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HIV attacks the health of infected persons. Some of them will develop psychiatric illnesses. / The first chapter examines two of the many possible consequences on mental health. First, an increased incidence of suicide on the part of infected persons and second, the influence of HIV/AIDS on their decisions concerning treatment, in particular when they are terminally ill. / Some mentally ill persons with HIV/AIDS will be involuntarily hospitalized. The second chapter compares the mental health law of Quebec and Ontario governing involuntary hospitalization. / The third chapter examines consent to or refusal of treatment by mentally ill persons with HIV/AIDS in particular with respect to their competence. It explores the law governing substitute decision-making for incompetent persons. / The last chapter considers what protections of the rights of mentally ill people with HIV/AIDS are provided under Quebec and Ontario human rights codes and the Canadian Charter of Rights and Freedoms.

This thesis analyzes the degree of cultural relevance in the Asha Gram Mental Health Program in Barwani, India. The focus is on the role of community mental health workers as bridges between a professional culture of psychiatry and the local cultural understandings of mental health. Processes of cultural interaction are analyzed on a continuum from negotiation, defined as interaction without fundamental cultural change, to accommodation, defined as interaction with cultural change. Accommodation at the level of the vision of mental health disorders was limited while there was an active negotiation that resulted in some transformation of the social vision. Negotiation with communities at the level of relationships underpinned this transformation and contributed to a social accommodation with local forms of relationships. Although, professional and class power were important obstacles to achieving cultural relevance, the Program also demonstrates the necessity to subvert this power in order to create social change.

This thesis explores the relationship between inpatient mental health environments and children and adolescents. Research was conducted by way of observation, questionnaires, interviews, and reading floor plans, partnering with two hospitals in Ontario that offered inpatient child and adolescent mental health services. The primary goal of this study was to develop considerations and recommendations that inform design decisions. I set out to gather the opinions and insights of children and adolescents who were inpatients in these facilities. The staff were also interviewed to capture their views on the role that the physical environment can play in supporting and enabling them to do their best work. The research provided a portal into a complex and sensitive area of study, and offered insights into the experiences and preferences of the children and adolescents. Their perspectives and stories contributed significantly to the knowledge gained in this exploration.

<p> The purpose of this project was to locate a potential funding source and write a grant to fund an evidence-based program, Buried in Treasures, that will help women 35&ndash;55 years old with hoarding behaviors. An extensive literature review was performed to investigate the best way to treat Hoarding Disorder in the community. The proposed program will be located at Mariposa Women's Center and funded by a Promoting Innovation grant by the California Wellness Foundation. </p><p> The primary goal is to help people with Hoarding Disorder while utilizing web tools and newer technology in an evidence-based program. The objectives are to increase quality of life by 20% and knowledge by 30% and to reduce the amount of items acquired. If funded, this structured program will decrease hoarding behaviors and improve mental health. The actual submission of the application was not a requirement of the thesis project.</p>

<p> <b>BACKGROUND AND PURPOSE:</b> This study sought to examine the association of severe mental illness (SMI) among stroke survivors treated in Veteran Administration (VA) hospitals with medical (non-psychiatric) hospitalizations, recurrent stroke hospitalization and mortality risk over a five year period after the initial stroke. Additionally, this study used administrative data to explored inpatient stroke treatment differences between patients with and without SMI. </p><p> <b>METHODS:</b> This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VA medical center during fiscal year 2003. This cohort of stroke survivors was followed from discharge in 2003 through 2008 using administrative data documenting patient demographics, disease co-morbidities, subsequent VA hospital admissions, recurrent stroke admissions, and death. Multivariate Poisson regression with log link functions was used to examine the relationship between SMI status and non-psychiatric hospitalizations after stroke. Cox proportional hazards regression was used to examine the relationship between SMI status and recurrent stroke and post-stroke mortality. The differences in compliance with inpatient stroke treatment guidelines between patients with and without SMI was assessed using logistic regression. </p><p> <b>RESULTS:</b> The study cohort of 523 veterans included 100 with SMI comorbidity and 423 without SMI comorbidity. It was found that stroke survivors with SMI do not have significantly increased risk for non-psychiatric hospitalizations, recurrent stroke or mortality at any time period post-stroke after adjustment for covariates. It was also found that there was no significant difference in the delivery of guideline concordant inpatient stroke care between patients with and without SMI. </p><p> <b>CONCLUSIONS:</b> The finding that SMI had little impact on the post-stroke outcomes of hospitalization, recurrent stroke and mortality among veterans who receive their care at VA hospitals was surprising. It was hypothesized that SMI would continue to disadvantage individuals even after having survived a stroke. These findings may be partially explained by the highly integrated nature of care for the mentally ill in the VA system, which may equalize disparities associated with SMI post-stroke. This study offers preliminary evidence of this in VA hospital inpatient settings where acute stroke treatment did not significantly vary between patients with and without SMI.</p>

