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This study investigated the relationship between intensity of grief and coping patterns of parents of individuals affected by psychotic disorders. The study investigated the intensity of grief in a sample of parents of individuals with psychotic disorders in Western Australia to determine if the results replicate international studies. It further examined if the characteristics of the psychotic disorders of children, had an impact on the grief reactions of parents and if the disorder had a measurable impact on the nature of the relationship between parents and children. The study also identified specific coping strategies that parents consider as being most helpful to them in dealing with their grief, the relationship between intensity of grief and coping patterns of respondents and gender differences in grieving and coping strategies. The research findings suggest that there is measurable grief in a cross section of parents of individuals with psychotic disorders in Western Australia with many similarities to studies done internationally. The findings also suggest that this grief increases in intensity from the time of first diagnosis and peaks at 1-2 years after diagnosis and again 20 years after diagnosis. There was a strong association between past behaviours related to grief reactions and present feelings related to grief. To the best of my knowledge, these findings have not been reported before. IV Certain characteristics of the disorder of children had an impact on the grief reactions of the parents. Higher levels of grief were reported in parents whose children needed frequent assistance with personal care and children with a late onset of the disorder. / There was a positive correlation in parents who had a close relationship with the child before the onset of the disorder and following onset of the disorder suggesting that the disorder did not affect the relationship. To the best of my knowledge, these findings have not been reported before. While this research has replicated other studies, it has also researched coping strategies that have not been identified before. Although cognitive coping strategies were most frequently used by parents and subjectively found to be more helpful, parents using predominantly behavioural methods of coping showed less intensity in their grief. Parents oscillated between approaching the feelings of grief and distracting themselves from them, which highlighted the idiosyncratic nature of coping. Although there were no gender differences in the intensity of grief, there were distinct differences in coping strategies used by fathers and mothers. These findings have important implications for social work practice and policy development within the mental health settings of Western Australia.

Western researchers conducting studies with Somali refugee participants have identified Somali-specific idioms of psychological distress as well as high rates of Western psychological disorders such as depression and post-traumatic stress disorder (PTSD) in this refugee group. Methodological limitations of these previous studies, however, have limited the validity of the conclusions drawn. These limitations include the use of Western psychometric instruments and diagnostic nosologies, limited information about the methodological procedures undertaken, the apparently unqualified use of terms such as mental illness, madness and craziness in interview schedules, minimal exploration of psychosomatic idioms of distress, and limited applicability of some of the research findings to Somali women.. The current research primarily aimed to address these methodological short-comings and build on the findings of previous studies that have explored Somali conceptions of distress. Two additional objectives were to (i) identify protective and resilience factors which may decrease vulnerability to experiencing psychological distress in Somali women, (ii) gauge non-Somali health professionals' understanding of (a) the nature of distress and suffering experienced by Somali women, and (b) effective treatment modalities to ameliorate this distress. The analytical style employed in all three studies of this thesis was thematic. In the first study, ten Hamilton (New Zealand) based Somali women were interviewed. Particular areas of interest explored in the first study included psychological, physical and spiritual conceptions of distress, the symptoms of key idioms of distress, and the way in which these are managed/treated at the individual, community, and family levels. The findings of Study 1 identified spirit (jinn) possession as a form of distress known by at least some members of the local Somali community. Jinn appeared to be an explanation for both milder forms of distress akin to depression and anxiety, as well as more severe forms of distress similar to psychosis. Treatment for jinn possession tended to focus on Koran readings in conjunction with family and community-based support. Generally participants considered there was a very limited role for mental health professionals and Western psychiatric medication in the extraction of jinn. Faith was considered a key protective factor against experiencing non-spiritual forms of distress such as stress, worry, anxiety and depression. Although war trauma was acknowledged to have an adverse impact on the psychological functioning of Somali women it was not considered to impact on a woman's ability to manage her day-to-day responsibilities. The impact of having family in refugee camps in Africa was, however, identified as a common and very distressing issue impacting on many Somali women. The only way of alleviating the distress associated with this stressor, according to participants, was reunification. Interviewees stated that Western interventions for distress were rarely pursued by Somali as they were not considered efficacious. Given there is evidence that Somali communities residing in various cities in New Zealand are at various stages of acculturation, it was considered important to ascertain how valid the results from Study 1 were considered to be by women from other Somali communities. Six focus groups were conducted with a total of 27 Somali women recruited from three New Zealand cities. The findings of Study 2 identified numerous culturally specific forms of distress reported by participants. These states were qalbijab, boofis, murug, welwel and jinn. These Somali idioms of distress were akin to some Western psychological disorders, particularly the depression and anxiety spectrums. Treatment for Somali forms of suffering were reported to focus on Koran readings, in addition to family and community support. Generally, participants in Study 2 considered there was a very limited role for general practitioners (GPs) and mental health professionals in assisting Somali to deal with psychological and spiritual distress. Consistent with the findings of Study 1, faith was considered the most important protective factor, family separation was described as one of the most significant stressors, and war related trauma was suggested to cause significant distress only if the sufferer had family still in Africa. Study 3 explored non-Somali health practitioners' understanding of Somali idioms of distress, as well as their perspectives about how to best treat Somali presenting with psychological distress. A total of 18 mainstream mental health practitioners, general health practitioners (both GPs and primary care nurses), and specialist refugee mental health practitioners took part in this research. Few practitioners mentioned spirit possession as an aetiology for distress and none mentioned other Somali-specific forms of distress. The psychosocial stressors identified as contributing to the psychological distress of Somali women were relatively consistent across the three groups of practitioners and also consistent with the stressors identified by participants in Studies 1 and 2 (e.g., family separation, social isolation, financial concerns). Interviewees did not consider PTSD to be a common psychological disorder amongst Somali women living in New Zealand. Advocacy work and assistance with day-to-day concerns were suggested by many participants as more efficacious for the amelioration of psychosocial stressors than medication-based treatment. Generally, participants in Study 3 were supportive of traditional forms of healing being used as the treatment of choice by Somali clients. The findings of the current thesis suggest that there are clear parallels between Somali idioms of distress and those of Western cultures. However, the data indicate that equating Somali idioms with Western diagnostic labels would be rejected by Somali. Regardless of the similarity of symptom profile of some of the Somali states to Western states, the manner in which these states are conceptualised, understood and treated is markedly different. The findings of all three studies suggested that Somali tend to opt for their own traditional interventions to treat psychological and spiritual forms of distress rather than engage with Western mental health services. Numerous barriers including long waiting lists, mental health practitioners' apparent lack of knowledge/expertise working cross-culturally and poor treatment outcomes were provided for Somali not engaging with such services. The stigma attached to having a mental illness was also considered a barrier to engaging with mental health services. With respect to improving service provision for non-Western clients, an intermediate service that sits between primary and secondary health care agencies is recommended as an effective means of meeting the needs of non-Western clients experiencing psychosocial stressors and mild to moderate psychological distress. It is imperative, however, that any such service involves key stakeholders from the community groups it would serve, in the design, development, and implementation of interventions.

