and the typical profiles of mental health service users in a range of study settings, in one area. Secondly, it identifies the differences between users in each study setting. Thirdly, it identifies the overlap in use of one service and another. It is argued that the findings have profound implications for both developing a clearer picture of the referral processes and for highlighting for planners, producers, and providers possible complementary or inefficient service utilization patterns. On the fourth and macro level, this research project has developed a revised model of mental health service referral routes. This model provides a framework for further investigation, and has potential as a planning tool in and beyond the geographical boundaries of the current study area.