Children of parents with mental illness (COPMI) are often referred to in the literature as invisible given the lack of services dedicated to this large population at increased risk for a multitude of psychosocial difficulties. Of the services available, few have been empirically validated. This study undertook a qualitative evaluation of Kids in Control, a psycho-education and support program intended to enhance the resilience of children of mentally ill parents. The goals of this study were to: determine whether the program was beneficial to the participants, identify the critical program elements deemed helpful/unhelpful by the participants, determine whether program objectives were being met, and to provide insight on how to improve the program to better meet the needs of this population. It is ultimately hoped that this research will give children of parents with mental illness a voice, thereby boosting their visibility and contributing to their psychosocial well being. Flanagan’s (1954) critical incident technique (CIT) was employed to determine the participants’ perceptions of helpful and unhelpful aspects of the program. Twelve participants (10 boys, 2 girls) ranging in age from 8-12 were recruited from 4 groups held in the Lower Mainland of British Columbia. Semi-structured interviews were conducted, followed by telephone interviews to discuss and verify the information shared. Participants reported a total of 121 critical incidents, which were classified into 8 helpful categories (105 incidents) and 2 unhelpful categories (16 incidents). The eight helpful categories were: identifying, communicating and managing feelings; learning about mental illness; helpful messages about responsibility, control, and empowerment; effective facilitator group management skills; having fun; connecting with other children experiencing parental mental illness; learning about stigma; and identifying supports. The unhelpful categories were: ineffective facilitation skills, and disruptive behaviour exhibited by other group members. Participants recommended improvements related to the areas of group instruction, time management, and group management. In addition, a 10-point rating scale was administered to determine the participants’ overall perception of program helpfulness. A mean rating of 7.63 was obtained which corresponds to very helpful on the scale. A comparison of incident categories with program objectives indicated a high degree of consistency, with a few exceptions. Implications for program improvements, wider program dissemination, and counselling practice are discussed. In addition, methodological issues related to using the critical incident technique with children are outlined. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Background: Today, there are over 65 million refugees exist worldwide and arrival of the refugees has increased rapidly in Sweden as well. Refugees and asylum seekers may be more susceptible to mental disorders because of the traumatic events they encounter prior to immigration and adverse circumstances in the new country. Aim: A literature study was aimed at exploring different kind of mental ill health among immigrant refugees and the factors that affect their psychological ill health. Further aim of this study was also to find association between mental disorders observed in refugees and the factors responsible for them.  Method: Systematic literature study has chosen to provide an overall summary of the existing researches within the subject. A systematic search for relevant literature in PubMed and CINAHL was performed and it was limited to original research articles published between 1st January 2008 and 31st December 2017.  Data was extracted from 11 scientific quantitative articles. All the articles were reviewed for quality according to Forsberg & Wengström’s review template. Results: Depression, post-traumatic stress disorder (PTSD), anxiety and somatization are common diagnoses among refugees. Many refugees experienced traumatic events in their home country and during escape. Unfavorable conditions like violence, murder, lack of food, shelter and money affect their mental health negatively. Landing in new country can be expressed in joy, but it did not stay for a long time with upcoming resettlement difficulties such as communication problems, discrimination, unemployment, separation from family and culture. Conclusion: Depression and PTSD were most common among refugees. Unemployment and language difficulties were the main reasons for their miserable mental health. There was an association between mental disorders and the factors like trauma in the home country and on the way to new destination as well as adoption difficulties in a new country.

