Posttraumatic stress disorder (PTSD) affects more than 60% of Cambodian immigrants in the United States. However, researchers do not yet know why less than 5% of Cambodian immigrants are accessing mental health services. This qualitative study involved investigation of participants' perceptions of how PTSD is manifested in the Cambodian immigrant community to understand barriers to mental health services access. The social ecological theory provided a frame for understanding how traditions, values, culture, and beliefs affect Cambodian immigrants' perceptions of PTSD and the mental health system. Data was collected from semi structured interviews of 13 participants, 18 to 70 years of age, residing in Stockton, California, who shared their perceptions of PTSD. NVIVO was used to organize each data category for thematic analysis. The themes included: (a) hearing of PTSD, (b) meaning of PTSD, (c) contributing factors, (d) healing practices, (e) recognition of PTSD, (f) reactions, (g) reasons most often given, (h) encouraging family members, (i) healing practices, (j) ways of helping, (k) counseling, (l) medications, (m) mental health support, (n) mental health resources, and (o) want more information. The findings indicated that stigma continues to be one of the barriers in accessing mental health services, and that Cambodian immigrants have a strong desire to learn more about mental health and mental health services in San Joaquin County. Results from this study contribute to an area of mental health research that is limited, and they may be used by researchers and mental health practitioners to improve cultural understanding and awareness among diverse communities and help reduce the stigma regarding mental health issues.

The purpose of this research was to analyze the effectiveness of psychotherapy for individuals diagnosed with schizophrenia spectrum disorders who reside in community residential settings. The present body of literature did not address the utility of psychotherapy treatment for this population. A key area of focus for this research was whether psychotherapy has an impact on psychiatric hospitalization rates for the target population. An additional research question was whether significant differences exist in psychiatric hospitalization rates between males and females for the target population. Data analyses were conducted using archival data from the Blossom Hill Corporation and Sunrise Farm Corporation in the State of Minnesota. Research questions were analyzed with a 2x2 factorial analysis of variance (ANOVA). Results indicated no significant differences in hospitalization rates for individuals in the target population who received psychotherapy (n = 60) compared to those who did not (n = 76). Hospitalization rates also did not differ between gender in psychotherapy treatment response for individuals diagnosed with schizophrenia spectrum disorders in community residential settings. This study has implications for social change because it informs community residential providers in Minnesota serving individuals in the target population about the impact of psychotherapy on reducing psychiatric hospitalizations. Social change is further affected by providing data about how psychotherapy and theory can be used to better treat and understand the target population's mental health stability.

Thesis (M.A. (Clinical psychology)) --University of Limpopo, 2012 / A number of studies have indicated that help-seeking pathways followed by individuals suffering from mental disorders and other conditions of ill-health are not random, but are structured by a range of psychosocial and cultural factors. The quality and seriousness of the distress provide the impetus to the pathway, but its direction and duration is shaped by the convergence of psychosocial and cultural factors. This study explored the help-seeking pathways followed by patients receiving mental health care services in Polokwane-Mankweng Hospital Complex (PMHC) in Limpopo Province (South Africa). A qualitative approach was followed and participants were selected through purposive sampling. Ten participants (5 males and 5 females) who are receiving mental health care services at PMHC and were apsychotic at the time were recruited to the study. Data were collected using semi-structured interviews and analyzed using content analysis. The following psychological themes emerged from the study: participants’ subjective notions of the events or factors that could have led to their mental illness; their explanations of mental illness; the reasons for entering the mental health care system; the pathways they followed before receiving mental health services in the hospital; concurrent use of hospital mental health services and other services; their experiences of living with mental illness; and, the role of significant others in this regard. The study revealed that various agencies and providers of health care are visited by individuals suffering from mental illness and that there is also some evidence of concurrent use of these services, i.e., Western and African. The findings emphasize that help-seeking pathways are mainly determined by the perceived causes of the illness, which are derived from cultural ideologies.

Thesis (M.Dev.) --University of Limpopo, 2015 / In preparation for the launch of the Flemish Interuniversity Council-Institutional Cooperation (VLIR-IUC) in 2010, the Development Facilitation and Training Institute (DevFTI), University of Limpopo, conducted a scoping exercise with community members in villages within Dikgale in the Limpopo Province. The purpose of the exercise was to identify both the assets within the community — as well as the challenges being experienced in the area. During discussions with leaders of the Community Based Organisations (CBOs) it became apparent that mental health related issues were an emerging issue of concern — with special emphasis placed on the levels of stigma that existed towards mental illness in the area. It is against this backdrop that the researcher was motivated to conduct a study with the aim of finding out the opinions and knowledge of the lay people about mental illness in Dikgopheng community, situated within the broader Dikgale area, in Polokwane Local Municipality in the Limpopo Province. The study used a quantitative descriptive survey research design in which participants answered questions administered through questionnaires. A random sampling strategy was used to secure a representative sample size of 249 respondents out of the total population of 700. IBM’s Statistical Package for Social Sciences for Windows (SPSS version 20) was used to analyse the descriptive statistics. Inconclusive results were found about formal knowledge of the psychosocial risk factors associated with the onset of mental illness. In contradistinction, patterns of cultural associations linked to the onset of mental illness were significant. Furthermore, an overwhelming majority of the community (75.1%) of the community members were found to have ‘stigmatisation’ opinions about people with mental illness. Due to the lack of the psychosocial knowledge about risk factors and the onset of mental illness, it is recommended (i) that there is a need for education and training to raise awareness about risk factors associated with the onset of mental illness and (ii) that further qualitative research be undertaken to explore issues relating to mental illness and stigma in more depth in the area that specifically focuses on ameliorative measures that address stigma that could be implemented within the community.

