Neurological rehabilitation aims to reduce the restrictions on an individual's participation in society. Psychometrically rigorous and clinically relevant outcome measures, used appropriately, enhance the evidence base of rehabilitation. This Thesis assesses routinely used outcome measures at three time points: inpatient, outpatient, and longer-term follow-up. First, a retrospective analysis of the inpatient database of the Neurorehabilitation Unit was carried out to assess the Barthel index (BI) and Functional Independence Measure (FIM). Second, a prospective study examined the impact of rehabilitation on physical function and emotional wellbeing. Five measures were completed on admission, discharge and three months post-discharge: the BI (clinician and patient scored versions), FIM, General Health Questionnaire and Hospital Anxiety and Depression Scale. Finally, the effect of multiple sclerosis (MS) on work retention was assessed in a cross- sectional study using a newly developed outcome measure, the Impact on Work Questionnaire. In the first study, the responsiveness of the Bl and FIM total scores ranged from moderate to large. But item level analyses indicated differential item performance, with effect sizes varying from very low to large, associated with large floor and ceiling effects. The second study demonstrated the significant improvements in physical and psychological functioning in patients undergoing rehabilitation. Physical gains persisted after discharge, however, emotional wellbeing deteriorated. The last study revealed that a combination of MS-related problems, environmental restrictions and poor vocational support impact on work retention in people with MS. Following patients through the rehabilitation process, in the form of three distinct studies, has afforded a unique view of the effect of rehabilitation in neurological conditions. Furthermore, the examination of routinely used measures has provided guidance on the application of these in future research. Choosing the most appropriate measures and analytical techniques provides richer data, facilitates accurate evaluation of rehabilitation interventions, and ultimately improves patient care.

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"Crisis Resolution" teams are a growing element of community mental health services in the England. The Department of Health intended to have 335 services established by the end of 2004 and had in fact achieved a total of 343 by mid 2005. This study focuses on two such crisis teams operating in the north east of England and aims to describe important features of their routine work. Using a fusion of observation and discourse analysis (the latter based on audio recordings made during team meetings and interviews with team members), areas such as multidisciplinary team working, expertise, user involvement and the understanding of mental health crisis itself are subjected to scrutiny, discussion and analysis. The study was funded as an ESRC CASE studentship. A variety of professional expertise comes into play in the formation of any multidisciplinary community mental health team. How these disciplines interact when delivering crisis resolution is a key focus of the study in hand. Both teams are made up of the same professional disciplines; medicine, nursing, and social work. In addition, support workers are present in both teams. This research examines the interaction of these disciplines and roles, the possibility and actuality of conflict between them and the various ways in which individuals work together to create a team. While Department of Health guidelines deliver a referral criteria with a definition of the constituents of a mental health crisis, this definition is general and cannot describe the numerous interpersonal processes involved in accepting a referral. Hence, the nature of mental health crisis itself is debatable. The study examines a variety of ways in which "crisis" is constructed and understood. Also, the practice of crisis resolution does not simply involve the work of mental health professionals; it also involves the input of the mental health service users themselves. "User involvement" is a phrase that commonly appears in contemporary Health Service literature. This study seeks to describe what this phrase actually means in the day to day delivery of the service.

This study is about the exploration of the concept of community, using the Mamelodi Counselling Clinic as the context for the exploration. The members who got involved in different phases in the running of the clinic, went through the process of defining and redefining the concept. This process was based on their experiences and their coevolved reality of what the concept means. These experiences will be discussed and in the end, a punctuated end product of the coevolved meanings will given. Furthermore, an account will be given as to how the running of the clinic evolved with the changes in meaning. The author's perception of the division between clinical and community psychology was altered as a result of the findings in the study and this will also be discussed. / Psychology / M.A. (Clinical Psychology)

A partir de sa clinique au sein d'une unité d'accueil familial thérapeutique pour adultes psychotiques, l'auteure revient à la clinique et à la théorie des psychoses dissociatives non pas à partir d'une théorie des maladies mentales et d'une psychopathologie générale (comme peuvent l'être la psychanalyse, la phénoménologie ou l'organodynamisme) mais à partir du « travailler » et du « travail vivant » de ceux qui prennent soin de ces malades. Si on part de l'analyse pratique du soin (Accueil Familial Thérapeutique) avec les psychotiques et jusqu'à leur caractérisation clinique, on en arrive à une conception renouvelée de la psychose dissociative.Ces hypothèses théoriques permettent alors à l'auteure de proposer une nouvelle anthropologie de la famille et du maternel, à partir des apports théoriques de la psychodynamique du travail. / From her clinical experience in a therapeutic foster care unit for psychotic adults, the author returns to the clinic and the theory of dissociative psychosis, not from the perspective of the theory of mental illness and general psychopathology (as in psychoanalysis, phenomenology or organo-dynamism), but rather from the "work" and "living work" of those who care for these patients.If one starts from the practical analysis of treatment (Therapeutic Foster Care) with psychotic patients and their clinical characterization, one arrives at a renewed understanding of dissociative psychosis.These theoretical assumptions then allow the author to propose a new anthropology of the family and mother, rooted in theoretical contributions from the psychodynamics of work.

This thesis examines ways in which social policy supported by successive Conservative and Labour Governments has affected the British User/Survivor Movement (BUSM) since the introduction of the 1990 NHS and Community Care Act. It focuses on the formalising effects of community care policy, and the discursive resistance tactics of user/survivor activists in opposition to formalisation of their movement. The aims of the thesis are: firstly, exploration of the contradictory potential of community care policy where there is a formal relationship between local and/or health authorities with mental health services user/survivor-led groups; secondly, tracking New Labour’s policy agenda and the responses of user/survivors; finally, an attempt to develop a user/survivor theoretical standpoint towards community care policy. To achieve these aims the following were undertaken: a literature review which informed the development of a theoretical standpoint; interviews with user/survivor pioneers of the movement; and interviews with discussion groups of user/survivors who were active at local, regional, and/or national level. Analysis of respondents’ statements was completed using a theoretical standpoint based on Feminist/Foucauldian methodology. The chosen methodology resulted in an amended theoretical standpoint to take account of the use of reason by user/survivors and the creation of taxonomies which describe ways in which user/survivors discursively resist formalisation. These results formed the basis for the main conclusions which are as follows: first, user/survivors who engage in ‘consumerist’/empowerment activities, such as advocacy or involvement, can rightly claim to be challenging existing power relations; second, user/survivors entering into formal relationships with health/social services authorities do not necessarily reproduce discriminatory forms of care; third, although the culture of the BUSM has changed since the late 1980s, user/survivor activists are still trying to keep informal/empathic values alive; fourth, a danger exists that user/survivors will be pushed out of providing services and relegated to being the objects of consultation; and finally, there is a need to challenge the reason/unreason dichotomy enabling New Labour to characterise user/survivors as ‘dangerous’. The distinctive focus of this thesis on theoretical standpoint and discursive knowledge provides the basis for its contribution to theoretical and social policy debates in the field of mental health.