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This thesis is based on a study conducted for the state of Oregon's Office of Mental Health Services (OMHS). OMHS' primary research objectives included 1) the identification of the unfunded population (individuals who are uninsured and ineligible for Medicaid) who seek services at community mental health programs and 2) an examination of this group's access to atypical antipsychotic and antidepressant medications. OMHS sought this data in order to inform legislative decisions regarding a forthcoming state budget proposal for a specialized atypicals fund. The author collected ethnographic data through semi-structured interviews with 57 mental health clinicians and 41 mental health advocates throughout Multnomah, Linn and Lincoln counties. While answers to the primary research objectives were inconclusive, the qualitative data characterizes the target population and contextualizes the unfunded client's medication access issues at county-related mental health clinics. Specifically, the study results indicate that 1) the complex characteristics of the unfunded population and the inadequacies of the available medication resource programs should be examined more thoroughly before allocating appropriated funds, 2) insufficient mental health services in general is the foremost problem for unfunded clients, and that which contributes to difficulties in accessing psychotropic medications, and 3) appropriated funds from the state's budget would not adequately resolve the medication needs for the target population. The study findings suggest that the state's concern with atypical medications overshadows existing practical, everyday problems in the clinics. The author analyzes the study from a Critical Medical Anthropology perspective, examining the relationships between the global and local contexts surrounding atypical medications, and discussing the practical use of the research data. From this perspective, the state's preoccupation with supplying atypical medications for the target population appears to be driven more by the pharmaceutical industry's profit-making interests and the historical role of the public psychiatric field than by quality health care decisions. The author also discusses medical hegemony in terms of the psychiatric field, and the ways in which this effects the asymmetrical power within the Oregon mental health system. / Graduation date: 2000

Child and adolescent mental health represents a key area of concern and public health relevance. Mental health disorders are one of the most prevalent illnesses affecting young people and contribute significantly to the global burden of disease. Childhood and adolescent mental health problems often persist into adulthood and as such frequently result in lifelong negative consequences. Yet despite the growing concern with regards to the mental health needs of children and adolescents, not much research, both internationally and particularly locally, has focused on the provision of mental health services to children and adolescents. Additionally, little has been published on the changes and trends in diagnostic rates and assessment procedures over time. Only a few international studies have investigated mental health trends in children and adolescents; hence, there is a crucial need for South African data to inform preventative and curative services for children in South Africa. This present study therefore investigated the trends and patterns relating to diagnostic rates and assessment practices in children and adolescents over time at a local South African psychological community service centre in Pietermaritzburg. The study was a retrospective chart review and the sample consisted of 679 case files from children and adolescents between 3-17 years of age, who had been seen at a local psychological service centre between 1987-1989, 1997-1999 and 2007-2009. The case files were systematically analysed with regards to diagnosis and assessment practices. It was hypothesised that the years of continuous social and political conflict in the Pietermaritzburg area, namely 1987-1989, had a direct impact on the psychological development and well-being of children and adolescents from this area, and that this would be reflected in the case files from the corresponding years. The research findings with regard to the assessment practices were comparable to the internationally observed trends relating to choice of tests and procedures. In addition, the findings of the current study also showed similar trends with regard to the increasing diagnostic rates for ADD/ADHD, Mood Disorder, and Autism Spectrum Disorders as were observed internationally. Additionally, the reported decreasing diagnostic rates for Mental Retardation and behaviour disorders were also found in this local study. However, the internationally observed increases in Anxiety Disorder diagnoses contrast with the findings of this study, where the results revealed that the rates for Anxiety Disorder and PTSD were considerably higher in the late 1980s and 1990s. This finding supports the initial hypothesis that the violence and social unrest had an effect on children’s psychological well-being. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