Background Mental illness is increasing in the society and it affects the person in the daily life. Relatives are helpful in the recovering of the person with mental illness. In order to provide a good nursing it is important that the nurse knows how relatives experience how it is to live with a person with mental illness. Aim The aim of this study was to illuminate relatives experiences of living with a person with mental illness. Method This study was literature- based and 11 qualitative articles were analyzed for the results. The articles were analyzed by the method of contributing to evidence-based nursing based on analysis of qualitative research. Results The results of this study showed that relatives living with a person that suffers from mental illness experienced a heavy burden. Feelings of guilt and shame was described, which had an impact on the daily life because of constant worry for the person with the mental illness. Relatives also experienced anxiety for the future. The relatives felt excluded from the healthcare and they felt that the healthcare did not take responsibility for the person with the mental illness. The rights to be provided with adequate care, both for the patient and for their relative was described as a constant fight. Conclusion The relatives experienced social isolation, feelings of guilt and loneliness. A need for greater support from the hospital staff desired due the relatives had a need for care and experiences of being excluded from the healthcare was described.

While early-onset bipolar disorder (EOBD) has increased in prevalence, much remains to be understood about its phenomenology. Research and treatment models remain rooted in neurobiological conceptualizations of the illness that borrow heavily from models for the traditional adult-onset form of bipolar disorder. This study utilized a transcendental phenomenological design as a first step in obtaining an understanding of the lived experience of EOBD. A purposive sample of eight participants ages 18-25 participated in semi-structured interviews that elicited information on experiences of EOBD symptomatology and course of illness, stigma, experience with healthcare and treatment, and impact on identity, interpersonal relationships, and coping responses. Transcendental phenomenological analysis was used to construct individual and composite descriptions of participants’ experience of EOBD between ages 13 and 17. Implications of findings are presented for research and treatment of EOBD, as well as social work education and policy reform.

People with diagnoses of mental illness have been described as the last minority group against whom it is socially acceptable to discriminate. Challenging the stigma of mental illness is a major social issue and public health concern. Despite a range of anti-stigma efforts being conducted in recent years, the problem persists. It has been argued that a good place to start when changing social attitudes is with young people, whose attitudes are in a state of flux, making them more open to alternative ways of thinking. However, school based educational approaches designed to address this issue are in their infancy. To date, the mental health stigma reduction agenda has largely been drawn up by those who hold most power in the field – predominantly psychiatrists. This has led to anti-stigma initiatives drawing primarily on a biomedical model. There is a growing body of evidence that this approach is not only ineffective, but can actually increase stigma. There is therefore a need to investigate and test alternative approaches. Furthermore, previous research investigating young people’s knowledge of and attitudes about mental illness has been constrained by being conducted within the terms of the dominant discourse.This research set out to investigate how young people construct their positions in relation to mental illness. A primary aim was to understand how they negotiate the ambiguities of the mental health discourse. In addition, it has looked at the impact of engaging in ‘inclusive dialogue’ about mental illness on young people’s sense making. Mental illness is itself an essentially contested concept. Inclusive dialogue is an approach which takes seriously the variety of competing concerns which make up the ways in which mental illness is approached in day to day life, aiming to embrace the complexities and encourage people to grapple with them, bringing their own experiences and beliefs to bear. The underlying purpose of the inquiry was to consider whether there is potential for educational initiatives to help young people adopt non-discriminatory stances in relation to mental illness. The research was conducted qualitatively, and engaged a group of seven year 10 pupils in a series of discussions, which took place over the course of a half term. In addition, individual interviews and follow up group sessions were carried out later in the academic year.The results of this study indicate that engaging young people in inclusive dialogue is beneficial across a range of domains. The young people said that the discussions left them more comfortable in talking about mental illness and confident about their ability to respond to mental illness in people around them. The study revealed that context and the specific details of each situation are crucial in determining whether young people take up stigmatising or supportive positions towards people with a mental illness. Stepping outside the terms of the dominant discourse reveals that far from being the product of poor comprehension of biomedical psychiatry, ‘stigma’ may in fact be just one of a set of responses to people with mental illness. People who are mentally ill sometimes behave in ways that are disturbing and frightening, and it is vital that education accepts, rather than sidesteps, this reality. The findings of this investigation suggest that what is needed to improve social responses to mental illness is a reframing of the issues; a conceptual shift, wherein the notions of ‘knowledge’ and ‘attitude’ are not taken for granted and the aim of ‘reducing stigma’ is left behind in favour of the positively framed target of increasing solidarity.

