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This M.A. thesis argues that the closure of the Templeton Centre was caused by the convergence of political, social and economic trends in psychopaedic care, occurring in other Western countries. The research paper commences with an historical exploration of the emergence of state institutions. It continues with an investigation of the role scandals played in creating the demand for the closure of psychopaedic institutions. The disability rights movements' discourse of 'normalisation', is shown as the social ideological force in the closure of state institutions, while neo-liberal ideology is seen to exploit deinstitutionalisation for economic gains. The research concludes with an assessment of parental and public reactions to the community placement of people with intellectual disabilities and an analysis of the positive outcomes and negative consequences of deinstitutionalisation. While current research on the closure of the Templeton Centre has explored the effect of deinstitutionalisation on the intellectually disabled and their respective families, the contribution of this research to the subject is its exploration of the sociological causes and effects of the deinstitutionalisation of the Templeton Centre The research methodology involved the collection, collation and interpretation of primary and secondary documents to construct a sociological account of the deinstitutionalistion of the Templeton Centre. The primary sources include health and social welfare documents, newsletters and letters and the secondary sources comprises books, journals and newspaper articles. The principal argument is that the Western political, social and economic ideologies which converged at differing times to create, shape and eventually close psychopaedic institutions, also affected the Templeton Centre (1929 to 1999) in New Zealand. The research paper's conclusion is that Western political, social and economic trends will continue to shape New Zealand Governments' policies on people with intellectual disabilities. Therefore, disability research specialists must continue to study changes on the international stage, to enable them to predict the probable discourses, issues and events which will inevitably occur in New Zealand.

The professional component of this thesis focuses on how deinstitutionalisation and the current public mental health system have affected individuals with schizophrenia. Chapter one discusses the process of deinstitutionalisation and the research that has examined the impact of this initiative. Chapter two concentrates on schizophrenia, specifically the symptoms, course, etiological theories and treatments of this illness. Four case studies are then provided in order to explore how deinstitutionalisation and the current mental health system have affected individuals with schizophrenia. The names and identifying characteristics of these clients and their families have been modified to ensure anonymity. Chapter three describes a 47 year old woman, AA, who was referred for a neuro-psychological assessment. Chapter four outlines the second case study, a 23 year old male, BB, who was referred for a psychological assessment regarding diagnosis and treatment recommendations. Chapter five describes the third case study, a 54 year old woman, CC, who was referred for therapy and consultation regarding future treatment recommendations. Chapter six discusses the fourth case study, a 21 year old male, DD, who was seen for crisis intervention and treated in the community. Each of these case studies outlines the background history, formulation and treatment approaches. These case reports are used to illustrate how deinstitutionalisation and the present public mental health system affect individuals with schizophrenia. Chapter seven provides an overall discussion and conclusion to these case studies.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-01-13T14:02:38Z No. of bitstreams: 1 grazielalonardonidepaula.pdf: 745742 bytes, checksum: 3785901b1acb2809dd1bd37eb949ed8c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-02T12:05:38Z (GMT) No. of bitstreams: 1 grazielalonardonidepaula.pdf: 745742 bytes, checksum: 3785901b1acb2809dd1bd37eb949ed8c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-02T12:06:12Z (GMT) No. of bitstreams: 1 grazielalonardonidepaula.pdf: 745742 bytes, checksum: 3785901b1acb2809dd1bd37eb949ed8c (MD5) / Made available in DSpace on 2017-02-02T12:06:12Z (GMT). No. of bitstreams: 1 grazielalonardonidepaula.pdf: 745742 bytes, checksum: 3785901b1acb2809dd1bd37eb949ed8c (MD5) Previous issue date: 2016-08-08 / A Reforma Psiquiátrica, no Brasil, efetivou-se com o objetivo de substituir o modelo hospitalocêntrico por sistemas extra-hospitalares e viabilizou-se com a criação do número adequado de aparatos e serviços substitutivos de assistência aos portadores de transtornos mentais. O processo de desinstitucionalização dos portadores de transtornos mentais asilados é uma realidade brasileira e um evento histórico a ser tratado com distinção. Neste sentido, é válido que se pense sobre o desdobramento e a efetivação deste processo, já que a maioria da sociedade não está apta e preparada para aceitar o convívio com o “diferente”, com o portador de transtorno mental, descaracterizado pelo modelo manicomial que se apoderou de sua