Concurrent and prospective relationships between symptoms of depression, anxiety, attention deficit/hyperactivity disorder (ADHD), and conduct disorder (CD) and academic achievement were examined in a large sample of Canadian children. Students in Grade 5 (N = 715) completed the depression and anxiety subscales of the Behaviour Assessment System for Children – Second Edition. Parents reported on their child’s symptoms of ADHD and CD using the Brief Child and Family Phone Interview. Academic achievement was measured using teacher-rated learning skills and students’ grade point average (GPA) from their Ontario Student Record (OSR) in fifth grade and again in sixth grade (N = 627). Symptoms of depression, anxiety, ADHD, and CD were significantly negatively correlated with academic achievement at Time 1 and Time 2. After controlling for child’s sex, household income, maternal education, and days absent, children’s mental health problems accounted for an additional 12% and 11% of the variability in their Time 1 mean ratings of learning skills and GPA, respectively. Only symptoms of ADHD predicted Time 2 GPA (1% of the variance) after controlling for Time 1 GPA and other sociodemographic variables. Findings highlight the unique contribution of mental health problems in predicting academic achievement and point to the need to promote children’s mental health in schools.

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> This paper, written in journalistic style, discusses the disclosure of mental illness and its relation to stigma and discrimination. It consists of two magazine length articles. The first article (designated as Chapter I) is about the personal disclosure of mental illness by mental health professionals, including psychiatrists, psychologists, social workers, and others who have experienced mental illness themselves. This article discusses the extent of mental illness among professionals, the reasons professionals often remain silent, the risks and benefits of disclosing, and the complexity involved in revealing mental illness. The second article (designated as Chapter I) discusses disclosure as it pertains to all people who have mental illness. This article discusses disclosure and its relationship to stigma and discrimination, why stigma exists and persists, the disclosure of mental illness on the job, and the role of work in stigma reduction and recovery.</p>

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There is increasing awareness that mental health consumers may have important information for the development of services. In this qualitative study, I interviewed 10 consumers with the purpose of exploring in depth their experiences in interacting with service providers in the greater Vancouver area. Using constant comparative analysis, I found that the data suggested participants’ experiences of recovery developed largely out of connecting with other consumers rather than with service providers. Current services were portrayed as primarily reliant on the use of psychiatric medication. Consumers pointed to numerous difficulties in seeking help, including a lack of treatment alternatives, stigma and isolation. They also presented a strong demand for services and policies that promote an individual sense of recovery and support their fundamental human rights. Mental health service providers need to critically reflect on their current practices and policies, and how they may negatively impact their clients' lives by failing to properly listen to their narratives, grievances, experiences and perceptions. This study suggests further inclusion of consumer's views and participation in services to foster collaborative, recovery-oriented practices.

Abstract The global burden of neuropsychiatric disorders is rising worldwide. This burden will be felt most in developing countries which have limited resources to respond. Within the health sector, mental health has traditionally been a low priority in most countries, resources to address the burden are limited and mental illness competes with other serious disease for government attention. Despite high-profile international statements, mental health reform has been slow and mental health has remained a low-level political priority, particularly in developing countries and Newly Independent States. There is growing recognition of the need for mental health development and reform. There is growing consensus that successful delivery of mental health interventions to address the disease burden is constrained not only by resource limitations but also by the absence of policy and planning frameworks to identify and deliver these interventions. This thesis highlights that the preparation and adoption of a policy position and the development of a comprehensive policy document is the outcome of a range of complex interactions between environmental factors and the stakeholders within the policy environment. There is growing recognition within the policy sciences literature that a comprehensive understanding of the overall policy process requires an individual and combined understanding of the content of a policy and the processes involved in achieving policy status and implementing policy. Little is documented regarding the content domains and elements which should be included in a mental health policy and the key variables within the policy environment which impact on the mental health policy development process. As a result there are no universally applicable blue prints or policy formulation tools for mental health policy which recognise the complexity of mental health systems and identify key issues which need to be considered in understanding how to promote mental health onto the policy agenda, how to develop a policy once this has been achieved and how stakeholders can more effectively engage in mental health policy agenda building. This thesis addresses this issue by undertaking three distinct but interlinked tasks. Part 1 contributes new knowledge to the area of mental health policy content. It identifies the key content domains and elements which constitute a comprehensive mental health policy. The domains and elements are validated through an extensive consultative process, undertaken by the author, with key mental health stakeholders in 40 countries in all six WHO regions of the world in 2000 and 2001. Based on this work the thesis develops an innovative conceptual tool for mental health policy makers, The Mental Health Policy Template. Whilst responding most particularly to the needs of developing countries and Independent States, the Template is sufficiently generic to be used in a range of countries, provinces and at district levels. The experience of many mental health reformers in developing countries and Newly Independent States is that raising mental health onto the policy agenda and maintaining it there is an on-going challenge. Conceptual models for understanding mental health policy process are extremely limited. Part 2 of this thesis responds to this situation by drawing on the policy analysis literature, with particular focus on agenda building. It identifies two key variables, Context and Stakeholders and their components. These variables are argued to impact on raising mental health onto the policy agenda. The applicability of these variables and their components is demonstrated through the analysis of two country experiences of mental health policy development and reform. One country, Lithuania is a Newly Independent State and the other, Zambia is a developing country. The information collected for these country studies was developed by a series of country visits and stakeholder consultations by the author between 2000 and 2007. The analysis of the country data suggests that the experiences of two quite disparate countries can be usefully organised using the variables and components identified from the literature and may be applicable across a diverse range of countries. This constitutes new knowledge of the variables which impact on mental health policy process and mental health policy reform. Part 3 of this thesis proposes a conceptual model which synthesises the new knowledge established in Part1 and 2. A Mental Health Policy Development Model is proposed which brings together the policy literature and country experiences. It identifies the key content and process factors which need to be considered in mental health policy development and reform with particular application to developing countries and Newly Independent States. The model can be used by those wishing to more fully understand and undertake mental health policy development and reform. To my knowledge such work has not been undertaken in the area of mental health and constitutes a basis for further development in the field. Finally, the thesis acknowledges the formative nature of the work and makes suggestions for further research to build this knowledge ideally in partnership with other key mental health policy stakeholders throughout the world.

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