Background About 2 % of children aged 0-15 years have at least one parent diagnosed in a psychiatric facility with any mental illness. Three common mental illnesses are schizophrenia, depression and bipolar disorder. Schizophrenia is a common form of psychosis, depression affects human behavior, thoughts and emotional life and bipolar disorder involves symptoms such as depression and mania.  Aim The aim of this literature study is to describe children's experiences of living with parent with a mental illness. The study also described the included articles data collection methods.  Method This study is a descriptive literature study and the scientific articles were searched in the Cinahl and PsycInfo databases.  Main results The result of the articles showed that the children felt different fears by living with the parent who has a mental illness. The fear was that the parent could commit suicide, if the illness was hereditary and that the mood was unstable. The children also felt ashamed of the parent so they found different ways that made them feel more “normal”. An adult responsibility was something the children occupied at an early age by taking care of households chores, their siblings and their sick parent. One wish that the children had was that they wanted more support from the environment, for example, adults from the health care.  Conclusion Feelings such as fear, shame and heavy responsibility is common in children of parent with mental illness. Also lack of support and information about the parents illness is experienced by the children and it is therefore important in the nurses work to be able to support these children and accommodate their needs.

Mental health screening is frequently recommended to facilitate earlier detection of mental illness in prisons. For this goal to be achieved: (1) the screening process must be accurate; (2) appropriate follow-up treatment must be provided; (3) the treatment must lead to improved outcomes. The current thesis aimed to evaluate mental health screening in relation to these three criteria by studying 13, 281 prisoners admitted to Correctional Service of Canada. Screening achieved comparable accuracy to tools that have been studied internationally and many inmates received at least some treatment. However, interruptions in treatment were frequent and long-term treatment was rare. There was weak evidence that treatment led to reduced rates of institutional incidents of suicide, self-harm, victimization and violence. While screening remains widely endorsed, further study of its impacts is needed to maximize its value. This could include considering alternatives to screening itself, or as follow-up for those who screen positive.

Although the theme of madness has been of concern to writers of all ages, there is a perceptible change in the madness of the dramatic character of the twentieth century from that of the past. This thesis is an attempt to analyse that phenomenon as it is manifested in a number of characters of twentieth century drama. The introduction contains a brief outline of the history of madness in society, and a general discussion as to how it is reflected in literature, from Biblical times to the present. It is found that writers make little attempt to explain the madness of a literary character, other than by attributing to him specific personal reasons for his behaviour; i.e. disappointment in love. The characters of twentieth century drama however, are found to be not "mad" in the same way; their madness is linked to their relationship with the rest of society. Thus, a character who considers the rest of society mad, and acts in a way which counteracts that society, is considered mad by those around him. However, to the audience or reader, who are made to recognize the motives for his behaviour, the character is not necessarily mad, and in fact it may be, the playwright implies, that the people who accept the values of the society as absolute who are "mad." By discussing principally "madmen" of four recent dramas: Romulus der Große (1956) and Die Physiker (I962) by Friedrich Düirrenmatt, Graf Öderland (final version 196l) by Max Frisch, and Albert Camus' Caligula (1944), as well as making peripheral references to other dramas in the Conclusion, definite patterns of behaviour emerge. The "madman" is judged in ways which are not understood by his contemporaries. He is generally more intelligent, more perceptive than the other members of his society, and has perceived a truth which is hidden from others. In revolting against a society whose values he cannot accept, he is making what he considers a positive step towards improving in some way the quality of life. (In this respect he is perhaps different from "madmen" of previous literature who are presented as having chosen to opt out.) In each case the revolt fails, leading to chaos or a reimposition of the old system. Despite the failure of the revolt to achieve permanent change, each hero is found to be an idealist oblivious to the reality around him rather than a "madman." The breakdown of traditionally accepted norms such as religion, has meant that in the twentieth century there are no absolute standards of behaviour. Sanity thus becomes a relative concept. This thesis attempts to explore that nebulous and shifting area between madness and sanity as it is reflected in modern drama. / Arts, Faculty of / English, Department of / Graduate

