Esta investigaÃÃo discorre sobre as experiÃncias intersubjetivas de trabalho situando-as na micropolÃtica cotidiana de um CAPS que vem reorganizando algumas de suas aÃÃes. Buscamos compreender tais experiÃncias articulando-as Ãs posiÃÃes e disposiÃÃes dos agentes que as vivenciam, o que nos levou a identificar algumas configuraÃÃes relacionais relevantes entre os trabalhadores. Dialogamos com diversos autores que vem abordando a temÃtica do trabalho em saÃde no Brasil e em equipes comunitÃrias de saÃde mental na literatura estrangeira. A literatura nacional neste campo, caracterizada por uma propositividade importante para a constituiÃÃo de um ideÃrio sobre o trabalho em saÃde, apresenta, no entanto, lacunas em relaÃÃo a estudos empÃricos que enfoquem ambivalÃncias e contradiÃÃes emergentes nos microprocessos cotidianos. Isto nos levou a trilhar uma trajetÃria alternativa, referenciada no percurso histÃrico da constituiÃÃo do trabalho em saÃde e dos processos de profissionalizaÃÃo, de maneira a enfocar as interaÃÃes estabelecidas entre os trabalhadores considerando as relaÃÃes e conflitos interprofissionais, bem como as concepÃÃes, dificuldades e limites do trabalho coletivo e multiprofissional em saÃde mental. Utilizamos um referencial metodolÃgico fundamentado na hermenÃutica crÃtica, de maneira a compreender as experiÃncias intersubjetivas de trabalho nas suas diferentes versÃes emergentes entre os trabalhadores. Apresentamos uma contextualizaÃÃo de Ãmbitos sÃcio-histÃricos, locais e singulares de maneira a inscrever processual e dialeticamente tais experiÃncias, dotando-as de mÃltiplos sentidos. As experiÃncias intersubjetivas de trabalho sÃo permeadas por ambivalÃncias e contradiÃÃes emergentes no cotidiano que representam limites e possibilidades para a constituiÃÃo de uma nova prÃxis coletiva entre os trabalhadores. Ãs dimensÃes Ãticas e polÃticas que referenciam o trabalho em saÃde, devem associar-se dimensÃes afetivas, por compreender o afeto como uma potÃncia mobilizadora de disposiÃÃes e de posiÃÃes que permitem reconfiguraÃÃes em relaÃÃes de saber/fazer/poder estabelecidas. / This reasearch investigates the intersubjective experiences of work in the cotidiane micropolitical processes of a community mental health service. We tried to understand the experiences in articulation to the dispositions and positions of the workers. This process conducted us to the identification of some relevant relational configurations considering the perspective of the workers. We established a dialogue with several authors that investigate the health work in Brazil and the mental health community work in other countries. The national literature presents a propositive tendency that contributes to the elaboration of some principles for the health work. However, new empirical studies are necessary to understand the ambivalences and contraditions that appear in the cotidiane between the health workers. Thus, we decided to study this subject considering the historic process of health work and profissionalization, in order to understand interprofessional interactions and conflicts that affect conceptions and establishe possibilities and restrictionas for the constitution of a collective multiprofessional work in mental health. We used a critical hermeneutic approach presenting the multiple versions of the workers experiences relating them to different contexts. Ambivalences and contradictions are relevant in the intersubjective experiences of work and they represent restrictions and possibilities for the constitution of a new praxis among the workers. Ethical and political dimensions of the health work may be associated to affective dimensions, understanding the affect as a potent agent in the mobilization of positions and dispositions that may conduct to reconfigurations of established relations.

Given the high prevalence of client unilateral termination from psychotherapeutic services, elucidating client reasons for ending therapy is an important activity for researchers. Three studies were designed to shed light on reasons for both premature and appropriate termination from the perspective of adult clients and therapists: 1) In Study 1, I examined data from the Canadian Community Health Survey, Cycle 1.2, to establish base rates of client reasons for psychotherapy termination in Canada, along with their demographic and clinical correlates, 2) In Study 2, I used training clinic data to examine client and therapist perspectives of reasons for termination, working alliance, and barriers to treatment participation in mutual versus unilateral terminators, and 3) In Study 3, I collected data from Canadian clinical psychologists to examine their perspectives of client reasons for early versus later termination, and their use of engagement strategies to reduce client-initiated unilateral termination. In Study 1, 43.1 percent of respondents reported terminating therapy for reasons other than feeling better or completing treatment. In general, individuals with low income and diagnosable mental disorders had significantly increased odds of premature termination. Study 2 revealed that when clients made unilateral decisions to end therapy, therapists were only partially aware of either the extent of clients’ perceptions of their success in therapy or with their dissatisfaction with therapy. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by both clients and therapists than in the context of mutual decisions to terminate therapy, all clients, in general, rated the early alliance and barriers to treatment as higher than did their therapists. In Study 3 psychologists assigned differential importance to reasons for termination depending on whether termination was before versus after the third session. Theoretical orientation (CBT versus other) did not influence views of reasons for termination, but influenced use of some engagement strategies. Results are discussed in terms of research and clinical implications.

