This critical hermeneutic study explored what it is like to re-enter the workforce following long-term forensic hospitalisation. An in-depth analysis of the phenomenon was completed, with the aim of evoking insights and developing understandings about the lived return-to-work experience. As this research was situated within the critical paradigm, the process of seeking, securing and sustaining employment was viewed in terms of power relationships, and through the multiple positionings of psychiatric disability, employment status and social capital.An unstructured interview process was used to explore the return-to-work experiences of eight purposefully selected informants with a history of mental illness and prior illness-related offending. They were living in the community and had returned to part or full-time employment, which they had sustained for at least six months. The gathered data was interpreted using hermeneutic analysis. This process revealed a number of themes, which were clustered into related groups, under eleven essential overarching themes. Freire's (1972) critical social theory was used to add critical depth to the findings.The findings reveal that returning to work exposes people who are affected by mental illness to an array of challenges and personal opportunities. People who have a forensic psychiatric history can encounter complex employment barriers related to stigma and misunderstanding. Therefore, the selected critical hermeneutic design provided a congruent framework with which to view the informants' quest to seek, secure and sustain employment. Despite significant obstacles, securing employment provides opportunities for individuals to test their skills while engaged in meaningful work activity. The acquisition of work skills can result in individuals' experiencing a strong sense of self-satisfaction. The experience of being bolstered by personal accomplishment often co-exists with, but is not necessarily negated by, difficulties that arise on-the-job.As there is scant reference to forensic rehabilitation within the mental health vocational literature, this study may be a timely contribution. It may also be used to add depth to the knowledge base within the field of mental health rehabilitation, in particular the specialised areas of forensic rehabilitation and vocational practise. Therefore, it may be a positive precursor to further discussion and analysis regarding work and education outcomes from the unique forensic psychiatric perspective.

The National Project to Counter Stigma and Discrimination was established by the New Zealand government in 1997. The Project recognised that people with a diagnosis of mental illness are marginalized and excluded from full participation in society. The Mental Health Foundation was contracted to provide workshops for mental health service providers to shift workplace attitudes and behaviours that were discriminatory or stigmatising. This thesis used a case study approach to capture and evaluate the significance and nature of the transitory form of process drama in three workshops I facilitated in largely Maori communities in the far north of the North Island. The principles of reflective practitioner research informed the use of research tools, data collection and analysis. This research focused particularly on reflective strategies that occurred inside process drama work and the way in which meaning was constructed in that context. The central research question asked: 'In what ways does process drama work to assist people to reflect on their attitudes and behaviours associated with mental illness?' This raised a secondary question: 'What potential is there for a model to counter stigma and discrimination that uses process drama as a central strategy?' This thesis posits a new model for understanding the nature of reflection in process drama. The mimetic notions of the fictional and the real as discrete and defined entities should instead be seen as permeable frames of existence that on occasions collide and collapse into each other. The double paradox of process drama is that, having created an empathetic relationship with the roles taken, we purposefully structure distance so we can then deliberately collapse the distance to create deep moments of reflection. I suggest a more accurate term to describe reflection in process drama is refraction. Refraction acknowledges that, rather than clarity, process drama seeks ambiguity: instead of resolving issues it seeks to further problematise and complexify. The tension of working with a democratic and open-ended art form towards a pre-ordained end as part of the project is closely examined. The impact of performative rituals and proto drama processes as part of the context of working in Maori settings is also explored. A three step model for countering stigma and discrimination is formulated and workshopped. The content of the model is based on an analysis of research undertaken within an anti-racist context, and models that have informed similar mental health campaigns. The form of the model is process drama. An analysis of the workshops demonstrated that the first model developed was limited in its effectiveness. Instead, participants should engage in repeating cycles of generating and investigating images. This leads to the development of what I have termed the Spiral Three Step Model. Although the effectiveness of the Spiral model is not tested in this research, it became apparent that the workshops based on this structure provided opportunities for participants to consider and reflect/refract deeply on their workplace's attitudes and behaviours.

Self neglect among older people refers to situations in which older individuals fail to adequately maintain their environment and to perform essential self care tasks. This concept has been variably addressed in the fields of biomedicine, adult protection, and suicide prevention, yet minimal research has been conducted on this topic in Australia. While the existing literature acknowledges that these situations can pose considerable challenges for professionals, no research has explored the actual experience of these dilemmas in professional practice. This thesis aims to address these gaps by critically exploring how self neglect among older people is understood in the Australian context, investigating the content of ethical dilemmas that arise in these situations, and examining how professionals resolve these ethical dilemmas. A two-part, qualitative methodology was used to address the research aims. In Part One, a five-month period of participant observation was conducted at a community-based organisation that had obtained funding to provide case management to people living in squalor. In Part Two, 18 semi-structured interviews were conducted with professionals who worked with situations of squalor and self neglect in the community. The results from both parts of the research were analysed using NVivo, a software program specifically designed to assist in the analysis of qualitative data. This research uncovered that, unlike the definition of self neglect used in the wider literature on this topic, participants clearly differentiated between personal neglect (self neglect) and environmental neglect (squalor and hoarding). Ethical dilemmas were common in these situations and fully understanding how professionals resolved these dilemmas required that both objective and relational approaches to ethics be used to analyse participant responses. In this way, a pluralistic approach to ethics emerged as the theory best suited to fully explore ethical decision-making in situations where older people were self neglecting or living in squalor. Decisions that resulted in good outcomes were found to be increasingly constrained by changes to services driven by neoliberalism and managerialism. Individual reflection and peer support emerged as important elements that helped professionals to cope with the ethical dilemmas and the practical constraints that were encountered in these situations.