Suicide is a major public health concern in the UK, with recent published rates for England at 11.8 per 100,000 population for the year 2011. There has been extensive research into individual-level risk factors for suicide, though some suggest that ecological and social factors may also have an influence on suicide. The majority of the UK literature investigating this has examined suicide rates in relation to area-level deprivation or social fragmentation scores. Most of the research has not accounted for ecological fallacy (in this instance the erroneous assumption that factors associated with suicide at the group-level would be associated with suicide at the individual-level and vice versa). This thesis uses multilevel modelling to investigate differences in suicide by area, in order to account for both individual and area-level factors. Data from the 2001 UK Census, and the Office for National Statistics (ONS) were combined to create a complete case-control sample of suicide vs. non-suicide for the year 2001. This represents an alternative methodology for examining suicide incidence in England and Wales. Analysing this data by NHS Primary Care Organisation (PCO) for England, and Local Health Board (LHB) for Wales could influence how NHS services are allocated. UK Census data was then linked with patient data from The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), to examine suicide amongst both the general population and people in contact with mental health services. Analysing this data by PCO and LHB highlights specific risk factors for certain types of suicide in different areas in England and Wales. Again, this could influence the allocation of NHS services within particular areas. This study found that including information about individual-level characteristics explained the majority of variance in suicide types between areas. Social fragmentation was associated with certain types of suicide after controlling for individual-level factors, and was associated with suicide risk in the initial case-control sample. This suggests that social cohesion at a local level is important for suicide prevention, and for improving the mental health of the nation. This supports the goals of the National Suicide Prevention Strategy for England.

This thesis explores the experience of parenting with severe mental illness, using qualitative methodologies. It is presented in three parts: a literature review, a report of the empirical research, and a critical reflection of the process undertaken. The literature review provides both a systematic review of qualitative studies exploring the experience of parenting with a severe mental illness (SMI), and a meta-synthesis of the findings from the included studies. The findings demonstrated six overarching themes that were central to the parents' experience. The themes were interlinked and often conflictual in nature and a model of the relationship between the themes is provided. The synthesis revealed how the additional and conflicting pressures faced by parents with SMI can interact with their symptoms to affect parenting behaviours and decisions about engagement with services. The model of themes elicited by the synthesis provides a broad conceptual framework in which parenting with SMI can be considered across the age range of children, parental symptoms and parenting roles. The empirical research provides a specific focus on the views and experiences of parents with Bipolar Disorder (BD). Interpretative Phenomenological Analysis was used to explore the lived experience of parenting with BD, to provide insight into the parents' perspective and the influence that this may have on outcomes for parents as well as their children. The analysis resulted in six overarching themes, each of which consisted of a number of sub-themes. There were important interactions between the themes and these are illustrated for the reader. It was found that the parents identified a number of challenges in being a parent with BD and experienced feelings of inadequacy, guilt and worry relating to the impact that their illness had on their children and family. Strategies for managing these feelings and limiting the impact of BD could have an inadvertent negative effect on their own well-being, and that of their child. Learning to accept their diagnosis and developing strategies for managing their symptoms were crucial for positive parenting, although the changing needs of their children often presented new challenges. Contextual factors, including the stigma associated with mental illness, could also either mediate or exacerbate the challenge of parenting with BD. The clinical implications of these findings are discussed. The critical reflection provides a consideration of qualitative methodologies and a personal reflection on the qualitative process in relation to the empirical research. It details the critical debates around qualitative methodology, the application of qualitative methodologies, and the challenges this presented for the researcher. The report was written on completion of the investigation and reflects the process by which, as a novice, the author was able to develop an understanding of qualitative methodology and carry out an insightful piece of research.