Introduction In recent years the concept of ‘recovery’ has become increasingly prevalent in both government and health service policy, and in the terminology used by mental health service users. The current study examines the experiences of recovery as described by service users living in a rural / semi-rural population. This is in contrast to the majority of similar studies, which have tended to focus on urban centres where population characteristics, and the services available to service users, differ in many ways. As such, the aim of the current study was to add to the growing theory regarding what constitutes recovery from the viewpoint of service users living in a relatively remote area of the UK. Methodology Eight adult participants, all of whom defined themselves as either recovering or having recovered from significant mental health problems, were interviewed about their experiences using a semi-structured interview. Interviews were audio-recorded, transcribed and analysed for emerging themes using a social constructionist version of Grounded Theory. Data Analysis & Discussion Analysis revealed a consistent set of themes emerging from the participant interviews. These are encapsulated in the concept of reflection and integration, and the dynamic nature of these phenomena over time. Participants made reference to the nature of their problems and the impact they had on relationships, the treatment they had sought and received, and the effects of their experiences on their notions of themselves as individuals. Conclusions The findings of the current study are discussed in the light of existing relevant literature and in relation to current policy initiatives. Comparisons to the emerging theory regarding recovery are drawn, and distinctions made between the existing theory and the findings which appear to be particularly pertinent to the sample population. Suggestions for clinical applications are made. Limitations of the study are also addressed, and areas for potential further research are outlined.

Class of 2017 Abstract / Objectives: To assess access to and quality of primary health care services by individuals receiving meals at a food bank in a rural location using the Primary Care Assessment Tool- Short Form (PCAT-S). Also, to investigate whether individuals with a mental health condition at a rural community food bank receive different care compared to those without a mental health condition. Methods: The PCAT-S, a survey developed by John Hopkins University, was administered to evaluate care at first contact, ongoing care, coordination of care, and comprehensiveness of care. Demographics data (age, gender, health conditions, insurance status, etc.) was also collected. Results: The majority of our participants surveyed lived within an urban zip code (84.8%), had government insurance (81.4%), were male (61.9%), or were Native American (45%). The groups with the highest mean PCAT-S scores were participants with diabetes (mean score= 96.8), participants with no insurance (94.63), and participants who were female (91). The patient populations with the lowest scores were those with less than a high school education (63.11) with serious mental illness (64), or who had bipolar disorder (69). Groups with higher mean PCAT-S scores indicated more involvement with a primary care provider or overall better care within that section of the PCAT-S. Conclusions: Participants with a mental health condition may be receiving less healthcare than those without a mental health condition, especially in the coordination of care between healthcare services, as indicated by lower mean PCAT-S scores. Those living in a rural community, among our population, do not appear to be receiving less healthcare than those in an urban setting.

This thesis explores the representation of mental illness and mental incapacity in medieval Irish and Norse-Icelandic saga literature, with a particular focus on the theme of deception in representations of madness. These texts are compared using the methods of literary close reading. It begins (Chapters 1 and 2) with an overview of concepts of madness found in the two bodies of literature (drawing on law texts and poetry as well as the sagas) and the different narrative uses to which these concepts are put. Some general parallels and contrasts are drawn, and the cross-cultural transmission of the concept of the geilt is discussed in this context. Chapter 3 lays the ground for the thesis's analysis of deception in madness narratives by comparing two Irish and Norse-Icelandic narratives about fools and discussing links between the language of mental impairment and the notion of deception. Chapters 4 and 5 explore narrative representations of how deception is used with the aim of rehabilitating the mad person and reconnecting them with society, focusing in particular on the late Middle Irish saga Buile Shuibhne and an episode in the Icelandic family saga Egils saga Skalla-Grímssonar. Chapter 5 concludes with an extended discussion of the role of poetry and memory in representations of mental illness as seen in these two texts. Chapter 6 explores narratives in which deception is used with the purpose of destroying or humiliating the person of unsound mind, here focusing on the late Middle Irish saga Aided Muirchertaig meic Erca and an episode in the Norwegian king's saga Ágrip.