autonomia, quesito imprescindível para atos da vida em sociedade. A inserção social se constitui em um caminho a ser perseguido a partir do movimento da Reforma Psiquiátrica e, em consonância a isto, considera-se relevante a percepção da família acerca desse processo, em especial, quando coabita com o portador de transtorno mental. Nessa pesquisa objetivo é compreender como os familiares de portadores de transtornos mentais percebem a inserção social destes a partir do processo de desinstitucionalização, é indispensável considerar e discorrer acerca de determinados elementos que precederam tal processo e foram responsáveis pelo afastamento do ‘louco’ do convívio social. Para contemplar o objetivo proposto e seus desdobramentos, propõe-se a abordagem qualitativa com o intento de aproximar-se, ao máximo, do objeto pesquisado. A coleta de dados foi realizada nos meses de janeiro e fevereiro do corrente ano, por meio de entrevistas individuais semiestruturadas. O encerramento da coleta de depoimentos ocorreu no momento em que houve a saturação dos dados necessários para a pesquisa. O critério de saturação foi determinado a partir dos significados similares expressos nos depoimentos, o que determinou a interrupção da coleta dos mesmos e o início do processo analítico que gerou três unidades de significados, a saber, O dia-a-dia em 11 cena: o ente portador de transtorno mental; O dia-a-dia em cena: o tratamento; O dia-a-dia em cena: motivações para o cuidado familiar. A análise do significado da percepção dos familiares dos portadores de transtornos mentais, acerca da relação cotidiana com os mesmos, foi intermediada pela Sociologia Compreensiva do Cotidiano de Michel Maffesoli. Esta pesquisa vem ao encontro da necessidade de buscar evidências que melhor elucidem a percepção das famílias de portadores de transtornos mentais acerca da inserção social deste a partir da ‘com-partilha’ de experiências da vida cotidiana. Esta compreensão contribui para revelar potencialidades de reinserção social, mediadas pela lógica do cuidado integral, que necessitam ser consideradas pelo enfermeiro, demais profissionais de saúde e gestores ao demandar assistência à saúde não apenas aos portadores de transtornos mentais, mas também a seus familiares. / The psychiatric reform, in Brazil, was accomplished with the purpose of replacing the hospitalocêntrico model for out-patient treatment systems and assisted with the creation of the appropriate number of devices and services supplying temporary replacements of assistance to people with mental disorders. The process of deinstitutionalization of people with mental disorders asylum seekers is a brazilian reality and a historic event being treated with distinction. In this sense, is valid if you think about the deployment and the effectiveness of this process, since the majority of society is not qualified and prepared to accept living with the "different", with the carrier of mental disorder, mischaracterized by the asylum model who took their autonomy, essential item for acts of life in society. Social inclusion is a path to be pursued from the psychiatric reform movement and, in accordance to this, it is considered relevant to perception of the family about this process, in particular when it with the carrier of mental disorder. On the exposed, this research aims to understand how the families of people with mental disorders understand the social inclusion of these from the de-institutionalisation process, it is essential to consider and discuss about certain elements that preceded this process and were responsible for the removal of the ' crazy ' of social conviviality. This research is part of the research line "Theoretical, political and cultural Foundations of health and Nursing Care" program of post-graduation stricto sensu of the Nursing School at the Federal University of Juiz de Fora, a master's degree in nursing. To contemplate the purpose proposed and their offshoots, the qualitative approach with the intention of approaching the most, of the object searched. The data were collected in January and February of this year, individual semi-structured interviews. The closure of the statements collection occurred at a time when there was a saturation of data needed for the research. The saturation was determined from similar meanings expressed in the statements, which determined the interruption of the collection of the same and the beginning of the analytical process that generated four cores of signification, 13 namely, the day-by-day on the scene: the bearer of mental disorder; The day-by-day: treatment; The day-by-day on the scene: motivations for family care. The analysis of the meaning of perception of the relatives of people with mental disorders, about the daily relationship with them, was represented by the Comprehensive Sociology of everyday life of Michel Maffesoli. This research comes to meet the need to seek evidence to better elucidate the perception of families of people with mental disorders on the social integration of this from the with-share ' experiences of everyday life. This understanding helps to reveal the potential of social reintegration, mediated by the logic of full care, that need to be considered by the nurse, other health professionals and managers to demand health care not only to people with mental disorders, but also to their families.

