The aim of this study has been to examine, in the light of recent events in the field of Health Care in South Africa, the remarks and claims made by the World Health Organization, and the American Psychiatric Association between 1976 and 1978 on Health Care services, as provided for Blacks, by the South African government. In two reports, these organizations instituted the earliest, and arguably most significant claims against South Africa's system of Health Care. This study sketches firstly the political genesis and social context of the WHO, and APA examinations. Secondly, this study evaluates responses made by the South African State to the critical climate inspired by the above mentioned reports, through a close analysis of recent events associated with the politics, and provision of Health Care Facilities - particularly with regard to Black South Africans. This analysis suggests that the governments' earlier tentative policy of privatisation (which was soundly condemned by WHO and the APA) has been even more enthusiastically pursued - in contradiction to it's avowed policies of Commu ity Health Care, and to the continuing detriment of those South African communities who are in most need of adequate Health Care services. The study concludes that the criticisms raised by the WHO and APA had the effect of inspiring positive reforms in South Africa's health services, but in no way thwarted the governments', at first only tentative plans, to increasingly privatise it's psychiatric and other medical institutions.

One of the major issues of mental health provision in Indonesia is related to services for carers of people with serious mental illnesses. Very basic and limited services have been offered to the carers. Understanding the needs of Indonesian carers is of key importance before developing appropriate interventions for them. The aim of this study was to explore the needs of carers from mental health hospital services in Indonesia from the perspectives of carers, service users and professionals. It consisted of three separate, but, interrelated studies: (1) a review of international literature about carer needs from mental health services and Indonesian policies relating to carers contribution in the services, (2) focus groups with carers and service users, and (3) individual interviews with professionals. In the first stage, 40 studies eliciting the needs of carers from mental health services were reviewed systematically. The results could not provide adequate information of carer needs which were suitable to an Indonesian context. Therefore, reviewing additional literature of 15 policy documents relating to the contribution of carers in mental health services in Indonesia was conducted. The policy review showed that the need of involving carers in the services was acknowledged, but there has not been clear and strong political endorsement ensuring the carers to receive adequate supports based on their own needs and for their own wellbeing. In the second stage, focus groups with carers and service users were undertaken to explore the needs of Indonesian carers and how mental health hospital services could help to meet those needs. In total, 9 focus groups were conducted, seven with carers (n=33) and two with service users (n=13). All carer and service user participants were recruited from two government mental health hospitals in the capital city of Indonesia. The data were analysed by using framework analysis (Ritchie and Spencer 1994), and resulted in four themes: experiences in caregiving, carer needs from mental health hospital services, current support for carers, and recommendations for service improvement. In the third stage, individual qualitative interviews with health professionals were conducted to explore their views of what Indonesian carers need from the mental hospital services, the extent to which the current services have met the needs, and ideas for service improvements. The interviews involved 24 practitioners from a wide range of health professions, recruited from the hospitals where the earlier focus groups were completed. Framework data analysis (Ritchie and Spencer 1994) was adopted and produced five major themes: Professional views of why services should involve carers, professional views of what carers need for ill relatives, professional views of what carers need for own wellbeing, focus of current contact, and perspectives of support provision. The synthesis of the findings sourced from the focus groups and interviews was completed by adopting a thematic approach (Harden and Thomas 2008). This resulted in overall identifications of the needs of carers for own wellbeing as well as for ill persons, current support provision the carers and recommendations for service improvement within an Indonesian context. The synthesis could also identify similarities and differences between the groups of carer, service user and professional participants in viewing the needs of carers. The findings were valuable resources to aid in the design of a need-based and culturally sensitive intervention for carers in the country.