Class of 2007 Abstract / Objectives: To identify differences between patients diagnosed with a serious mental illness who test positive for cocaine and/or methamphetamine compared to patients who test positive or other abused substances. Methods: This retrospective study of clinical data obtained through a community mental health agency that provides outpatient services for patients with a serious mental illness. The study population was divided into two subgroups: positive cocaine and/or methamphetamine drug screen versus other positive drug screens and were compared over a 12- month period for the frequency and types of positive drug screens and blood alcohol levels, days of court-ordered treatment, the number of psychiatric hospitalizations and length of stay, primary psychiatric diagnosis, and the cost of care for services provided. Results: More females were in the “cocaine/methamphetamine” group versus more males in the “other substances of abuse” group, (p < 0.01). A higher proportion of patients diagnosed with psychotic disorders tested positive for “other substances” than for “cocaine and methamphetamine” (p < 0.01) and the “cocaine/methamphetamine” group had significantly more mood and anxiety disorders than the other group (p < 0.05). The frequency of patients testing positive for marijuana, methadone, and other opiates was higher in the “other substance abuse” group (p < 0.001). Patients in the “cocaine/methamphetamine” group had higher rates of polysubstance abuse (p < 0.001). The most commonly abused substance was cocaine (53.8%). Conclusions: Regular drug screening for substances of abuse and utilization of drug treatment programs should be recommended for SMI patients to improve their care and treatment outcomes.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.Med.(Psychiatry))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / The Luthando Neuropsychiatric HIV clinic was set up at Chris Hani Baragwanath Academic Hospital as an anti-retroviral roll out centre, specifically designed to provide anti-retroviral therapy to HIV positive patients with a psychiatric illness. Adherence to HIV treatment is essential for virological suppression, and non-adherence is a key factor in treatment failure. Research has suggested that psychiatric illness may negatively influence adherence to ART. Importantly, negative perceptions with regards to adherence may affect the decision to initiate ART in psychiatric patients. Attendance at clinic appointments is the first step in adherence, and has been found to be one of the most important predictors of medication adherence. Attendance at first clinic appointment is easily measurable in a limited resource setting, such as South Africa. The aim of this study was to examine the rate of attendance at the first clinic appointment post discharge from psychiatric hospitalization in HIV positive psychiatric patients initiated on ART as in-patients, and to determine which factors, if any may be related to clinic attendance. This study was a retrospective record review, conducted at Chris Hani Baragwanath Academic Hospital, at the Luthando clinic. Patients that were initiated on ART as psychiatric in-patients, 18 years to 65 years of age from 1st July 2009 to 31st December 2010 and then discharged for follow up as out-patients at Luthando clinic were included in the sample. The primary outcome was attendance at the clinic post discharge from hospital. Socioeconomic and clinical data were also recorded and analysed, comparing attendant and non-attendant P a g e | vi groups. The rate of attendance was 79.59%. There were a number of similarities between the attendant and non-attendant patients in terms of demographic and clinical data. The only significant difference between the attendant and non-attendant groups was disclosure of HIV status, and significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p = .01). Further research needs to quantify the significance of in-patient vs. out-patient initiation of ART, as well as to investigate the impact of a psychiatric diagnosis on attendance at ART clinics. Non-disclosure of HIV status needs to be further investigated and addressed in HIV treatment facilities in order to improve attendance.

A Thesis submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements of the Degree of Doctor of Philosophy. Johannesburg, 2015 / Sensemaking is the process through which people construct meaning around issues or events that are novel, ambiguous, confusing, or in some regard run contrary to expectations. Drawing on key insights from the work of Karl Weick on sensemaking, the aim of this study was to explore how staff members and volunteers at a non-profit human service organisation make sense of and enact the idea of quality in their environments. The study employed an interpretive approach and took the form of a single-case holistic case study. Using thematic analysis, several themes emerged from the data, which suggest that in order to deconstruct the idea of quality, as it exists in the minds and behaviours of organisational members, it is critical to obtain insight into the social and context driven processes that influence sensemaking. The findings also suggest that existing models and approaches to quality in the literature are incomplete in terms of their lack of a sensemaking focus. Practical recommendations are made for human services organisation administrators and managers to improve and monitor quality in their respective environments. The study concludes with a discussion of limitations as well as possible avenues for future research in light of the findings

Digitized by Kansas Correctional Industries

This dissertation traces the evolution of ideas and experiences of mental illness (seishinbyō) in Japan around the turn of the twentieth century, showing how it changed from a diagnostic category of biomedical disease into a dynamic but stigmatized pathology of the self in which the mental and emotional core of a person – who he or she was, essentially – was thought to have malfunctioned. In the course of this transformation, seishinbyō had multiple manifestations, its meanings shifting across time and in different social contexts. It originated in Japanese psychiatric discourse of the 1870s as an allegedly universal category of disease, but was soon modified to account for such existing phenomena as fox-spirit possession. In the family, one of the main sites for the management and treatment of madness in modern Japan, mental illness was associated less with medical etiology and more with violent and socially unacceptable behavior, as seen in cases of home confinement. As the concept of mental illness spread in popular culture and legal discourse, it evolved into a broader cultural idiom about the pathology of the self during a time of rapid social and cultural change. From the gendering of hysteria as the feminine counterpart to male neurasthenia in the media to the menstrual psychosis defense invoked to absolve female defendants of criminal responsibility, gender played an especially prominent role in this evolution. By the 1930s, the idea that the self was the source of its own distress had taken root, shifting attention away from external and social factors, whether fox possession or the stresses of modernity, to inner causes of suffering. The driving forces behind this conceptual change were the social structures and relations of family, gender, and the urban-rural divide. In the context of these three overlapping social sites, changing ideas and practices concerning the mentally ill produced broader transformations in the understanding of the relationship between self and society, including conceptions of mind and body, gendered norms of thought and behavior, and the boundary between the inner self and social forces during a time of modernizing change.

Paper one is a systematic literature review of qualitative studies examining psychosis in women using a metasynthesis approach. The review involved three stages: a systematic search of qualitative studies reporting the experiences of women with psychosis, critical appraisal of these studies, and the metasynthesis. Thirteen studies met the inclusion criteria, yielding data from 220 women in total. The synthesis of the studies demonstrated three overarching themes: (a) women's beliefs about their illness, (b) perceived consequences of illness, and (c) strategies to cope with illness. Important barriers to strategy use were identified and recommendations made for addressing them. In the second paper grounded theory methodology was used to explore recovery in women who had experienced psychosis following childbirth. Semi-structured interviews were conducted with 12 participants and data were analysed using grounded theory methodology. A theory of four superordinate themes was developed from the data, including: (a) the process of recovery; (b) evolving an understanding; (c) strategies for recovery; and (d) sociocultual context. It was concluded that women experienced a complex process of recovery which was ongoing. The role of other people, including professionals in the recovery process was central. Recommendations were made for professionals to assess women's position in terms of their recovery in order to offer timely, appropriate interventions. The final paper is a critical reflection of the work reported in the previous two papers. I reflected upon how my previous experiences influenced my decision to undertake this research and other aspects of the research process. I explored the rationale for my choice of research methodology and discussed the debates which exist around the use of these methods. Finally, my personal reflections upon the entire research process are included.