Mental illness is a widespread public health concern. Stigma is a known barrier to recovery, and individuals often avoid seeking treatment because of it. The purpose of my research was to understand how individuals process peer-created, mental illness messages on social media, and to what extent these messages reduce stigma. I conducted two experiments based on the Elaboration Likelihood Model (ELM) to examine attitudes related to negative beliefs about mental illness and preferred social distance from mentally ill individuals. Argument quality and amount of elaboration influenced empathetic responses to a message. Empathy was directly associated with a decrease in stigmatized beliefs about mental illness. Individuals who perceived that the message sharer was a close, trusted friend were more likely to indicate that the original message creator was more credible. Original message creators who disclosed having a mental illness were also perceived as more credible than creators who did not disclose having a mental illness. In addition, participants who perceived that the message sharer positively endorsed the message had less stigmatized beliefs about mental illness than participants who perceived negative endorsements. Results of this project suggest that traditional ELM variables, such as elaboration and argument quality, influence the processing and outcomes of viewing social media messages about mental illness. Several new media characteristics, such as who shares the message online and comments they attach to the message, also influence how users think about the message and influence processing outcomes.

This dissertation documents the joys and terrors of caring for my father throughout my twenties and early thirties. The story is autoethnographic and demonstrates the value of narrative research in fostering understandings of self, other, and the world around us. I call this reflexive practice of writing narrative education because as I engaged in it, I learned what it means to care, and how mental health and illness factor into the ways in which care is expressed and provided in my own relationships and beyond. In addition, throughout the story I was a member of the academic community, which makes caring more than an act or behavior, but a concept to unpack, an ideograph. This dissertation begins with the goal to write my story and learn from it so others might learn from it as well. While the narrative portion of my dissertation focuses on story and the craft of creative nonfiction, the final chapters present a discussion of narrative ethics and the writing process. I also delve into concepts of care, family, and community to shed light on the narrative and create a space for reflection.

The overarching aim of this dissertation is to use health services research methods to address three problems in behavioral health services. This dissertation seeks to address the knowledge gaps in behavioral health services through the generation of evidence intended to support evidence-based practices (EBP). Previous work has examined epidemiology of behavioral health disorders in the ED, but they have not attempted to examine disorders by the cause of injury. Chapter 2 examines the epidemiology of psychiatric disorders among adults who seek care in the emergency department (ED) by cause of injury. Data from a national hospital discharge survey was analyzed using logistic and multinomial regression. Estimates are given as average marginal effects (AME) to simplify the interpretation and application. Intentionally-caused injury and undetermined cause of injury are significantly associated with psychiatric disorders. Patients with undetermined cause of injury were more likely to be diagnosed with anxiety disorders, depressed mood, and psychoses relative to patients with unintentional injuries Since there are several treatment options for obsessive-compulsive disorder (OCD), including cognitive behavioral therapy (CBT), serotonin reuptake inhibitors (SRIs), and combinations of these, a comparison of treatment effects denominated in dollars is helpful when comparing risks and benefits. Chapter 3 builds on previous randomized control trials of treatments for OCD in children and adolescents by ranks the cost-benefits of first-line treatments. The analysis aggregates treatment effects from published trials in meta-analytic framework and a Monte Carlo simulation of 100,000 hypothetic children and adolescents to derive ranked cost-benefit. Treatments strategies starting with CBT, but not CBT and SRIs concurrently, were the most cost-beneficial. The relationship between cost-sharing and utilization of behavioral health services has been studied in the aggregate, but there has been little work examining the relationship by disorder and treatment modality. The aim of Chapter 4 is to examine the association between cost-sharing and utilization of psychotherapy and adherence to pharmacotherapy among insured adults with OCD. This chapter utilizes the Truven MarketScan Commercial Claims and Encounters dataset to perform zero-inflated negative binomial regression and logistic regression analyses. Increased cost-sharing was significantly, negatively associated with psychotherapy intensity and dose, but not associated with SRI adherence. This dissertation examined three different research questions to address gaps in the behavioral health services research. The findings of these chapters have implications for patients, clinicians, insurers, and policymakers. The results can be used to improve aspects of cost, quality, access, and efficiency of behavioral health services.