This thesis considers the response of one New Zealand institution, Tokanui Mental Hospital, to legislation and policies for 'mental deficiency' introduced during the first half of the twentieth century. Institutional reactions to these policies have been under examined in New Zealand. While psychiatric or mentally ill patients have been the subject of a number of New Zealand histories of the asylum, 'mental defectives' have often been overlooked. Yet during the early-twentieth century, 'mental defectives' were thought to be a source of a number of social problems, and the New Zealand government considered a range of measures aimed at limiting the spread and effect of mental deficiency in society. Policies for 'mental deficiency' were influenced by contemporary anxieties about crime, sexuality and hereditarism. As a policy of segregation was formally prescribed, more 'mental defectives' were committed to mental hospitals and other institutions than ever before. An understanding of the responses to this perceived problem also provides an insight into wider social policies in New Zealand in the first half of the twentieth century. This thesis argues that gender was a significant factor in the decision to commit mental defectives to Tokanui. Subsequent categorisation and treatment within Tokanui was also affected by gender. Official reports inform us about the policies that were in place, and historical materials from Tokanui show how these worked in practice. Most of the archives of Tokanui Mental Hospital have been unexamined by historians before now, and close analysis of patient cases also reveals more about institutional practices. The connection between Tokanui and neighbouring Waikeria Prison is also explored, in the context of contemporary fears surrounding mental deficiency and crime.

Doctor of Philosophy(PhD) / Policy makers, service agencies and people with mental illness themselves view employment for people with mental illness as a major concern. This is due to the low rate of employment of people with mental illness, the difficulties many experience in finding and keeping satisfactory jobs, and the perception of paid employment as highly desirable for people with mental illness. The most extensive research on employment for people with mental illness has focused on establishing statistical relationships between various hypothesised predictors of employment success and vocational outcomes. While some attention has been paid to how individuals with mental illness view being employed, this has primarily focused on specific areas such as the benefits of employment, difficulties encountered and coping techniques used. My aim in this research was to develop a theoretical formulation which explains the processes that people with mental illness engage in with regard to employment. Data was gathered by way of in-depth interviews with users of psychiatric services. Some of these participants were employed, others were seeking employment, while others were not engaged in employment-related activities. At the centre of the theoretical formulation is a process I have called negotiating an appropriate vocational place. Using this process, people with mental illness make decisions about actions to take in relation to employment and these may or may not include trying to get and keep a job. Decisions are made by weighing up the benefits and drawbacks of employment and the advantages and risks of different vocational strategies. In doing so, people with mental illness are influenced by the Australian societal context, their individual social networks, their individual characteristics and circumstances (including their mental illness), and their employment options. This process of negotiating an appropriate vocational place is cyclical, ongoing and dynamic, as individuals' views and circumstances change. Knowing that people with mental illness strive toward an appropriate vocational place rather than taking for granted that they are working towards getting a job presents a challenge to policy and practice in which a successful outcome is defined as obtaining and maintaining a paid position in the workforce. Detailing and elaborating the process by which people with mental illness go about negotiating an appropriate vocational place provides a framework for practitioners, policy makers and researchers to understand the decisions made by people with mental illness and their actions in relation to employment. The understanding provided by the findings from this study will assist those working with people with mental illness and those responsible for employment policies to tailor their work more closely to individuals' desired goals. Immediate and longer term research opportunities are identified to apply the theoretical formulation derived from this study to vocational service practice with people with mental illness.