ABSTRACT Introduction In Southern Botswana, an expected advantage of the decentralisation and integration of mental health services into general health services was the potential to allow for the district hospitals to manage a larger number of mentally ill patients thus decreasing the patient load of Lobatse Mental Hospital. However, the number of admissions to the referral hospital for the south of Botswana is increasing. The objective of the study was to describe the capacity of district hospitals to care for mentally ill patients in terms of the provision of relevant inpatient, outpatient and outreach mental health services as well as the availability of trained workers who agree with the principles of decentralisation of mental health services. Materials and methods This was a descriptive cross sectional study involving a self-administered questionnaire survey of key informants and health care providers conducted in five district hospitals in the south of Botswana. There were a total of 5 Chief Medical Officers, and 75 ward staff (12 doctors and 63 nurses) in the study. The quantitative data was entered using the Statistical Package for Social Scientists (SPSS version 13) and analyzed by this software. The qualitative data was coded and thematically analysed and reported. Results In all five hospitals, all the doctors and nurses had undergraduate training in psychiatry and were expected to manage mentally ill patients. There were eighteen health workers (1 doctor and 17 nurses) with postgraduate training in psychiatry/mental health.

State and federal aid payments to local governments have grown explosively over the last fifteen years. One reason for this growth is that the donor governments can alter a local government's budget choices through grants. Grants have not remedied social problems, however, because the local governments' responses to grants were not anticipated. Economists have broadened our understanding, but debates remain about the proper modeling of local buur grant impact knowledge. Accordingly, this study examined the effects of thdgeting and, because researchers used aggregated data, gaps exist in oree types of mental health grants on the budget allocations for Oregon counties. The theoretical literature on the expenditure effects of grants was first reviewed. The constrained maximization, median voter, and budget maximization models of local fiscal decision-making were described and then compared as to their predictions about the effects of different grants. It was concluded that too little was known about budgetary processes to use or compare the models' predictions. Empirical studies were then reviewed. Researchers, largely using demand frameworks, found that grants significantly affected local spending and that different grants induced different spending responses. Their estimates of the stimulus differed, though. Moreover, little or no research was undertaken on the employment, wage, and output effects of grants. The theoretical and statistical problems with these studies were examined. These problems were: (1) the misspecification of aid variables; (2) the aggregation of government units and public services; (3) the lack of institutional and political realism. A theoretical model of Oregon counties' expenditure and production decision-making for mental health services was developed based on the insights and criticisms of existing models. The model consists of eleven equations; some describing the "expenditure stage" of the budget process, others describing the "output stage". It was argued that county commissioners make the expenditure decisions, and that mental health administrators make the production decisions. The framework allowed us to examine the effects of mental health grants on expenditures, wages, staff numbers, patient numbers, and output and to study the determinants of grant participation. Using regression analysis, the equations were estimated from the observations for 31 Oregon counties in fiscal year 1975-1976. Ordinary least squares was used in the expenditure and grant participation equations. Two-stage and three-stage least squares were used in the rest. Regressions were run for western and eastern Oregon counties when possible. For all observations, the major findings suggested that a dollar of state matching mental health aid per capita stimulated per capita mental health expenditures by $1.37, increased the professional staff by .556 to .762 persons per 10,000 county residents and increased average professional salaries by $2,173. A dollar of federal matching aid per capita appeared to have an expenditure effect of $1.03, an employment effect of .722, and no salary effect. A dollar of non-matching aid per capita had an estimated expenditure effect of $1.00, an estimated employment effect of .35, and no salary effect. In eastern Oregon, the major findings indicated that the marginal expenditure effect of federal aid was $1.41, the marginal expenditure effect of non-matching aid was $.96, and that state matching aid had no expenditure effect. In western Oregon, a dollar of state matching aid per capita had an estimated expenditure effect of $2.23, a professional employment effect of 1.25, and no significant salary effect. A dollar of non-matching aid per capita had an estimated expenditure effect of $1.67, and no significant employment or salary effects. In all regressions, the mental health grant estimates were not statistically different from one another. Finally, a production function for mental health services was unsuccessfully estimated and discussed. / Graduation date: 1979

Thesis (Ph. D.)--Open University. BLDSC no. DX219994.

The thesis grew out of the recognition that there is a dearth of information on the users of mental health services. It set out to describe the characteristics of users across a range of health settings and to consider the role of such characteristics in the mental health referral process. The early phases of this research project were strongly influenced by a model of the referral process developed by Goldberg & Huxley (1980). They conceptualized users of health care existing on 5 levels ranging from people living in the community to users in hospital. Hypothetical filters are said to operate between each level to govern who is referred on to the next level of services. This research project borrowed the notion of filters and their arrangement of services in a referral sequence. However, the focus of this research is on the characteristics of users, and not the detail of the filters per se. What is described is the effect of the referral process not the mechanism. This thesis also moves substantially beyond the five settings in the Goldberg & Huxley model to produce a uniquely comprehensive analysis of the users of all the main mental health care providers in one health district. The research project uses a wholly quantitative methodology. The challenge has been to design a range of compatible survey forms to collect data in seven separate study settings, to collate information on over one thousand one hundred users, to describe the user profiles in each study and to develop a comparative analysis of users across a range of settings. The emphasis throughout has been to align the research with contemporary developments in health care policy, and as the project has progressed, to make a practical contribution to the important debate about information systems in mental health service planning. The thesis has been divided into four parts. Part I introduces and sets the context of the research, and describes the methodology. In seven chapters, Part II of the thesis reports the .findings of each of the seven study settings. Part III of the thesis reports the demographic and utilization characteristics comparatively across all the study settings. The conclusions of the thesis are reported in Part IV of the thesis, where the theoretical, research and policy implications are discussed.The research project makes a contribution to knowledge on 4levels. Firstly, it identifies and describes the characteristics and the typical profiles of mental health service users in a range of study settings, in one area. Secondly, it identifies the differences between users in each study setting. Thirdly, it identifies the overlap in use of one service and another. It is argued that the findings have profound implications for both developing a clearer picture of the referral processes and for highlighting for planners, producers, and providers possible complementary or inefficient service utilization patterns. On the fourth and macro level, this research project has developed a revised model of mental health service referral routes. This model provides a framework for further investigation, and has potential as a planning tool in and beyond the geographical boundaries of the current study area.

No description available.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 5 uppsatser.

Thesis, PlanB (M.S.)--University of Wisconsin--Stout, 1998. / Includes bibliographical references.

Thesis (Psy. D.)--Wheaton College Graduate School, 2002. / Abstract. Includes bibliographical references (leaves 88-94).

Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 83-88).

Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2002. / Abstract. Includes bibliographical references (leaves 88-94).