The aim of this Australian Research Council Linkage doctoral project with industry partners UnitingCare-Lifeline Ballarat and Lifeline Australia was to investigate whether calls to Lifeline – a generalist telephone counselling and referral service – could be used as valid and reliable social indicators of health. The Lifeline Australia service receives approximately 1,000 calls a day and key details of each call are recorded on its Client Services Management Information System (CSMIS). A number of research questions directed this study: (1) What are the characteristics or attributes of callers to Lifeline?; (2) How do the patterns of calls to Lifeline vary spatially?; and (3) What is the statistical relationship between calls to Lifeline and other measures of community health? This thesis presents a detailed descriptive summary and analysis of Lifeline’s national CSMIS call data (N = 90,128 cases) from 01-04-2003 to 29-06-2003. It explores this and other sources of call data, such as the Telstra Exchange data, for their potential to be used as social indicators. The project created a model of generalist telephone counselling and referral use (MGTCRU). The MGTCRU was used as a theoretical base to a call rate indicator, named the Lifeline Indicator of Social Need (LISN), which reflects the community’s capacity to provide social support to its most socially isolated residents. The LISN was found to have useful attributes and a potential for use as a social indicator of community strength. The call rate indicator showed a statistically significant relationship with the Accessibility/Remoteness Index of Australia, measures of socio-economic disadvantage, and suicide rates. However, the CSMIS database was found to have certain limitations. The thesis presents recommendations for this situation to be addressed. While acknowledging that there are limitations to telephone counselling call data it is clear that these call data can be used to create cost effective, rapid, reliable, and potentially valid social indicators. This thesis has made a number of significant empirical and theoretical contributions to knowledge on telephone counselling and referral. The descriptive summary of the CSMIS data provided in this thesis might be used in innovative ways by social researchers. The LISN could be used on its own or included in other social indices. The MGTCRU provides a theoretical framework for understanding telephone counselling and referral services use and may assist these services to organise their operations and meet the needs of their callers. This project may have particular application to a current upgrade of Lifeline Australia’s telephony and call data systems. / Doctor of Philosophy

Psychostimulant dependence is a major public health issue in many parts of the world associated with a wide range of psychological, medical and social problems. Psychosocial interventions are the mainstay of treatment for psychostimulant problems, although their effectiveness is compromised by poor uptake and compliance. Despite increasing knowledge of the neurobiological consequences of psychostimulant use, no medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Modafinil is a non-amphetamine type psychostimulant that may have potential as an agonist pharmacotherapy for psychostimulant dependence. The aim of this thesis was to examine the safety, efficacy and cost-effectiveness of modafinil 200 mg/day over ten weeks plus a four session brief CBT intervention for methamphetamine and cocaine dependence through two concurrent randomised placebo controlled trials. There were no statistically significant differences between modafinil and placebo in treatment retention, medication adherence, psychostimulant abstinence, psychostimulant craving or severity of psychostimulant dependence. Methamphetamine-dependent subjects tended to provide more illicit psychostimulant negative urine samples while in treatment than those who received placebo. There appeared to be a reduction in self-reported days of psychostimulant use among methamphetamine-dependent subjects who received modafinil compared to placebo, but the effect size was too small to be statistically significant in this sample. The reduction in self-reported psychostimulant use did reach statistical significance in methamphetamine-dependent subjects with no other substance dependence. Uptake of counselling was the most significant predictor of reduced psychostimulant use post treatment, and the addition of counselling improved the cost-effectiveness of modafinil relative to placebo. Modafinil appeared to be safe, well-tolerated, and non-reinforcing in this treatment population. Compared to placebo, there was a significant increase in weight in subjects who completed the 10-week course of treatment, and a significant decrease in systolic blood pressure in methamphetamine-dependent subjects who received modafinil. The results support further trials of modafinil in methamphetamine-dependent patients, although future trials in cocaine-dependent patients from this treatment population were not likely to be viable. Modafinil appeared to be modestly effective in reducing, but not stopping, methamphetamine use in selected patients. Multi-centre trials with larger sample sizes, and measures sensitive enough to detect quantitative changes in psychostimulant use would be needed to confirm the findings. Blood pressure and weight may be important indicators of clinical outcome, and warrant particular attention in future trials, particularly given the cardio-toxicity of both methamphetamine and cocaine. Strategies to enhance medication adherence including a higher dose and counselling adherence are recommended to improve outcomes. Given the predominance of behavioural and psychosocial factors in psychostimulant dependence, it is likely that the role of medications such as modafinil will be as an adjunct to psychosocial therapy.

