While health authorities have administered licensed residential care facilities for years, in the last two decades, health authorities have increasingly contracted with nonprofit organizations to house persons diagnosed with mental illness in the community in "supported" projects. Services may include medical and/or social supports such as medication, addiction services, case-management and life skills training. While flexible supports customized to meet the needs of service users may sound encouraging, numerous questions remain. This thesis generates a basis from which to explore how services might shift to better meet the needs of tenants. To do so, I examine meanings of support from a tenant perspective and consider the environment in which tenants experience support in supported housing. The analysis involves semi-structured, one-on-one interviews with two female and four male tenants who had been previously homeless, currently living in one supported housing project in a mid-sized city in British Columbia, Canada. The study draws on love ethic and neoliberal theory in an effort to frame mental health service user understandings and mainstream models of support. The tensions between support services employing principles of love ethic theory and mainstream models raise the question of whether the two models can co-exist, and if so, how and where compromises are made and at whose expense. These tensions are evident in the data and in turn are taken up within the analysis. Tenant meanings of support include relationships and resources that increase safety, security and independence, understood as the freedom to identify your own goals and maintain control over the support you receive. The findings point to a vital need to ensure tenants are included in decision-making with regard to support practices and policies. Utilizing tenant knowledge would go a long way toward addressing many of the concerns and dilemmas which surface in the research.

This study examines the experiences of dementia caregivers (DCs) and caregivers of older adults with non-dementia related mental illness (CMIs) through the application of Pearlin's stress process framework, which conceptualizes the caregiving experience as an interplay between various contextual factors, stressors, moderating resources, and outcomes variables. A total of seven caregivers (4 DCs, 3 CMIs) participated in this study. Participation involved a one-on-one semi-structured interview focused on tapping into the components of Pearlin's framework, following which participants completed three measures (CES-D, STAI-Trait form, SF-36) aimed at assessing levels of depression, anxiety, and physical and mental health, respectively. Qualitative data were analyzed using content analysis and quantitative data were examined in relation to qualitative results and to normative data. Qualitative analysis revealed that CMIs are exposed to particularly severe forms of problematic behaviours and that they utilize far fewer formal services and resources. In relation to quantitative findings, it was found that, in general, the CMIs experienced higher levels of emotional distress and worse physical health and functioning. Overall, results suggest a need for research focused on how formal services could be modified to best capture the needs of the diverse population of CMIs.

In recent years, mental illness in pregnant and postpartum women has become a public health concern. Untreated and undertreated maternal mental illness has a significant negative impact on not only the mother, but also on the baby and family. Further, many women do not seek help or access mental health care due to stigma surrounding mental illness, the unrealistic social expectations of motherhood, and the fear of being judged or rejected. An interpretive descriptive study informed by a feminist perspective was conducted with six postpartum women who sought maternal mental health care services. Semi-structured interviews provided an opportunity to explore women’s experiences of having a maternal mental illness, accessing care, and the role of stigma. Analysis focused on the bio-psycho-social dimensions of their experiences. A shared experience and meaning emerged: self stigma and expectations of motherhood, stigma and infertility, factors influencing self stigma, level of self-efficacy, and treatment satisfaction, engagement and outcome. Findings are discussed with reference to the current literature on maternal mental illness, stigma, and infertility. Findings are conceptualized using Brown’s (2006) Shame Resilience Theory, implications for practice are presented including women’s advice to other women, and recommendations for future research are made.

Alla människor har en vardag, med rutiner, vanor och förpliktelser som upptar vår tid. I denna uppsats undersöker jag hur fyra personers vardag formas och påverkas av psykisk ohälsa. Den vardag de beskriver handlar i första hand om att bemästra den psykiska ohälsan och ta kontrollen över hur de mår. För att lyckas med detta använder de sig av olika hjälpmedel, där mediciner är det viktigaste. Medicinerna är en stor del i att informanterna kan hantera sin vardag, men den psykiska ohälsan ger även verkningar i andra aspekter av vardagen, såsom arbetsliv, ekonomi, hur de ser på sig själva och hur de uppfattas av andra. / All people have their own routines, habits, and commitments to deal with on a daily basis. In this essay, I examine how four individuals’ everyday lives are shaped and influenced by their mental illnesses. They describe how the primary tasks of their everyday struggles are to master their mental health by controlling their mood and their feelings. To succeed with this, they use different aiding methods, where medications are the most important ones. The medications are essential in helping the informants to handle their everyday lives, but the mental illnesses also affect other aspects such as work, finance, self-image, and how they are perceived by others.