D.Cur. / The purpose of this research study was to describe a model to facilitate collaboration between the institutions of higher education and psychiatric health care services in order to promote psychiatric clinical nursing education, with guidelines to operationalise the model. In spite of the calls by statutory bodies and contemporary legislation for collaboration between institutions of higher education and psychiatric health care services, there are few instances where formalised collaborative ventures exist to promote psychiatric clinical nursing education. Since the move of nursing education from hospital-based schools to colleges and universities, there was no attempt to redefine the most appropriate roles for nurse educators and clinical facilitators regarding student teaching and learning, given this realignment. The consequence was that the relationship between these institutions is characterised by territoriality; a lack of integration of knowledge and expertise of nurse educators and clinical facilitators; a lack of sharing the necessary resources to facilitate cooperative teaching thus increasing the existence of academia-service gap and/or theory-practice gap to develop. There was therefore a need to develop a model with guidelines for operationalisation of the model to facilitate collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education. The research questions that emerged were: • What is the meaning of collaboration between institutions of higher education and psychiatric health care services within psychiatric clinical nursing education? • How can collaboration between institutions of higher education and psychiatric health care services be facilitated to promote psychiatric clinical nursing education? To realise the aim of this research, the following objectives are formulated: • to explore and describe the meaning of the concept “collaboration” between the institutions of higher education and psychiatric health care services within a psychiatric clinical educational context (theoretical and empirical perspectives); • to explore and describe the perceptions of nurse educators, nurse managers, and (i) clinical facilitators with regard to how collaboration between institutions of higher education and psychiatric health care services can be facilitated to promote psychiatric clinical nursing education; • to conceptualise the identified concepts of the model for collaboration to facilitate psychiatric clinical nursing education; • to describe the model to facilitate collaboration between institutions of higher education and psychiatric health care services, evaluate the model and describe guidelines for its operationalisation. The study was conducted in four phases. Phase One of the study involved an exploration and description of the meaning of collaboration within psychiatric clinical nursing education in accordance with Rodgers and Knafl’s evolutionary method of concept analysis (Rodgers & Knafl, 1993:77-90) and empirical meaning description from the participants’ perspective. Integration of the theoretical and empirical meaning of collaboration formed the basis on which a conceptual map was designed. Content analysis of literature was done using deductive and inductive reasoning strategies, synthesis, and inference and derivation as described by Chinn & Kramer (1995:63-67), and Walker and Avant, (1983:58-62). Theoretical validity was ensured (Chinn & Jacobs, 1987:208). A conceptual map constituting the four phases of collaboration was described.

This study explored the experiences of street-involved youth who have received mental health services for symptoms of methamphetamine-induced psychosis. Specifically, the study investigated what factors were perceived by participants to promote and hinder access to mental health services. The researcher interviewed nine street youth at Covenant House, a Vancouver agency serving street-involved youth. Interview data and the researcher's field notes were coded and analyzed within a grounded theory paradigm. Youth discussed formal and informal sources of help and routes to both. Two distinct perspectives to treatment were identified: an addictions perspective and a concurrent disorders perspective. Respondents outlined the typical pathway into methamphetamine use and described barriers and supports for accessing services while undergoing drug-induced psychosis. Significant factors that encouraged access to services were positive relationships with helpers, strong peer supports, and the use of involuntary services when necessary. Identified barriers included fear of being stigmatized, lack of problem awareness, and systemic barriers. The current research proposed a model of access to mental health services that positions outreach and frontline workers as key figures to mediating street youth's access to appropriate services. / Arts, Faculty of / Social Work, School of / Graduate

Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.

Evolution in the improved treatment of the mentally ill has been slow, and even today there is much variation in hospitals and communities. One of the most recent developments towards more effective treatment is the use of the treatment team. The members of this team, as a rule, are: doctor, nurse, psychologist, occupational therapist and social worker. Each one of these professional disciplines shares his knowledge of the patient with the others, so that all areas of the patient's life can be given full consideration. This thesis examines the role of the social worker in the treatment team that works with the mentally ill in two treatment centres - the Provincial Mental Hospital and the Crease Clinic of Psychological Medicine at Essondale, B.C. The study was undertaken to point up the social worker's area of competence and show where it can be used to the best advantage in the mental hospital program. The material used to evaluate the program was obtained through interviews with members of the social service staff, by attendance at staff meetings, reviewing, records of past staff, meetings, and by examining reports that have been prepared by various members of the staff on their casework activities. The study was meant to be more of a qualitative analysis and because of this a minimum of statistical material has been included. An examination of the treatment program shows that the social worker offers casework services to the patient and. his family from the time of the patient's admission to the Hospital or the Clinic until long after his discharge. Specifically, this means that social service is available, to the patient from the time of his reception; while he is under treatment on the ward; at the time that he is preparing for his return to his home; and also after his discharge in the form of counseling or rehabilitation services. The social worker offers further services in the areas of education and training (of social work and other professional staff); in research primarily to point out the needs in their own area of the treatment program; and also in community interpretation. Participation, to a limited extent, is seen in hospital administration. In concluding the study, it was pointed up that there is a need for more participation in the administrative aspects of treatment, the importance of social workers on the wards was stressed, and an increased emphasis on the rehabilitation of the patient was recommended. / Arts, Faculty of / Social Work, School of / Graduate

