Thesis (Ph. D.)--University of Washington, 1984. / Vita. Bibliography: leaves [70]-78.

Thesis (Ph. D.)--Open University.

Thesis (Ph.D.)--University of Melbourne, School of Nursing and Social Work, 2009. / Typescript. Includes bibliographical references (p. 316-328)

Thesis (Psy.D.)--Rutgers University, 2009. / "Graduate Program in Clinical Psychology." Includes bibliographical references (p. 88-97).

Thesis (MSD (EAP))--University of Pretoria, 2003.

Background Persons with severe mental illness (SMI) are vulnerable to mental health (MH) crises in the community. These crises often resulted in costly hospital admissions. Crisis Resolution Team (CRT) was implemented based on limited empirical evidence to address this problem. In 2001, UK implemented a national policy making CRT mandatory nationwide. Since then, more studies were performed on the effectiveness of CRT. It appeared CRT is cost effective in reduction of admissions. There was evidence of positive clinical outcome in comparison with standard care. Hong Kong does not have a specific community crisis program for people with SMI. It is desirable for policy makers to consider alternatives to reduce hospital admissions and to strengthen community support for people with SMI. Aims To evaluate the feasibility on the implementation of CRT Model in Hong Kong as a service to reduce hospital admissions. Method A review of current evidence on the effectiveness of CRT model and assess the feasibility and desirability of such model for implementation in Hong Kong. Results Evidence from observational studies and randomized controlled trials show CRT to be effective in the reduction of hospital admissions and inpatient days in the UK. CRT is also associated with higher acceptance from patients and family members than from standard care. CRT appears to be feasible against other service to address the acute needs of persons with SMI in reducing hospitalization. Conclusion A preliminary assessment ruled out a number of alternatives in dealing with mental health crises in the community. Preliminary results suggested the CRT model might be a feasible and desirable solution. There is evidence on the effectiveness of such teams in the UK. Successful implementation of CRT service in Hong Kong will be a challenge for stakeholders of the mental health system. / published_or_final_version / Public Health / Master / Master of Public Health

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The U.S. Army has undergone extreme transformation to meet new national security needs of the nation due to the Global War on Terror (GWOT). In order to meet the needs of Soldiers and families exposed to increased stressors, the Army behavioral health system has undergone much transformation as well. The Army Social Work Care Manger Program (CMP) is one program recently developed to enhance Army behavioral health services to this population. It provides care for Soldiers and their families who experience psychological or interpersonal difficulties throughout the deployment cycle. This study investigates the ability of this new program to create effective services throughout several locations across the Army. More specifically, the study evaluates the extent to which the CMP has been implemented as intended, reaches the target population and accomplishes the intended tasks. Soldier survey data, multiple Care Manager (CM) activity reports, interviews and focus groups were analyzed in a triangulated methodology. CMPs studied were found to reach the target population and address target issues across installations; however, senior enlisted as well as white male Soldiers appeared to be exposed to trauma at higher rates than they received treatment. Burnout, lowered health benefits, overtasking, and recommendations for program formalization through manuals were identified as areas of program development.

Policy initiatives are calling for mental health services to change their ways of working to prioritising the promotion of service users’ personal recovery. This requires a major re-negotiation of working practices and the relationship between service users and staff/services and their respective social positions. Preliminary research has shown that change has been problematic. The present study aimed to explore the construction of recovery and the positioning of service users and staff during the adoption of recovery-oriented practices in a community support and recovery team. Transcripts of two rounds of focus groups with service users (n=9) and staff (n=5) held six months apart, service user care plans and Recovery Star notes were analysed using a Foucauldian Discourse Analysis. The study found that recovery was constructed as clinical/medical and personal recovery, at different times and in tension with each other. These constructions positioned service users as dependent, passive and hopeless or empowered and hopeful, and staff as helpless or facilitative. It was also apparent that a discourse of personal recovery was not available to service users. Staff oscillated between the constructions of recovery as medical and personal resulting in different subject positions and opportunities for action. The study concluded that adopting a recovery-orientation in services should lead to service users being positioned as more influential in decisions about their treatment and modes of support from the service, and services less likely to dictate their treatment. However, this can only happen if the recovery-orientation constitutes a widely shared discourse with all its assumptions and associated practices. The problematic aspects of the medical discourse and how it can position people socially and how those positions impact on the potential for personal recovery needs to be highlighted.

This work considers the nature of therapeutic relationships between nursing staff and patients on acute mental health inpatient wards. Section A is a literature review, exploring the psychological theories behind the care delivered by nurses through the medium of therapeutic relationships in inpatient settings and providing a meta-synthesis of studies investigating the nature of therapeutic relationships between nursing staff and patients from the perspectives of nurses. Section B presents a phenomenological study in which nursing staff completed in-depth interviews providing descriptions of their therapeutic relationships with patients. The results suggest a great variance in the nursing staff ability to get to know and understand patients and their needs from a psychological perspective. The knowledge gained about patients through the medium of relationships did not seem to be shared by the staff team and did not seem to be integrated into a coherent treatment plan.