This thesis deals with issues concerning adults and seniors with mental disability living in institutions providing social services. Special care is dedicated to those who relocated into the institutions in their adult life, often after their parents' death. Qualitative research was chosen to provide the obtained information with proper depth. The results of this research come from the analysis of interviews provided by users of social services and professionals working with people with mental disability. The aim of this thesis is to describe behavioural problems associated with users who came into the institutions later in their life, and offer them specific recommendations that would make their transition easier. Key words Mental disability, ageing, social services, deinstitutionalisation

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-07-05T19:54:03Z No. of bitstreams: 1 KarennBorges.pdf: 702612 bytes, checksum: 41a46f828aba12caca8d1b3a03c9d3a1 (MD5) / Made available in DSpace on 2017-07-05T19:54:03Z (GMT). No. of bitstreams: 1 KarennBorges.pdf: 702612 bytes, checksum: 41a46f828aba12caca8d1b3a03c9d3a1 (MD5) Previous issue date: 2016-11-08 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / In the field of mental health care has been reoriented towards the hospital - centred model to the extra-hospital care model from the Psychiatric Reform, Psychosocial Rehabilitation Movement and the deinstitutionalization of the mentally ill. In this context, the CAPS assumed the role of service substitutive Authorising care network in mental health. However, in many of these units, this role has not yet been incorporated. Faced with the need to better understand the dynamics of work that leads to mental health care, originated this research. The objectives of this study were to understand the dynamics of mental health care; understand the links with the network of attention to the construction of mental health care and meet the design of care in mental health professionals interviewed. The methodological approach was descriptive and analytical qualitative research conducted with professionals working in mental health in three CAPS-I and a CAPS-II Health Region Pedreiras - MA. Data collection involved semi - structured interviews and focus groups. There was lack of resources, inadequate professional assistance associated with the work process fragmentation and not joint Network and difficult access to services. Conclusion: There was an outpatient, fragmented care emphasis, formed by multidisciplinary teams with little multidisciplinary, and a service that does not articulate the Care Network Health There is great personal investment of most professionals, however, little understanding of the purpose CAPS and how this fits into the network. / No campo da saúde mental, o cuidado tem sido reorientado no sentido do modelo hospitalocêntrico ao modelo de atenção extra-hospitalar a partir da Reforma Psiquiátrica, Movimento de Reabilitação Psicossocial e a desinstitucionalização do doente mental. Nesse contexto, os CAPS assumiram o papel de serviço substitutivo ordenadores da rede de cuidado em saúde mental. Os objetivos desta pesquisa foram compreender a dinâmica do cuidado em saúde mental; compreender as articulações com a rede de atenção para a construção do cuidado em saúde mental e conhecer a concepção do cuidado em saúde mental dos profissionais entrevistados. O recurso metodológico foi a pesquisa descritiva e analítica com abordagem qualitativa realizada com profissionais trabalhadores em saúde mental em três CAPS-I e um CAPS-II da Região de Saúde Pedreiras/MA. A coleta de dados foi por meio de questionário estruturado e grupo focal. Foi realizada Análise de Conteúdo na modalidade Análise Temática. Resultados: observou-se escassez de recursos, inadequação da assistência profissional, associada à fragmentação do processo de trabalho, a não articulação em Rede e dificuldade de acesso aos serviços. Conclusão: Observou-se uma ênfase assistencial ambulatorial, fragmentada, formada por equipes multiprofissionais com pouca multidisciplinaridade, e um serviço que não se articula à Rede de Atenção à Saúde. Há grande investimento pessoal da maioria dos profissionais, entretanto, pouca compreensão sobre a finalidade do CAPS e como este se insere na Rede. Sugerimos reorganização do processo de trabalho e mais inclusão do usuário em todo o processo.

