Thesis (Psy. D.)--Wheaton College Graduate School, 2007. / Abstract. Includes bibliographical references (leaves 78-83).

Thesis (Ph. D.)--University of Florida, 1984. / Description based on print version record. Typescript. Vita. Includes bibliographical references (leaves 150-158).

Thesis (M.Med.Sc.) - University of Queensland, 2004. / Includes bibliography.

Thesis (Ph. D.)--University of Wisconsin, Madison, 1997. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 293-306).

Thesis (Ph.D.)--Ohio University, August, 2005. / Title from PDF t.p. Includes bibliographical references (p. 93-105)

Theses (Ph. D.)--Marshall University, 2007. / Title from document title page. Includes abstract. Document formatted into pages: contains vi, 108 pages Bibliography: p. 100-108.

Theses (Ed.S.)--Marshall University, 2007. / Title from document title page. Includes abstract. Document formatted into pages: contains iii, 23 pages. Bibliography: p. 22-23.

Thesis (Psy. D.)--Wheaton College Graduate School, 2007. / Abstract. Includes bibliographical references (leaves 78-83).

Mental health has become an increasingly importantly focus in the UK policy landscape because of its social and economic impact. However, most research to date has focused on living with mental health issues, or providing mental health services, in urban settings. There is limited understanding of the experiences of rural dwellers with mental health issues or the role of the voluntary sector in terms of its contribution to mental health service provision in rural areas. Thus, this PhD explores the experiences of rural mental health service users and providers in Scotland and Canada, and also considers the contribution of mental health voluntary organisations in helping to overcome the challenges of social exclusion for service users, as identified in previous research. Two theoretical lenses were used to frame the research questions. First, the concept of social inclusion provided a lens to analyse the processes by which service users achieve, or not, a sense of belonging and connection in society (Philo 2000). Second, Putnam's (2000) theory of social capital provided a further analytical lens by which to explore the contribution of rural voluntary organisations. Social capital focuses on the features of populations such as social networks, trust and norms of reciprocity that shape the quality and quantity of social interactions (McKenzie & Harpham 2006). The aims of the research were to: To explore the impact of rural life for mental health service users' daily life and access of services To understand the contribution of rural mental health services to tackling social exclusion for service users The five research questions used in this thesis were: What does it mean to experience mental health problems in remote and rural areas? What are the challenges that service providers face in remote and rural areas? What benefits are there for service users attending voluntary groups in remote and rural areas?

Background: Integrated working between health and social care services within England has been encouraged by Government policy in the last decade, and has been argued to provide a seamless, joined up experience for service users (Department of Health 2011). One way of integrating care is through the use of a single point of access to health and social care services. A single point of access to services has been trialled in mental health and learning disability services to improve access, and following on from policy (e.g. Department of Health 2007) and support from literature (Rogers, Entwistle & Pencheon 1998; Lovell & Richards 2000; Raine, Carter, Sensky & Black 2005) a single point of access to health and social care for older adults has been implemented in parts of the UK. This thesis examines the implementation of one such single point of access. Objectives: The aim of the study was to examine the single point of access and whether it had any impact upon integrated working within a county in England, UK. Methods: An ethnographic approach was taken, using a combination of methods including interviews, focus groups and observations. This was complemented by a grounded theory approach to analysis. Findings: The single point of access had an adverse effect upon integration. The poor management of change and lack of communication led to issues within the single point of access such as failure of IT systems and duplication. Staff became frustrated and disengaged from the process, and consequently reported feeling disempowered, retreating back to their professional 'tribes'. Conclusion: Firm conclusions about the efficacy of a single point of access with regard to its effect upon integrated working could not be reached. However, the findings suggest that clear communication, continued change management and recognition of professional culture are decisive factors when attempting to integrate health and social care. Further research into the impact of a single point of access upon integration as well as outcomes for service users is recommended.