<p> The purpose of this dissertation: <i>A Study of the Effectiveness of the Hope For Generations Buddy Partner Prayer Ministry on Christians with Bipolar 1 Disorder Who Exhibit Manic Symptoms</i> is to examine the impact of prayer during the manifest flare up of manic symptoms. The study will focus on the effectiveness of the prayer ministry of the Buddy Partner Prayer Group (BPPG) in &lsquo;Hope For Generation Church Ministry on behalf of participants in the midst of Bipolar Disorder 1 decompensating during worship services. Using a case study approach utilizing eight (8) participants, the results verified the hypotheses and demonstrated that when the Buddy Partner Prayer Group (BPPG) in Hope For Generation Church Ministry prayed, in 7 of 8 cases believers with Bipolar 1 Disorder who exhibited manic symptoms showed a decrease in these symptoms.</p>

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Optimal health is best achieved through direct access to effective holistic and relevant health prevention strategies, timely and accurate diagnosis, appropriate treatment, and follow-up (K. Woodcock & Pole, 2007). Effective two-way communication is an essential component in all of these stages. It increases the opportunity for a thorough assessment, and thereby contributes to an intervention plan that is appropriate, timely, and suitable to that particular consumer. This study explored how a group of Deaf adults, for whom ASL is their primary language, and all of whom have been diagnosed with depression, managed their symptoms of depression in a health care system that privileges hearing and speaking as the primary mode of communication. A case study methodology with individual, in-depth interviews, and the completion of a hand-drawn person and environment map were used. The participants shared the nature and depth of the barriers that exist and that intersect to prevent their equal access to quality mental health assessment, intervention, and follow-up otherwise available to their hearing counterparts. Faced with these intersecting barriers, negative attitudes from some in the dominant society, and the fear of discrimination from their own collectivist community, participants saw few formal options for managing their symptoms of depression. In most cases participants turned to a strategies of an intrapersonal nature. Some engaged in positive activities such as reading self-help books, volunteering within the Deaf community, walking, and, for two, accessing traditional counseling services. More frequently, however, participants were forced to engage in maladaptive activities such as isolating themselves in an attempt to avoid detection of their symptoms. Some distracted from their feelings of isolation and discrimination through exercise, though others used alcohol or over-eating as their strategy. A number of changes or enhancements were recommended by the participants, including creation of a comprehensive Deaf Awareness Training plan for professionals and the associated staff, an increase in the number and availability of ASL/English interpreters, and the creation of Deaf sensitive health promotional and prevention materials in modes easily accessible to Deaf visual language users. The study concludes by exploring implications for policy, practice, and future research.

The full experience of mental illness cannot be described in isolation from the context in which one lives, yet the internal physical manifestation of symptoms has been the focus of treatment in western cultures. The “recovery” paradigm is emerging as best-practice philosophy for mental health practice and represents a significant departure from existing standards thereby challenging mental health organizations to re-negotiate their relationship with the dominant bio-medical model. Despite the growing acceptance of recovery philosophy, literature exploring large-scale recovery-oriented organizational change is sparse. The purpose of this research was twofold; 1) to outline the steps taken by change agents within an organization embarking on recovery organizational change, and 2) to understand the experience, including successes and challenges associated with change. The qualitative data obtained from interviewing seventeen participants revealed the impact of organizational contextual factors, leadership and communication on recovery organizational change. Further, the data exposed the complexity of challenging preconceptions and practice when trying to adopt recovery approaches. The findings may guide other community based mental health organizations in their recovery journey.