This research examined intersectoral relationships and community participation in policy processes across the mental health and housing sectors. The focus was on the development of suitable housing options for people with a psychiatric disability. The study period covered five years of mental health system reform in South Australia (2000-2005). The research found a shortage of housing and support options for people with psychiatric disability and lack of significant strategic policy coordination or ongoing cross-sectoral programmes. The problems faced by people in gaining access to housing and disability support services and the ways in which families provide housing or support in the absence of public services are documented. This case study used qualitative research methods which were triangulated across four stages: 1) a thematic analysis of national and state policies in the health, housing and disability sectors; 2) participant observation of NGO activity, a thematic analysis of NGO documents, and interviews and focus groups with NGOs; 3) interviews and focus groups with consumer and carer representatives and a thematic analysis of the minutes from state-level groups; 4) interviews with professionals from the health, housing and disability sectors The housing situation for people with psychiatric disability was explained in terms of a number of key issues in the policy environment; „X The overarching neo-liberal policy context synonymous with a decline in public housing resources and increasing tension between NGOs service provider and advocacy roles. „X The political nature of the local mental health policy context and lack of political commitment to ongoing resources. Broad community stigma reflected in the media and government, affecting ongoing political commitment to mental health and housing and the introduction and progress of housing ¡¥projects¡¦. „X The slow development of peak NGO and consumer organisations and alliances in South Australia which affected access to policy networks and contributed to the dominance of professional interests within policy processes. „X The separation of health, housing and disability policy and networks within and across levels of government. This was associated with bilateral agreements (between Australian and state governments) tied to resources within departments, the programme objectives and the goals of bureaucrats. „X The separation of policy networks by sector was also connected to the dominance of bio-medical discourses and interventions and associated professional interests in the health policy sector. Medical discourses on health and disability and ¡¥consumerist¡¦ discourses on participation also led to social determinants of health such as housing being overlooked within policy processes. „X Governance reform at a state level contributed to organisational instability within departments, causing some problems for cross-sectoral initiatives and protocols. Kingdon¡¦s (2003) multiple streams analysis of policy helped to explain what missed or reached political agendas within each policy sector of the case study. Kingdon predicts that the unity of policy networks is important for the realization of policy solutions, and the lack of unity in policy sectors was an obstacle to policy agendas on housing for people with a psychiatric disability. However, the way in which problems were being represented (Bacchi 1999) was also important to understanding this policy environment. For example, a medical discourse on disability (Fulcher 1989) tied to the health sector led to a narrow focus on clinical mental health services. Similarly, neo-liberal discourse (Dean 1999) supported private housing solutions and resources or NGOs advocating ¡¥within sectors¡¦ for the types of services they already provided or wished to provide. The case study suggested strategies for ¡¥policy change¡¦ need to address a number of factors across service delivery, policy and political realms. Firstly, better recognition is warranted of the difficulty experienced by many people with psychiatric disability in achieving stable housing, and the need for indicators on housing access and stability for this group. Secondly, processes to address stigma (particularly that perpetuated in the media) will be instrumental for policy change and political commitment. Thirdly, ongoing cross sectoral advocacy and alliances require development at both a national and state level and support by a political culture which encourages advocacy. Developing processes for working across sectors such as policy learning forums involving both experts and community groups could counter problems arising from professional culture and territories that were documented in this study. Finally, the cross-sectoral development of policy, programmes and accountability mechanisms and the stability of policy networks will be important to ensuring stable housing for people with psychiatric disability.

During the period 1967-1995, Swedish mental healthcare underwent a complete re-organisation, starting with county councils taking over responsibility for mental healthcare from the state. Asylums were then phased out and mental health care moved closer to patients. The Mental Health Reform of 1995 completed this decentralisation and put the emphasis on an independent and integrated life as a citizen in society and the idea of a dwelling of one’s own. This thesis describes and analyses spatial aspects of decentralised mental healthcare in Sweden, focusing on the decentralisation discourse regarding organisation, localisation, patient care and working methods behind decentralisation and its spatial performance. A case study of decentralised mental healthcare in Nacka, a Stockholm suburb, between 1958-1999 examines in particular the emerging decentralisation discourse 1958-1973, The Nacka Project 1974-1980 (one of the first examples of community care in Sweden), psychiatry in Nacka 1980-1994 and the official report Welfare and Freedom of Choice from 1995. The methods used include studies of documents, interviews, visual and architectural drawing analysis. The theoretical point of departure for the analysis is a post-structural heterogeneous concept of space where spatial materiality and discursiveness are looked upon as intertwined.    The result shows that the re-organisation of mental healthcare brought about a substantial spatial transformation. Normalisation of patients’ lives involved integration into society and support for independent living. The local environment was the main trope for the early stage of decentralised mental healthcare, but the notion of a dwelling of one’s own became the important trajectory to an independent life after 1995. The idea of the patient is challenged by the independence discourse, which could be said to contain an idea of the ‘non-patient’. Overall, it can be concluded that spatial organisations of the built environment are never value-free or neutral. They reflect, enable and constrain power relations in a society and material space can contribute to the power of one group at the expense of another. Furthermore, the results of the spatialities, or the meanings, cannot be predicted. It is therefore crucial to distinguish power in all its configurations and scales and to keep negotiations alive, especially within the field of mental healthcare, but also in the care sector as a whole and in other societal institutions where policies buildings and built environment interact with user practices. This kaleidoscopic perspective can be used for examining complexities in the past and present and for encouraging future potentialities in the process of making/enacting spatial relations. / QC 20120306