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From medieval to modern times, mental illness is a construct that has been deeply misunderstood and stigmatized by humankind (Dubin & Fink, 1992). Individuals living in the United States experience a fear of being judged or ridiculed for their psychopathological symptomology as a result of mental illness stigma (Bharadwaj et al. 2015). Mental illness stigma impacts how individuals choose to seek help and whether they choose to seek help at all (Rusch et al., 2005). Individuals from diverse cultural and ethnic backgrounds face unique barriers to access to mental healthcare (Cauce et. al, 2002). Specifically, individuals from diverse backgrounds are affected by the social and cultural environment they are a part of where cultural factors can impact whether or not these individuals choose to seek help from mental health service providers (Cauce et. al, 2002). The theory of “Double Stigma” (Gary, 2005) proposed that individuals from diverse ethnic and cultural backgrounds face impactful barriers to mental healthcare as a result of of mental illness stigma combined with racial discrimination. Different ethnic minority groups face unique barriers to mental healthcare. African Americans are a group of individuals who have been found to associate seeking mental health treatment with feelings of embarrassment when compared to European Americans (Snowden, 2001). Additionally, Asian Americans are a group of individuals who have often referred to as the “model minority,” a problematic notion which suggests that in terms of mental illness, this ethnic group has had little to no social or psychological problems and have assimilated well to life in the United States (Sue & Morishima, 1982). This theory has contributed to Asian American communities internalizing the idea that they must uphold the standard that has been set for them, ultimately impacting their decision to seek help for mental illnesses (Sue & Morishima, 1982). Within the Asian American community, South Asians are the third largest and fastest growing ethnic group in the United States (U.S. Census Bureau, 2000). Within the South Asian community, stigma is highly prevalent and perpetuated by discrimination (Neelam, Mak, & Wessely, 1997). This discrimination and judgement from one’s own community impacts if and how individuals from South Asian communities choose to seek help. Loya, Reddy and Hinshaw (2010) found that relative to European American college students, South Asian college students presented with higher level of reluctance to seek help through University-based counseling services. Loya and colleagues (2010) also found over all poorer attitudes toward individuals with mental illness from South Asian college students. This study investigated perceptions of mental illness and help seeking across racial groups, with a specific focus on South Asian communities. Specifically, a model examining informal and formal help seeking was utilized to explore differences in perceptions of help seeking practices across racial groups. Through multigroup structural equation modeling (SEM), changes in model fit were explored to assess whether negative perceptions of mental illness predicted informal and formal help seeking behaviors across racial groups. Participants included 355 individuals, 18 and older, across the United States who identified as South Asian, White/European American or Black/African American. Based on previous research which has found that ethnic minority groups face unique barriers to accessing appropriate mental healthcare (Cauce et. al, 2002; Gary, 2005; Snowden, 2001; Sue & Morishima, 1982; Neelam, Mak & Wessely, 1997; Loya, Reddy & Hinshaw, 2010), it was hypothesized that South Asian individuals would have more negative perceptions of individuals with mental illness as well as more negative attitudes towards all modes of help seeking compared to their non-South Asian counterparts. Additionally, it was hypothesized that South Asian females will have more positive attitudes towards mental illness than South Asian males. Results indicated that a more positive perception of mental illness is associated with more likelihood of seeking help for mental illness for all racial groups examined through SEM. Results also indicated similar fit indices and invariance across all racial groups examined through SEM. Through univariate analyses, South Asian females were found to have a more positive view of individuals with mental illness than South Asian males. Univariate analyses also revealed that compared to White/European Americans, individuals who identified as Black/African American perceived mental illness more negatively when assessing individuals their own racial group. Implications, strengths, limitations, and directions for future research are discussed. / School Psychology

