M.Sc.(Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Mental health in South Africa has undergone many changes since the pioneering work of colonial doctors in the early 1900’s. With the advent of a human rights based constitution in the 1990’s, mental health was forced to review its methods of care and the political motivation behind many long-term hospitalisations. Because of these practices, government mental health structures maintain and fund institutions that warehouse a legacy of institutionalised and disenfranchised patients from the apartheid area. A number of these patients have been hospitalised for over forty years – some without an appropriate psychiatric diagnosis. Many of these patients cannot be discharged back into the community, as their families have been lost over time. Many patients are institutionalised to the extent that they are unable to manage even the most menial of personal tasks and thus cannot leave the safety of the centres in which they are housed. International developments in the field of Eugenics underpinned much of the sweeping social change that was embraced by Europe and the USA. Germany based many of its policies of eradication of the ‘unfit’ on eugenic principles that could comfortably accommodate the rejection of racial differences. The profound effect that eugenics exercised in the medical and social spheres internationally drove the development of many apartheid-based government policies in South Africa. These included reform in the areas of education, mental health, social development, group areas etc. This research report briefly explores some of the social, medical, political and legislative influences active in the field of mental health from 1904 to 2004.

The purpose of this study was to investigate the relationship of the presence or absence of tardive dyskinesia (TD) to drug and behavioral history variables. The author hoped to determine if there were descriptive characteristics, unique to patients with TD, which could merit further investigation as precursors of TD. Two samples, with 26 subjects each, were drawn from patients identified at Eastern State Hospital and screened by a psychiatrist. The TD and No-TD groups were matched on age, sex, and diagnosis. Entire drug histories were recorded and entire behavioral (hospitalization) histories were rated. Data collection was discontinued, for both subjects, with the emergence of TD symptoms in the TD subject. This was an ex post facto design.;It was hypothesized that significant differences would be found between the two groups on history of antipsychotic and antiparkinson medications, history of polypharmacy, history of drug-free days and periods, history of extrapyramidal symptoms (EPS), history of psychiatric behavior patterns, race, eye color, and dental status. A trend was noted for the No-TD group to have consistently higher means on all of the drug variables. Significantly higher means for the No-TD group were found for mean cumulative and mean daily dose of antipsychotics, mean length of antiparkinson agent administration, and in the number of EPS incidences. The TD group had significantly more edentulous subjects than the No-TD groups.;Although TD is clearly related to antipsychotic ingestion, apparently it is not related to the quantity of antipsychotics ingested. Future study should, therefore, focus on the relationship of individual vulnerability to the development of TD rather than on drug variables such as those investigated in this study. Further investigation of the behavioral precursors is indicated. A prospective design is recommended in order to clarify relationships, such as EPS history and the development of TD, that remain unclear in retrospective investigations.

The purpose of this study was to analyze the efficacy of two group counseling approaches upon adult patients diagnosed with metastatic cancer since August 1, 1980. Eighteen adult outpatients from metropolitan Richmond, Virginia area hospitals were the subjects. All were volunteers and were randomly assigned, using a modified random sampling procedure, to a nondirective, stress management, or control group. Five personality characteristics were examined: state anxiety, trait anxiety, self-esteem, innerdirectedness, and time competence.;The nondirective and stress management groups met for 90 minute sessions twice a week for five consecutive weeks. The control group did not meet. Each group facilitator distributed the State-Trait Anxiety Inventory, Tennessee Self Concept Scale, and the Personal Orientation Inventory to the participants at an eleventh session and explained the directions. These assessment instruments were self-administered at home. Proper test-taking procedures were stressed by the facilitator. The same instruments were taken to the homes of the control group members for self-administration.;The research design used in this study was the Posttest-Only Control Group Design. The statistical procedure employed was the analysis of variance. Five null hypotheses provided the basis for testing for significant differences ((alpha) = .05) among the nondirective, stress management, and control groups on posttest anxiety, self-esteem, innerdirectedness, and time competence measures.;Analyses of the test data revealed that there was no significant difference among the nondirective, stress management, and control groups on any of the posttest measures. The investigator failed to reject all five null hypotheses.;Individual post-group interviews were conducted within two weeks of the termination of each group. They served as a validity check of the instrumentation results, and a content analysis was conducted with the interview data. The interview data analyses revealed that there was no appreciable difference among the nondirective, stress management, and control groups. There was, however, a qualitative difference when comparing the nondirective and stress management groups with the control group. In each treatment group, the group experience was credited for a diminution of stress and anxiety and an enhancement of self-esteem, innerdirectedness, and time competence. The control group period did not appear to be as meaningful or beneficial.

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Length of hospital stay (LOS) is a major indicator for measuring efficient care. Intellectually disabled psychiatric patients (IDPP) with chronic medical problems have longer LOS due to challenges faced by providers in jointly managing both psychiatric and medical problems. The purposes of this study were to understand the significance of LOS for IDPP, create an intervention toolkit to reduce LOS, establish the content validity of the toolkit, and recommend its implementation. The items of the toolkit are pharmacology, somatic, rehabilitation, psychosocial, and monitoring patients' psychiatric and medical symptoms across care domains. The toolkit was created from the constructs of the psychiatric rehabilitation process model to jointly mange psychiatric and medical issues. The project question asked if a universal agreement rating will be achieved to establish content validity of the toolkit. Orem's self-care deficit theory was used to guide this study. Ten experts with experience in the clinical, financial, legal, and psycho-social aspects of IDPP care, were recruited from 5 county facilities and asked to participate in the study. The inclusion criteria focused on the experts' leadership roles in those facilities. The experts answered two online quantitative surveys. Survey 1 asked 9 questions and elicited opinions on LOS issues for IDPP. Survey 2 asked the experts to rate the efficacy of the toolkit to reduce LOS for IDPP. Survey 1 finding showed that 8 of 10 experts agreed that LOS for IDPP needed to be reduced. Survey 2 finding showed a universal agreement toolkit rating of 0.84, indicating the experts' readiness to adopt the toolkit to reduce LOS for IDPP. This study has the potential to promote social change by enhancing interdisciplinary and collaborative use of best care processes in psychiatry to reduce LOS and jointly manage psychiatric and medical problems affecting IDPP.

A gap exists in the current literature on the training needs of professional counselors so they can meet the increasing demand for counseling services among refugee populations. The purpose of this constructivist, grounded theory study was to explore the perceptions of professional counselors related to their preparedness to demonstrate multicultural competence when counseling refugees. A constructivist grounded theory approach following Charmaz's principles guided the investigation into perceptions of professional counselors towards counseling with refugee clients. The author conducted a qualitative demographic form, individual interviews, and a focus group with professional counselors who had experience working with refugees. Sample included 21 licensed professional counselors who had experience working with at least one refugee client. Utilizing a thematic data analysis on the qualitative data, the main themes outlined in this comprehensive theory included contexts, challenges, competencies, and professional development. The study may contribute to positive social change through increasing access to mental health services for refugee populations who currently underuse the services.

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