The focus of this dissertation is the mental health experiences of Aboriginal people in Montreal as they interface with health policy, and lack thereof, for this population. / Drawing on anthropological fieldwork from Montreal, Eastern Quebec, and Ontario, this thesis endeavours to unravel the jurisdictional tapestry that Aboriginal clients must negotiate when seeking services in Montreal. Using an ethnographic methodology, this project provides an understanding of the ordering of health services for Aboriginal clients from street-level to policy offices. / This thesis draws on three theoretical areas (theories of illness, aboriginality, and public policy) to explicate four themes that emerge from the data. Analysis moves along a continuum between the illness experience and the macro-social determinants of politics and bureaucracy that impact the health of the individual as well as support and organize systems of care. / Discussion of Theme #1 (evolution of mental health and wellness categories in health theory, policy and practice) and Theme #2 ( the culture concept in health policy) demonstrates that despite the progressive evolution of concepts in health theory and policy, Aboriginal people generally do not find services in Montreal that provide culturally-sensitive, holistic care. Discussion of Theme #3 (barriers to wellness created by jurisdiction) argues that jurisdictional barriers prevent clients' access to even the most basic and rudimentary services and that such barriers can actually disable and increase distress. Discussion of Theme #4 ( Aboriginal-specific services) looks at the pros and cons of creating an Aboriginal-specific health centre in Montreal. / Together, these four themes show that understanding Aboriginal people in Montreal requires contextualizing their embodied experience within the colonial history and institutional racism which characterizes many healthcare interactions, and clarifying the bureaucracy that complicates the search for well-being. Montreal's Aboriginal problematic is located in a system characterized by entrenched bureaucracy, jurisdictional complexity and injustice, these elements mapping onto Aboriginal reality with serious repercussions for individual identity and well-being. / Hearing the voices of Aboriginal people in Montreal as they seek out care for mental health problems requires the resolution of jurisdictional and policy clashes that currently silence their suffering. This thesis endeavours to advance this crucial social agenda.

Thesis (Ph.D.)--Flinders University, Faculty of Health Sciences, Dept. of Public Health. / Typescript bound. Includes bibliographical references: (leaves 406-434) Also available online.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1999. / Source: Masters Abstracts International, Volume: 45-06, page: 2928. Typescript. Abstract precedes thesis as preliminary leaves iii-iv. Includes bibliographical references 122-127.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 100-106).

Este estudo trata da avaliação de um Centro de Atenção Psicossocial (CAPS), um serviço supostamente funcionando nos moldes apregoados pela Reforma Psiquiátrica Brasileira, a qual, atualmente, na sua vertente assistencial, é marcada pela implantação de serviços substitutivos ao hospital psiquiátrico. A proposta da avaliação centra-se no microespaço e no cotidiano do serviço e ocorre mediante a participação da equipe, usuários e familiares. Trata-se de uma avaliação qualitativa, mediante a qual se busca apreender a dinâmica do serviço, a forma como os atores interagem e os sentidos que constroem em relação à própria prática; uma avaliação que também possa ser dispositivo, permitindo, mediante um processo participativo, que grupos de interesse ampliem a possibilidade de intervir na realidade do serviço, e que possam ser sujeitos, uma vez que em metodologias tradicionais estão excluídos. A Avaliação de Quarta Geração, desenvolvida por Egon G. Guba e Yvona S Lincoln juntamente com o Método Paidéia, desenvolvido por Gastão Wagner de Sousa Campos, foram norteadores do processo teórico-metodológico da pesquisa. Os instrumentos de coleta de dados foram entrevistas com equipe, usuários e familiares e observação. As questões que emergiram no processo avaliativo foram agrupadas em três núcleos temáticos: dimensões do objeto de trabalho, equipe, práticas e os meios de trabalho. Foi constatado que, mesmo que o serviço pareça ser um substitutivo para o atendimento no hospital psiquiátrico, tanto fatores externos, relacionados às políticas locais de saúde mental, quanto fatores internos, relacionados ao cotidiano do serviço, impedem que isso se efetive. / This study is about the evaluation of a Center of Psychosocial Care (CAPS), a service supposed to work according to the patterns divulged by the Brazilian Psychiatric Reform which, currently, in its assistance trend, is marked by the implantation of services intended to replace the psychiatric hospital. The evaluation proposal is centered in the micro space and in the day-to-day of the service and is performed by means of the participation of the team, the users and family members. It is about a qualitative evaluation, by means of which one searches to grasp the dynamics of the service, the way how the actors interact and the directions that they construct in relation to the practice itself; an evaluation that can also device, allowing, by means of a participation process, that interest groups broaden the possibility of intervening in the reality of the service and that they may become subjects, considering that in traditional methodologies, they are excluded. The Evaluation of Fourth Generation, developed by Egon G. Guba and Yvona S. Lincoln, together with the Paidéia Method, developed by Gastão Wagner de Sousa Campos, guided the theoretical-methodological process of the research. The instruments for the collection of data were interviews with the team, users and family members as well as observation. The issues that emerged over the evaluation process were grouped in three central themes: dimensions of the work object, the team, practices and the working means. It has been noticed that, even though the service seems to be a replacement for the attendance in the psychiatric hospital, both external factors, related to the local policies of mental health, and internal factors, related to the day-to-day of the service, prevents it from becoming effective.