The dissertation discusses the provision and organization of mental health services through the operation of Community Mental Health Centres outside the Greater Vancouver area in the Province of B.C.. A derived organizational structure of a CMHC is presented permitting a generalizable discussion of inter- and intra-organizational features and their relationship to administration peculiar to this organization. A number of propositions are generated regarding CMHC organizational structure and process; these propositions are based on the dimensions identified in the areas of organizational technology, environment and goals. The propositions are applied to a model of management permitting an examination of general areas of management concern. Methods of optimizing these areas are discussed operationally with the intent of facilitating organizational effectiveness in a CMHC. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The chronically mentally disabled need to be defined as a special needs group in order to receive the social and health services they require for community survival. Their needs can be identified by reviewing the relationships between chronic mental disability and schizophrenia, poor social margin, long term use of treatment facilities, and poor social and vocational functioning. Before the 1950's, services to the chronic patient were provided mainly within the asylum system. Although some innovations in psychiatric services were developed earlier, these were directed to patient groups other than the chronically mentally disabled. This tradition of attention to other patient groups has influenced the community mental health movement of the last 25 years. This movement was expected to provide for the needs of the chronically disabled in the community as the mental hospitals were reduced in population. Recognizing that community centered care of the former asylum populations is a technically feasible goal, the National Institute of Mental Health (N.I.M.H.) has proposed a model community system of services for this patient group. This model addresses their special needs, but its application requires a concerted and coordinated effort by several separate agencies. Recent changes in Canadian health care financing allows a realistic look at the American model. This paper uses Vancouver Island, British Columbia, as a planning area for services to the chronically mentally disabled. The population of the area is 441,000. The mental health services available to these patients are reviewed in order to determine the extent of this availability. Criticisms of community services in other jurisdictions were found to be relevant in the planning region. Recommendations are made based on the model service system developed by N.I.M.H. A comparison of the costs of the existing services to chronic patients and the ideal system shows that the required improvements could be made with little extra cost. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

This research was undertaken to determine whether the growth of computer-supported information systems in community mental health centers can be characterized by distinct stages of development. Data collection and analysis were designed to answer the following two questions: (1) Can distinct stages of information system growth be characterized by common profiles of computer-supported applications? (2) Are there characteristic groups of enabling factors (i.e., organization of data processing activities, management planning and control techniques, and user involvement) consistent among community mental health centers at any given stage of growth? This study draws upon earlier work by Nolan who identified distinct stages which characterize the pattern of information system growth in business organizations. A model reflecting the unique characteristics of community mental health centers was formulated to describe the aspects of information system growth addressed by this study. The components of the model were used to develop three scenarios describing the hypothesized characteristics of mental health information systems at three different stages of growth. Data for this study were obtained through a two-phase survey. The preliminary survey identified which community mental health centers are using computer-supported applications. The second survey collected detailed data about each model component using a stratified random sample of centers using computer-supported information systems. Responses to the preliminary survey showed that seventy-nine percent of the centers are using computer-supported information systems. In addition, the majority of centers with manual systems have plans to automate within one year. By contrast, a 1974 survey reported that only one-fourth of the centers were using computerized information systems. The number of centers using computers has therefore increased dramatically during the last five years. The analysis of computer-supported applications showed that a refinement of the hypothesized applications profile for each stage would be more representative of the state of the art of computerized applications in community mental health centers. The original model depicting three stages of applications development was extended to four stages. The predominant types of applications being developed are those supporting administrative and clinical recordkeeping functions. These findings indicate that the development of computer-supported applications in centers parallels applications development in other mental health programs. The analysis of characteristics of enabling factors revealed distinct differences among centers in each stage of development. The study results clearly showed that centers which are developing the most comprehensive sets of computerized applications are implementing formal planning and control techniques and user involvement strategies. These centers also reported the most favorable staff attitudes toward the usefulness of the information system and the most interest in developing new applications. While distinct characteristics of data processing organization variables were identified, these characteristics did not reflect a progression toward increased formalization of the data processing function.