There is a tremendous discrepancy between the number of people likely meeting criteria for a mental disorder or substance dependence in Canada and the number of people actually receiving mental health or substance dependence treatment. Thus, it is important to examine what facilitates entrance into the mental health care system and what prevents people from receiving the treatment they need. Mixed findings exist as to whether socioeconomic status (SES) and other social determinants of health play a role in receiving treatment in Canada. However, due to several methodological issues with previous studies that have examined this issue, three studies were designed to re-examine and add to the literature in this area by investigating: (1) whether SES (i.e., income and education) and other social determinants as well as psychological distress predict the number of services received by any professional for any mental disorder or substance dependence, as well as predict overall satisfaction with the services received (2) the psychometric validity and reliability of the 3-factor model proposed by Statistics Canada to measure barriers due to accessibility, acceptability and availability, and (3) whether SES, other social determinants and psychological distress predict specific barriers to receiving mental health treatment for an unmet need. All data were obtained from the Canadian Community Health Survey, cycle 1.2, Mental Health and Wellbeing. In Study 1, the SES/social determinants model predicted the number of services received for both medication and psychotherapy. Out-of-pocket spending, was the strongest predictor of the number of consultations from any provider, however it was also inversely related to overall satisfaction with services. Higher levels of distress predicted greater dissatisfaction with services received. Study 2 revealed that the three factor model of accessibility, acceptability and availability was invalid and unreliable as a measure of barriers to mental health services. It is, therefore, recommended that each specific barrier be treated as an independent causal indicator of an index measuring overall accessibility to mental health services. Finally, in Study 3, when examining each barrier independently, both education and income played important roles in recognizing there was a problem, seeking services, and actually accessing the services needed. Other social determinants also played important roles which differed depending on the type of barrier being examined. The results of the three dissertation studies indicate a clear relation between SES, other social determinants and psychological distress, and accessibility and barriers to mental health services in Canada for those suffering any mental disorder or issue related to substance dependence. The findings have significant implications in terms of potential policy implications, recommendations for the design of future national level surveys, and recommendations for future research on this topic.

At the present time there is very little informational data available relating to the adult psychiatric day treatment centers in the province of British Columbia. In recent years the trend in psychiatric care has been to treat people within their family and community setting. Within the past five years, four new day care centers have been established at various hospitals throughout the province of British Columbia. The purpose of this descriptive survey was to provide a composite picture of the currently functioning adult psychiatric day care centers. A total of five official and two unofficial day care programs were surveyed and 290 patient records were examined. The specific areas of interest in day care functioning centered around; the family and community involvement in the treatment program, the types of treatment that were used, the type of role the staff carried out, the total program evaluation and a profile of the patients who were treated by this modality. To collect the data, the researcher used; a questionnaire which was answered in a taped interview, observational visits to each center, and an examination of the patients' records. The results of the questionnaire indicated that family involvement in the total day program was generally limited, group methods of treatment were used which gave the patients a sense of community, and patients were followed-up either by the day care center or by the referral source. Referral of patients to these centers were mainly from in-patient wards, other psychiatrists and psychiatric clinics. The criteria that was used to terminate a patient's treatment was on the basis of his actual performance in the program and his level of functioning at home and in the community. This was also the prevalent method used to evaluate the effectiveness of the total treatment program. Staff in these day care centers were both permanent and rotating with their role function being both specific and generalized. An examination of the patients' records revealed that the average patient was 33 years old, generally female, single, diagnosed as being depressed, above Grade 11 in education and presently unemployed. Seventy-seven per cent of the patients had previously received psychiatric treatment and the length of stay in the treatment program was 54 days. Findings from this study indicated that a wide variety of patients were treated in day care, which, had these centers not been available, would have been admitted to an in-patient ward. Day care is not only an alternative to hospitalization, but it may be the choice method of treatment for many patients. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis submitted in fulfilment for the requirements of Masters Degree in Psychology, University of Zululand, 2002 / The present investigation is a descriptive experimental study with two conditions (experimental and control conditions). The main aim was to develop, implement and evaluate a program directed at educating health professionals and families to accept and manage people presenting with mental health problems. The second aim was to teach mental health promotion strategies. To this end, a questionnaire was administered to a group of health professionals and relatives. Results suggest that the participants' training programme significantly improved attitudes and increased knowledge and understanding about mental illness.