This mixed methods study evaluated clinical and criminal justice outcomes of the Florida Jail Diversion and Trauma Recovery (JDTR) program that utilized compensated veteran peer mentors. Quantitative results showed veteran participation in JDTR improved clinical outcomes, such as PTSD symptoms, function difficulty and depression scores, but not criminal justice outcomes such as re-arrest rates. Study limitations, however, prevent the drawing of conclusions regarding the potential effectiveness of veteran peer interventions improving criminal justice outcomes. Qualitative results showed participants overwhelmingly viewed their assigned veteran peer mentor as a "peer" and rated them as "very important" to their future success. Improvements in avoidance and numbing and depression symptoms also suggest peer interventions may be effective in improving responsivity to evidence-based criminal justice interventions. Overall, findings were consistent with the RNR model that views mental illness as a responsivity factor, not a criminogenic need. They were also consistent with research on "first generation" forensic mental health interventions that shows improvements in clinical outcomes do not result in reductions in recidivism. Social workers as well as other mental health clinicians and policy makers should be familiar with evidenced-based criminal justice strategies, such as RNR, that focus on reducing recidivism and should incorporate these strategies into the development, implementation and evaluation of "second generation" interventions. Future research should evaluate the fidelity of implementation of such interventions as well as the role of peer mentors and importance of the recovery model and therapeutic alliance in improving criminal justice outcomes and responsivity.

Bakgrund: Bipolär sjukdom karaktäriseras av att sinnestillståndet pendlar mellan höga och låga stämningslägen. De växlande sjukdomsepisoderna bidrar till en komplex livssituation för patienten. Patientens symtombild står som grund för diagnostisering av bipolär sjukdom och behandling inriktas främst på farmakologisk behandling och även psykoterapi vid behov. Utöver det beskrivna krävs ett gott samarbete mellan anhöriga, patient och vårdpersonal. Detta är väsentligt för att patienten ska erhålla ett adekvat stöd och samtidigt öka förutsättningarna för god följsamhet av sin behandling. Syfte: Syftet var att belysa patienters upplevelser av att leva med bipolär sjukdom. Metod: Denna uppsats är en litteraturöversikt och elva vetenskapliga artiklar med kvalitativ metod har analyserats. Resultat: Utifrån analysen skapades fem huvudteman med tillhörande underteman. Fem huvudteman formades: Det sociala sammanhanget, Identitet och förlorad kontroll, Upplevelsen av sjukdomssymtom, Att bli stigmatiserad och Att medicinera- En ambivalent upplevelse. Resultatet visar att patienter upplevde bristande kunskap från omgivningen gällande bipolär sjukdom vilket ledde till isolering och en känsla av identitetsförlust hos patienterna. Diskussion: Bipolär sjukdom kräver i många fall ett starkt socialt nätverk för att patienten ska få stöd i sin hantering av sjukdomen och omgivningen kan bidra med både positiva och negativa upplevelser för patienten. För att patienten ska erhålla ett adekvat stöd krävs det vid bipolär sjukdom kunskap och förståelse från omgivningen samt vårdpersonal. Phil Barkers omvårdnadsteori belyser samarbete med anhöriga och evidensbaseradeverktyg, som fokuserar på patientens berättelse, som avgörande komponenter i patientens omvårdnadsprocess. / Background: Bipolar disease is characterized by a state of mind that commutes between high and low mood swings. The variating episodes contribute to a complex life situation for the patient. The patient’s symptoms are used for diagnosing bipolar disorder and treatment is primarily pharmacological treatment and psychotherapy commonly used when needed. Furthermore good cooperation between relatives, patients and healthcare professionals are required. This is essential so that the patient can receive adequate support and also increase presumptions for good compliance with treatment.  Aim: The purpose was to illustrate patients’ experiences of living with bipolar disorder. Method: This essay is a literature review and eleven scientific articles with qualitative method have been analyzed.   Results: Based on the analysis, five main themes were created with associated subtheme. Five main themes emerged: The social context, Identity and loss of control, The experience of disease symptoms, Becoming stigmatized and Being medicated- An ambivalent experience. The result shows that patients experienced insufficient knowledge from the environment regarding bipolar disorder which has led to isolation and a sense of identity loss in patients.  Discussion: Bipolar disorder requires in many cases a strong social network in order for the patients to receive support in their management of the disease and the environment can contribute with both positive and negative experiences for the patient. In order for the patient to receive adequate support, bipolar disorder requires knowledge and understanding from the environment as well as healthcare professionals. Phil Barker's Nursing Theory illustrates collaboration with relatives and evidence-based tools, that focus on the patient's story, as crucial parts of the patient's nursing process.

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