This sandwich thesis contains 3 studies using three distinct methodologies: scoping review, quantitative study, and qualitative study. This program of research explores employment for people with disabilities who are in receipt of publicly funded disability income benefits. / Employment is a key determinant of socioeconomic inclusion and health. Yet, people with disabilities (PWD) have one of the lowest employment rates in advanced welfare states. This thesis consists of three manuscripts using three distinct methodologies to examine this phenomenon. This thesis advances knowledge in the field by examining the employment outcomes of PWD who are in receipt of public income benefits, often referred to as programs of last resort. This thesis is framed by the theory of wicked problems which serves to emphasis the stubborn problem of low employment participation rates. Despite the numerous enhancements made to social assistance programming over the last two decades to facilitate positive employment outcomes, people with mental illness remain one of the most marginalized worker populations. Manuscript one is a scoping review identifying what is known about active labour market policies within welfare to work programs for PWD. This research acts as the foundational piece upon which the other two papers build. The purpose of the review is to present the existing body of literature on this issue across all advanced welfare states and identify the gaps in the evidence base, summarize these findings and disseminate them to policy makers and other key stakeholders. Manuscript two is a quantitative study. It takes a narrower focus and examines a subpopulation of PWD. This study uses administrative data from Ontario’s Ministry of Community and Social Services to examine the system level factors associated with earnings-related exits from the Ontario Disability Support Program, Ontario’s public income system for PWD. The study draws on descriptive and inferential statistical procedures to provide an overview of income support recipients with mental illness who gain enough earnings to transition off social assistance. This study contributes data on the numbers behind system exits to inform program development within ODSP. While manuscript two answers who exits ODSP for employment, manuscript three provides insight into why and how individuals succeed in exiting the system. Through a series of semi-structured interviews with three participant groups, this study explores the process of transitioning off disability income support benefits among people with mental illness. This study adds to a small but emerging literature on the economic fate of former ODSP recipients, which will help inform policy development. / Thesis / Doctor of Philosophy (PhD) / Employment is a key determinant of socioeconomic inclusion and health. Employment paid at a competitive wage equips a person with the social and economic resources they need to enjoy a decent quality of life. Yet, people with disabilities (PWD) are often underemployed or excluded from the mainstream labour market. This thesis sets out to explore the barriers and facilitators to meaningful employment for PWD, with a focus on people living with serious mental illness who are in receipt of income benefits from the Ontario Disability Support Program. This body of work begins with a global exploration of active labour market policies that are used to assist PWD enter or remain in employment. It then narrows its focus to explore the system level factors that prevent or facilitate people living with serious mental illness to transition from income benefits to mainstream employment. The study findings have implications for policy development in all advanced welfare states that could enhance successful transitions from welfare to work.

An interpretive description qualitative approach was utilized in this study. The main aim to was to understand the South Asian (SA) Punjabi community’s experience of having accessed mental health services for depression within Ontario, Canada. A sub-aim was to capture the participants’ conceptualizations and experiences of having depression, which provided context about this ethnic community and deepened insights into their accessibility experience. Six Punjabi persons living with depression (PLDs) and six family members were interviewed in Punjabi and/or English. Data analysis was guided by Thorne’s strategy for interpretive description. Twelve major themes detailed the challenges of PLDs and their family members regarding i) identification and understanding of depression and ii) accessing mental health support. Major themes revealing the community’s conceptualizations of depression are: i) most of us didn’t know what depression is, ii) we realized it was depression after getting help, iii) we keep depression a secret, iv) my family didn’t understand my depression, v) my family helped, vi) my family didn’t help- some made me sick, and vii) my family also became “sick”. These themes supported a better understanding of the major themes discussing the community’s access to mental health service for depression, which are: viii) we didn’t know where to get help, ix) my health providers’ lack of familiarity with my culture caused stress, x) I waited to get help, xi) treating my depression cost me, and xii) knowing my culture will help you treat me better. Findings of this qualitative study provide details of how these participants had their own unique cultural conceptualizations of depression and continue to experience difficulty with accessibility of mental health services while receiving care. Results suggest culturally tailored improvements of mental health service accessibility are required to support this population as they navigate the mental health system for their depression. / Thesis / Master of Science (MSc)

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Mental health and substance abuse treatment systems have a history of incompatible philosophies and conflicts that have been associated with poor treatment outcomes for persons dually diagnosed. The purpose of this study was to determine whether or not there are differences in attitudes between mental health and substance abuse professionals toward the dually diagnosed client and whether or not academic discipline, levels of training and experience, occupation, and amount of contact affect the attitudes of these professional groups. A non-experimental survey research design was used for this study, and data were collected by means of a revised Opinions About Mental Illness (OMI) survey instrument and supplemental demographic questionnaire. The modified OMI instrument was piloted by a panel of subject matter experts experienced in the treatment of persons who are dually diagnosed in which they rated each item for favorableness to concepts of dual diagnosis. The modified OMI survey and a demographic questionnaire were administered to a sample consisting of mental health and substance abuse professionals employed at a local community mental health center. A total of 86 respondents representing 95% of the sample population completed the modified OMI survey and demographic questionnaire. Data were analyzed using descriptive, independent sample t-test, and multiple analysis of variance (MANOVA) statistics. Results revealed no statistically significant differences in attitude between mental health and substance abuse professionals toward dually diagnosed clients. Analysis of the independent variables academic discipline, level of training and experience, occupation, and amount of contact demonstrated no significant interaction effects between mental health and substance abuse professionals. Despite the absence of statistically significant differences in attitude between the mental health and substance abuse professionals, the similarities may be significant in terms of the psychological value for building positive relationships. The atmosphere of agency culture and the significance of co-location of mental health and substance abuse professionals were also potentially important factors in the outcome of the present study. / Ed. D.