This study explored Canadian nurse practitioners’ (NPs) levels of therapeutic commitment (TC), role competency (RC) and role support (RS) when caring for persons with mental illness and mental health problems. Knowledge and experiential factors that impact these levels were examined and a model of therapeutic commitment was tested. A self-administered mail survey was sent to 1272 NPs from all Canadian jurisdictions except the Yukon, Saskatchewan and Quebec. The survey was comprised of the Mental Health Problem Perceptions Questionnaire (MHPPQ), demographic data and open-ended questions. Using Dillman’s Tailored Design Method, the target population was contacted 4 times: pre-notice letter, first survey, reminder letter, and repeat survey. Of the 1272 potential participants, 680 (57.2%) useable surveys were received. Out of a possible maximum score of 7, NPs reported mean levels of 5.05 (SD 0.83) on the TC, 5.02 (SD 0.88) on the RC and 4.86 (SD 1.27) on the RS subscales. As hypothesized, correlations between the three subscales were demonstrated with RC and TC being the most strongly associated (r = .754, p <.001). A composite variable, Confidence to Manage, which examined NPs’ confidence to manage 7 mental health disorders and suicide ideation was developed. Scores for this variable correlated with TC, RC and RS scores. Feeling ill-equipped to work with this population, knowledge of community mental health services, ratings of relevant theoretical and clinical NP education, previous mental health and NP work experience were all positively correlated with higher levels of the 4 subscales. Differences in categories for population size of the community the NP worked in, frequency of collaboration for psychiatric reasons, time since the NP accessed mental health education and highest level of nursing education were found to impact levels of TC, RS, RC and Confidence to Manage. A large number of NPs reported feeling inadequately prepared to manage the care of persons with mental illness and recommended either adding or increasing mental health education in their NP programs. Most NPs saw the care of this population as part of their role and acknowledged the need for increased support for persons with mental health issues.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1991. / Includes bibliographical references (leaves 83-96) / Microfiche. / ix, 96 leaves, bound ill. 29 cm

The high rates of depression and suicide among older adults have given rise to research which aims to identify factors that protect older people from mental illness. Recently, Bailey and McLaren (2005) developed and tested a model which investigated the relationships between engagement in various leisure activities performed alone or with others, sense of belonging, depression, and suicidal ideation. The present study examined an extended version of the mental health model, incorporating the additional variables of perceived freedom in leisure and physical health status. A sample of Australian males and females (N = 379) aged 65 years and over (M age = 77.23, SD = 7.48) completed the Perceived Freedom in Leisure Questionnaire, the Yale Physical Activity Survey,the Duke Health Profile, the Sense of Belonging Instrument, the Centre for Epidemiological Studies-Depressive Scale, and the Suicide Subscale of the General Health Questionnaire. Results indicated that the model was invariant for gender, and accounted for 56% of the variance in suicidal ideation. The model indicated that physical health had direct relationships with each variable in the model. Perceived freedom in leisure predicted engagement in physical activity, sense of belonging-antecedent, and depression, whereas sense of belonging psychological state predicted depression and suicidal ideation. Results suggest that interventions aimed at improving older adults’ perceptions of freedom and personal choice with regard to their leisure experiences, maintaining optimal health, and increasing opportunities to foster feelings of belonging and relatedness with others, should protect against the development of mental ill health. / Doctor of Psychology (Clinical)

The high rates of depression and suicide among older adults have given rise to research which aims to identify factors that protect older people from mental illness. Recently, Bailey and McLaren (2005) developed and tested a model which investigated the relationships between engagement in various leisure activities performed alone or with others, sense of belonging, depression, and suicidal ideation. The present study examined an extended version of the mental health model, incorporating the additional variables of perceived freedom in leisure and physical health status. A sample of Australian males and females (N = 379) aged 65 years and over (M age = 77.23, SD = 7.48) completed the Perceived Freedom in Leisure Questionnaire, the Yale Physical Activity Survey,the Duke Health Profile, the Sense of Belonging Instrument, the Centre for Epidemiological Studies-Depressive Scale, and the Suicide Subscale of the General Health Questionnaire. Results indicated that the model was invariant for gender, and accounted for 56% of the variance in suicidal ideation. The model indicated that physical health had direct relationships with each variable in the model. Perceived freedom in leisure predicted engagement in physical activity, sense of belonging-antecedent, and depression, whereas sense of belonging psychological state predicted depression and suicidal ideation. Results suggest that interventions aimed at improving older adults’ perceptions of freedom and personal choice with regard to their leisure experiences, maintaining optimal health, and increasing opportunities to foster feelings of belonging and relatedness with others, should protect against the development of mental ill health. / Doctor of Psychology (Clinical)

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.

The subject matter of mental illness has fascinated artists and writers for centuries. Filmmakers have responded in diverse and innovative ways to the artistic challenge of portraying mental illness. In this thesis, I focus on the representations of mental illness in six recent films from Australia and New Zealand: Sweetie (Jane Campion, 1989), An Angel at My Table (Campion, 1990), Bad Boy Bubby (Rolf de Heer, 1993), Heavenly Creatures (Peter Jackson, 1994), Angel Baby (Michael Rymer, 1995) and Shine (Scott Hicks, 1996). In each film, the protagonist is diagnosed, or treated by others, as mentally ill. Mental illness is portrayed as an affliction which the protagonist struggles to overcome. I argue that these films cultivate a relationship of empathy between the mentally ill character and the spectator. Whereas the related emotion of sympathy involves feeling sorry for someone, empathy involves feeling with that person; in other words, rather than feel for these mentally ill characters, we are invited to feel like they do. (For complete abstract open document)