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2004. / Vita. Includes bibliographical references (leaves 55-68).

Typescript (photocopy). / Digitized by Kansas State University Libraries

published_or_final_version / Social Work / Master / Master of Social Work

Research in community management of the severely mentally ill has been scarce. Two primary components of community care in particular need evaluation, residential arrangements and styles of "case management." The purpose of this study was to evaluate the interaction of two types of residential arrangements (single- and double-occupancy) and two types of case management ("assertive" and "limited") in a 2 X 2 design. Participants were individuals with a severe mental illness served by CMHS, Inc. Individuals were matched on DSM-III-R diagnoses and sex: 8 had roommates and received assertive case management, 5 had roommates and limited case management, 5 lived alone and received assertive case management, and 5 lived alone with limited case management. Data were obtained from three independent sources: (1) each client was interviewed using the Denver Community Mental Health Questionnaire (DCMHQ) and the Inventory of Socially Supportive Behaviors (ISSB) on four separate occasions over three consecutive months; (2) frequency of client contact with family members over the same time interval was tracked by case managers; and (3) concurrent attendance in day treatment sessions, diagnosis, number of previous hospitalizations, and approximate number of months of previous hospitalization were obtained from community mental health center records. DCMHQ scores for acute symptoms and interpersonal conflict were combined into an index called problems, while ISSB scores measured social support received. Monthly follow-ups for three consecutive months were used to obtain stable estimates of problems and support. Significant positive correlations were found between family involvement and problems, family involvement and residential arrangements, social support and problems, group attendance percentage and age, problems and social support, and a marginal relationship between residence and social support. Statistically significant negative correlations were found between case management and problems, social support and number of previous hospitalizations, group attendance percentage and problems, and residence and age. In multiple regression involving all predictors, the variables other than roommating and case management, (i.e., average family involvement, number of previous hospitalizations, program attendance, and age, considered together) predicted both problems reported and support received, while as second and third steps in the regression analysis case management and residence did not significantly predict problems or social support. In other words, once chronicity (i.e., number of previous hospitalizations), family contact, age, and group attendance were controlled, case management and residence both vanished as predictors. Future studies should consider these factors, and other aspects of the natural context, when evaluating community interventions for the mentally ill in a more controlled experimental design. With respect to developing new research for community adjustment, recommendations for more controlled studies were made and two new community intervention procedures were described. / Department of Psychological Science

No description available.

This thesis is based on a research project that explored the deinstitutionalisation and eventual closure of a large residential facility for people with an intellectual disability. The thesis is focused on family experiences of deinstitutionalisation in order to understand how families interacted with this major process of social change, and pays specific attention to the role of adult siblings within this context. Unstructured interviews were held with thirty-five families who had family members with an intellectual disability who were being resettled from an institution to alternative disability support services. Families were interviewed at three specific phases during the deinstitutionalisation process: prior to the resettlement of their family member; 1-3 months following resettlement; and one year after resettlement. In keeping with the constructivist paradigm that underpinned this qualitative study, repeated contact with families enabled me to develop some insights into how families made decisions relevant to their family members� transitions from the institutional environment. The study findings highlight the complexity and heterogeneity of families. While families who participated in this study were found to have shared a similar journey toward institutionalisation, their responses and reactions to deinstitutionalisation and the decision-making associated with such a process were more diverse. My analysis presents the notion that taking a constructivist approach to theorising can facilitate an understanding of how families are influenced in their decision-making with regards to the resettlement of a family member with an intellectual disability. That is, we may be able to gain greater understanding of families� perceptions of their family members who have an intellectual disability and, subsequently, the decisions that families make regarding the care of that person by exploring the meanings they assign to their world. Ascertaining how families come to construct their understandings of disability is, in my view, critical to responding appropriately to families� needs within the context of disability support and service provision.

Thesis (Ph. D.)--Open University.