Psychosis has long been recognised as a severe mental disorder characterised by derangement of personality, disorganised thought, and a loss of contact with reality. Certain mystical and alternate states, which have been practiced throughout history by various cultures, have also been deemed as pathological through the lens of western psychiatry even though many of these states provide beneficial contributions to the individual and their community. A number of similar states have been found in modern society and have been termed "Spiritual Emergencies". The aim of this research was to determine whether "spiritual emergency". (SE) is a valid concept and to outline the differences between SE and psychosis. One-hundred-and-nine participants from the general public completed a questionnaire developed for this research, comprised of measures of psychosis and ten spiritual emergency subscales. Results indicated that participants who were prescribed medication or previously experienced a psychotic episode scored higher on the SE subscales. One strong factor was found to underlie all the SE subscales and a significant relationship was found between this factor and the measure of psychotic experience. It is open to interpretation as to whether psychosis is nothing more than SE or whether SE is nothing more than psychosis. The implications of these findings are discussed. / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2008

This research examines interventions with adolescents in out-of-home care diagnosed with severe conduct disorder. Interventions from the service sectors of mental health, juvenile justice, child protection and welfare are reviewed and discussed. The research centred around three hypotheses. Firstly, that adolescents in out-of-home care diagnosed with severe conduct disorder have poor treatment outcomes. Secondly, that adolescents in out-of-home care diagnosed with severe conduct disorder are a particularly difficult client group to work with because of issues of attachment. Thirdly, that a diagnosis of severe conduct disorder negatively impacts upon the work professionals undertake with these young people. These hypotheses were considered in the context of an extensive literature review as well as findings gleaned from interviews and questionnaires conducted with research participants drawn from the abovementioned service sectors. Research participants were senio r practitioners and managers with many years of practice and experience working with adolescents in out-of-home care diagnosed with severe conduct disorder. The main findings from the research were that all three hypotheses appeared to be supported. These were that adolescents in out-of-home care diagnosed with severe conduct disorder have poor treatment outcomes and that one of the particular difficulties of working with this client group is the issue of attachment. Also, that the diagnosis of severe conduct disorder negatively impacts upon the work professionals undertake with these young people. These findings are discussed within the theoretical frameworks of attachment theory and critical theory, which are utilised in exploring the alienation and oppression of these young people on intrapersonal, interpersonal and societal levels. Finally, implications for social work research and practice are considered.

"January 2004" / Includes bibliographical references (leaves 297-313) / x, 313 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Social Sciences, Discipline of Gender and Labour Studies, 2004

<p>Background: During the last decades patient satisfaction has become an important measurement of quality in psychiatric care. However the patients are seldom asked to evaluate the treatments.</p><p>Objectives: The aim is to determine which factors the outpatients regard as beneficial in their psychiatric treatment. The purpose is explorative. During the study another purpose developed; to present research on the importance of the relationship between the caretaker and the caregiver for the outcome.</p><p>Method: 30 persons were interviewed about what they found helpful in psychiatric treatment. The interviews were open using Grounded Theory as methodological input.</p><p>Result: The most prominent topic was the quality of the relationship between the caregiver and the caretaker. The characteristics of a helping relationship seem to be when the patient:</p><p>- is being listened to and understood by a caregiver who is interested and concerned.</p><p>- is not only seen as a caretaker with problems but also as a complete person, someone more than an equation of symptoms, diagnoses and shortcomings</p><p>- is seen as a person worth listening to with unique knowledge which matters to the caregiver</p><p>- is seen as a unique person not possible to minimize to just another case</p>

<p>Syftet med denna beskrivande litteraturstudie var att beskriva vårdpersonals attityder till personer med psykisk sjukdom. Litteratursökning genomfördes i databaserna Medline och PsycINFO och totalt valdes 15 vetenskapliga artiklar ut. Resultatet delades in i två huvudkategorier: attityder till psykisk sjukdom samt skillnader i attityder. Resultatet visade att vårdpersonal generellt sett hade en negativ syn på personer med psykisk sjukdom och ansåg att de var farliga, oförutsägbara och mer benägna att ta till våld. Detta ledde till att personalen försökte undvika konflikter med dem och de tyckte även att det var svårt att kommunicera med dem. Attityderna varierade beroende på vilken sjukdom personen led av. Exempelvis ansågs en person med schizofreni vara långt mer farlig än en person med depression och den senare ansågs ha större chans till tillfrisknande. Sjuksköterskor och läkare var positiva till psykiatriska vårdinrättningar i bostadsområden men de ville inte ha sådana där de själva bor. Sjuksköterskor tycktes ha en mer positiv attityd än läkare till personer med psykisk sjukdom och de som jobbade inom psykiatrin hade en mer positiv attityd än de inom somatisk vård. Några större, entydiga skillnader mellan män och kvinnor har inte funnits, men yngre personal tycktes vara mer negativa än äldre.</p> / <p>The aim of this descriptive literature review was to describe the attitudes of health personnel towards people with mental illness. The literature was gathered through the databases Medline and PsycINFO and a total of 15 scientific articles were chosen. The result was divided into two main categories: attitudes to mental illness and differences in attitudes. The result showed that health personnel in general had a negative view of people with mental illness and they regarded them as dangerous, unpredictable and violent. The personnel tried to avoid unnecessary conflicts with them and thought of them to be hard to communicate with. The attitudes varied depending on what psychiatric illness the person suffered from. A person with schizophrenia was believed to be more dangerous than a person with depression and the latter was believed to have a higher chance to recover. Nurses and doctors were positive to mental health services in residential neighbourhoods but didn't want to live next door to a person with a mental illness. Nurses seemed to have a more positive attitude than doctors to people with mental illness and personnel working in psychiatric care had a more positive view than personnel working in somatic care. Any unequivocal differences between men and women have not been found, but young health personnel seemed to be more negative than elder.</p>

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