The purpose of this report is to introduce the reader to the system of psychiatric services in Sweden. The format of this report is a brief summary of the economic, political and value context of the Swedish welfare state, a review of the essential services available to the Swedish citizen under present Swedish social welfare policy, and then an overview of Sweden's psychiatric system. The overview of the system itself includes a discussion of general characteristics as well as an examination of the system as it operates in one particular region.

This thesis is a descriptive study of five child day treatment centers in Oregon. Its purpose was to generate hypotheses about the relationships between parent reactions to the day treatment center, the center’s theoretical orientation toward treatment, and the organizational structure of the center. The five centers involved in the study were: Poyama land in Independence, Oregon; the Child Psychiatric Day Center in Portland, Oregon; Mid-Columbia Children’s Center in the The Dalles, Oregon; the Child center in Eugene; and Edgefield Lodge in Troutdale, Oregon. These centers were selected for this study because of their proximity to the Portland area and their requirement that parents be involved in their child’s treatment program. Data were collected by a parent questionnaire, a staff questionnaire, and an interview with the executive director of each program. All three data collection instruments were designed specifically for use in this study.

The development of mental health services emerged from South Africa’s colonial history and the racist policy of apartheid’s influence on colonialism, race and legislative framework within mental health services. In social work practice, the critical issue relates to the required knowledge of DSM as it relates to the process of diagnosis guidance in social work education and practice. Assessment is a cornerstone of social work practice in the mental health field to gain a comprehensive and holistic view of our clients and their lives, not only a focus on both the person and the environment, but also to assesses their strengths and capabilities. Social workers are viewed as an important profession which have a huge contribution to mental health issues through prevention and early intervention, without considering whether they are working in a specialised mental health role, and regardless of the setting in which they work. The present study explored and described the experiences of social workers in the provision of mental health services in Johannesburg. The present study followed a qualitative research approach which was utilised and guided the research study. A case study design was selected and used in this qualitative study to explore the experiences of social workers in the provision of mental health services in their respective mental health institutions with Johannesburg. The research study made use of the purposive sampling technique and a semi-structured interview guide with open-ended questions, which were used in face-face interviews to collect data for the study. Ten interviews were conducted with social workers who provide mental health services in Johannesburg, whereby seven participants were from CGMHS and three were from Tara Psychiatric Hospital. The researcher reported on all ten participants who participated in the present study, which also included the pilot done prior the actual study. The findings indicated that social workers have knowledge and understanding of mental health services, what mental health services are, and how mental health care should be aligned with social work practice. The study found that social workers provide numerous services in their respective mental health institutions where they worked. The study found that social workers have working relations with other stakeholders who also have a role in mental health issues such as the police, to mention few. The findings also indicated a lack of continuous mental health training for social workers who work in the field of mental health as well as a lack or limited support and supervision. Lastly, the findings showed that social workers in the field of mental health encounter a numerous challenges such as lack of resources, staff compliment, relapse of mental health care users, financial support, stigma towards users, lack of leadership and ineffective policies and systems in the field of mental health. The study concludes that social workers do understand what mental health services are, and their role and tasks in the field of mental health. It can be also concluded that a lack of support and supervision is overlooked for social workers who are providing mental health services in respective mental health institutions and they are faced with various challenges which makes their work difficult to cope with under certain circumstances. Recommendations in the present study include that professional social workers be trained very diligently and comprehensively in the mental health field and such training should be continuous so as to improve the services provided by social workers in the field of mental health. / Mini Dissertation (MSW (Health Care))--University of Pretoria, 2021. / Social Work and Criminology / MSW (Health Care) / Unrestricted

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