Need assessment methods grew out of the Community Mental Health Centre movement. Developed during a time of rapid expansion of service, there was a focus on providing services matched to the unique needs of a community. In the following years need assessment further developed as a technology and a search began for a "best model'. This paper argues that a "best model' is illusionary, a "best fit' being a more desirable goal. As fiscal constraints have reduced the resources available to consumption Ministries such as Health, need assessment has been increasingly used an allocative tool. Users of the tool, it is argued, must therefore choose their model with care and an understanding of the values and concepts inherent in each model is seen as necessary for intelligent choice. Finally, an examination of the British Columbia mental health context offers an analysis of some of the factors which have and will affect the use of need assessment in this Province / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The study developed a model for projecting potential economies from manpower substitution among the four core mental health professions and applied the model to a proposed substitution situation which would substitute psychologists for psychiatrists in the delivery of a proportion of present private practice (fee-for-service) psychiatry services in British Columbia. The model identifies three controlling variables: treatment substitutability (TS), practice privilege constraints (PPC), and relative payment rates (RR). In the model, TS and PPC are conceptualized as determining the estimated substitutable share of costs (SSC%); RR, in combination with the values derived for SSC%, is then used to estimate potential cost savings (CS%). Two conditions were defined for each of the three controlling variables in order to provide a range of possible values for SSC% and CS%. For reasons of data availability, data were obtained from the Manitoba Health Services Commission for private practice psychiatry services for FY 1984 and estimates of SSC% calculated. These estimates were then applied to B.C. Medical Services Commission data for FY 1984, and projected values of CS% calculated. Calculations were made both for all services and for the subset of psychotherapy services, which accounted for 80 percent of the larger set of services. The results of the study indicated considerable possibilities for manpower substitution, ranging from 35 to 70 percent for all services and 40 to 75 percent for psychotherapy services. However, the study also found that while salaried psychologists offered the possibility of substantial cost savings, a fee-for-service arrangement suggested virtually no potential savings. Projected values of CS% for the salaried alternative were 20 to 40 percent for all services and 15 to 30 percent for psychotherapy services but in the fee-for-service alternative, only 4 to 8 percent for all services and 4 to 7 percent for psychotherapy services. Licensure and market rigidities which might pose barriers to implementation were evaluated and a review of professional training standards (TS), licensure standards (PPC), and funding alternatives (RR) indicated that the projected economies could be achieved with no necessity for modifications in existing arrangements. PPC appear to present almost no barriers to economies from the proposed manpower substitution and those barriers which are presented by TS and RR limitations still allow considerable potential for economies. Thus, the greatest opportunities for intervention in achieving and enhancing the projected, economies appear to be in the exploration of relative payment rates and relative effectiveness of treatment methods (e.g., psychotherapy vs. pharmacotherapy). The study concludes with a discussion of factors lying outside the boundaries of the model but which impinge, nonetheless, upon the feasibility of the proposed substitution and fall, necessarily, to policy makers to address. The existing network of B.C. community mental health centres was suggested as a possible mechanism for the delivery of the substitutable share of private practice psychiatry services. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The purpose of the study was to explore the experience of crisis centre volunteers. The research sample consisted of 134 active and 105 inactive volunteers from five crisis centres in the Lower Mainland. To solicit descriptive and non-descriptive data, an instrument was constructed and pilot tested. The questionnaire contained 49 attitude items which were collected from the literature and interviews with crisis centre staff and volunteers. They were grouped into six subscales suggested by a modified latent partition analysis. These subscales were A: Doing Shifts, B: The Community, C: Personal Change, D: General Impression, F: Other Volunteers. The subscales were found to be internally consistent (Hoyt, 1941). Volunteers responded to a five-point Likert Scale for each item. The research questions were: are there differences among five crisis centres, and are there differences between active and inactive volunteers, on each of the six subscales? The volunteers' self-perceived success in dealing with specific problems presented by callers was also examined. Descriptive data from the sample were analyzed using simple frequency counts on variables from each of the five crisis centres. Data from the attitude scales were analyzed to further examine internal consistency of the attitude questionnaire. Finally a 5 x 2 (centre by level of activity) multivariate analysis of variance (MANOVA) using Wilks1 likelihood ratio criterion was used to analyze the attitude subscales and Sheffe's multiple comparison procedure was applied where appropriate. Results of the statistical testing indicated differences, significant at .05 level between Crisis Centres #1 and #5 and between #4 and #5 on Subscale E: Staff. Significant differences were also found between Crisis Centres #2 and #5 on Subscale F: Other Volunteers. Active volunteers responded more positively than inactive volunteers at .05 level of significance on all subscales except E: Staff. Results indicated fairly narrow ranges in demographic variables however, tests of significance were not undertaken. The significant differences noted in the attitude subscales may be the result of differences in staff-volunteer contact with each other. In those centres where there was more opportunity for staff to relate to volunteers, the volunteers responded more positively to staff-related items. The crisis centre whose volunteers responded more positively to items pertaining to volunteers, has within its structure more opportunity for contact with other volunteers in the diversified activities in which all volunteers and staff participate. This factor together with the comparative isolation of this centre may account for the significantly more positive responses on this subscale. The attitude of volunteers appeared to be very positive toward their experience. They reported positive changes in self-perception and perception of others as a result of their crisis centre experience. It would appear that more focus on the experience of volunteers at crisis centres would be profitable. Several suggests for further research were discussed, particularly related to "burnout" and motives for becoming inactive. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

No description available.