Bibliography: leaves 233-306. / xvii, 306 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A study of the phenomenon of somatization as it occurs in the primary care setting. The phenomenon was studied in terms of aspects of illness behaviour and risk of psychiatric morbidity. It is suggested that abnormal illness behaviour in the form of somatization may be an important factor in the non-recognition of mild non-psychotic psychiatric illness in the primary care setting. The results of the study indicate that an assessment of the patients' attitudes and beliefs about symptoms, and an exploration of psychosocial issues, may lead to a better understanding of why the patients have sought help, and may lead to early identification and appropriate treatment of somatizing behaviour and the psychiatric morbidity underlying such behaviour. / Thesis (Ph.D.)--University of Adelaide, Depts. of Psychiatry and General Practice, 2001

The notion of recovery from mental illness has become a significant force in mental health policy, practice and literature. As a process, recovery can been described as the lived experience of personal growth and search for meaning after the onset of mental illness. The following phenomenological inquiry seeks to understand the meaning of day-to-day activities for 13 people in recovery from mental illness. In the recovery literature there has recently been a growing interest in the everyday aspects of recovery. Routine interactions between people and the human and non-human environment have been recognised as being significant in the recovery process. Additionally, there has been a call within occupational therapy literature for research focused on exploring the experience and meaning of different forms of occupation. This study aims to address and add to these areas of interest within the current literature. Recovery narratives were collected from the participants in two phases, using an open ended conversational style of interview. The first phase focused on gathering stories that reflected the lived experience of recovery for eight participants. The recorded interviews were transcribed and analysed using the hermeneutic philosophy of Martin Heidegger. In the second phase of interviewing a further five participants shared their stories. In this round the conversations were focused on some of the dynamics of activity and recovery that had emerged as broad themes in the first phase. This allowed further depth to be added to the data and subsequent analysis. The interpretation focused on descriptions of engagement in activity during different periods of the participants’ recovery journeys. It was important to dwell with the stories and allow themes of experience and meaning to emerge. Particular phrases and words were highlighted and their meaning explored if they showed something of the participants’ lived experience. Through a process of writing, reflecting and re-writing the findings were refined and clarified over time. Everyday activity was found to be an important medium for change as well as a recovery outcome in itself. Findings add to existing understandings about occupation as a medium for healing and transformation within the context of recovery from mental illness. In particular, the study highlights the dynamics at play in different modes of doing and the way in which carers can influence the experience and meaning of activity.

The aim of this qualitative research project was to investigate the phenomenon of spirituality within occupation as encountered by six people who have all experienced mental illness. A Heideggerian phenomenological philosophy was utilised as the theoretical background. Data were gathered through in-depth interviews with each participant, which were transcribed verbatim. Data were analysed using a hermeneutic, circular process. Eight themes arose from the investigation. Firstly, the experience of spirituality is diverse and each person has his or her idiosyncratic understanding of what spirituality is. Secondly, spirituality is experienced as a journey that changes across time. The third theme notes that spirituality is vitally important to the study participants, so much so, that participants??? spirituality saved them from suicide and filled their lives with meaning and purpose. The fourth theme is recognition that there are ???spiritual occupations??? that are designed to directly access one???s spirituality. Fifth is that spirituality is a form of being which provides the meaning to purposeful doing and that therefore spirituality can make even ???ordinary??? occupation spiritually meaningful. Theme six is that spirituality is not only important on an individual level, but that social and community dimensions of spirituality are also essential. Theme seven finds that mental illness provided the ???wake-up message??? that ???called??? each participant to a spiritual life. The final theme is that spirituality helps the participants cope with living with mental illness. The thesis concludes that spirituality is an indispensable part of each participant???s life. Spirituality has both irrevocably changed participants??? lives and allowed them find personal meaning in their lives that is life-sustaining and life-enhancing. The findings also reveal that spirituality can be related to occupation both theoretically and practically. Given that spirituality was found to be life-saving and life-sustaining and that it can be conceptualised as an essential dimension of occupation, it is argued that spirituality is an issue of high importance to occupational therapists. However, since some occupational therapists may not feel comfortable or knowledgeable enough to discuss spirituality in practice (Collins, Paul and West-Frasier 2001; McColl 2000) it is noted that this topic area forms an emergent frontier for occupational therapy. As a pioneer area of practice, further research and investigation into this fascinating and mysterious realm is recommended. / thesis (MApSc(OccupationalTherapy))--University of South Australia, 2003.

Thesis (M.A.)--Bowling Green State University, 2007. / Document formatted into pages; contains ix, 61 p. Includes bibliographical references.

Thesis (Ph.D.) -- University of Adelaide, Depts. of Psychiatry and General Practice, 2001. / Bibliography: leaves 233-306.

Thesis (Ph.D.)--University of Wollongong, 2004. / Trpescript. Includes bibliographical references: leaf 192-238.

Thesis (Ph.D.)--University of Adelaide, School of Social Sciences, Discipline of Gender and Labour Studies, 2004. / "January 2004" Includes bibliographical references (leaves 297-313).

Thesis (M.A.)--University of Toledo, 2007. / Typescript. "Submitted as partial fulfillment of the requirements for The Master of Arts Degree in Psychology." "A thesis entitled"--at head of title. Bibliography: leaves 57-82.