Power issues in the relationship between service users and clinical psychologists have received little attention from a postmodern perspective. The recovery approach and the scientist-practitioner model as recommended in best practice guidelines creates an argument for investigating power dynamics in academic and practical disseminations. This study aimed to investigate the social construction of service users and clinical psychologists in articles. Twelve articles and opinion pieces written by clinical psychologists and service users were sampled from publications of the Clinical Psychology Forum. A Foucauldian Discourse Analytic method was used to identify dominant discourses and counter-discourses. The discourses were linked to the power dynamics in play between relevant institutions. The analysis identified an economic discourse, a technical-rational discourse and an expert discourse as constructing service users and clinical psychologists. Clinical psychologists were found to have more discourse availability than service users, and in a position to make choices, whereas service users were found to have availability to a limited number of discourses with fewer options of subjectivity. A need for clinical psychologists to make conscious choices in practice was implied.

Forensic services have been described as largely based around the needs of men who form the vast majority of in patients. However women’s offending behaviour is quite distinct from men's: they are more likely to have a personality disorder, most commonly borderline personality disorder (BPD) and to have been victims of abuse both as children and adults. Abuse and borderline personality disorder are characterised by problematic relational styles which cause the person great distress. In the forensic services admission is not based upon treatment readiness and it may be difficult for women to form healthy relationships with care staff or their peers. The recovery model has been recently applied to the forensic service and emphasises that improving relationships is a fundamental target. Women in forensic services have said that their peers can help them to feel connected and less stigmatised but also they can find each other's behaviour very disruptive and disturbing. This research set out to develop a theoretical model of the peer relationships of women with BPD in forensic care using grounded theory methodology. 12 women with a diagnosis of BPD were interviewed about their experiences in forensic care. A model was developed that characterises how women's experiences of relating with each other will depend upon ward characteristics and personal readiness for forming relationships. This will determine whether the person is interacting in a survival mode where relationships are superficial or able to attempt to engage at a deeper relational level with their peers. Such engagement may perpetuate relational difficulties, or have the potential to develop recovery through fostering hope, providing encouragement, developing insight and learning new ways to connect with others and manage problems.

Little research has looked in detail at the subjective experience of adolescents who have been admitted to psychiatric hospital and the potential impact of this on their developing identity. This study aimed to construct a theory of the perceived impact of hospitalisation on the identity of young people admitted to a psychiatric ward, the ways young people might manage threats to their identity and any perceived impact of diagnosis. Nine young people aged 15-17 were interviewed in depth about their experience of admission and any perceived impact on their identity. Young people were current in-patients or ex-patients attending follow-up treatment in the community. Grounded theory methodology was employed in this study. A preliminary model is proposed showing the process from admission to post-discharge with hypothesised impacts on personal and social identity at each stage. Positive outcomes were associated with an improved sense of self and self-efficacy. In contrast, the development of an “illness” explanation for one’s difficulties while in hospital may be a risk for a more negative self-concept and a less favourable future outlook. The study concluded that longitudinal research is required to ascertain long-term outcomes of the proposed model. Emphasizing psychological formulation may ameliorate the perception of individual ‘deficit’ that appeared to be associated with diagnosis.

Research suggests elite athletes have an equal, possibly higher, probability of developing mental ill-health as the general population. However understanding of these issues amongst athletes and coaches remains largely unknown. The perceptions of 20 elite athletes and 16 elite coaches of mental ill-health amongst elite athletes were explored. Two concurrent, three round Delphi methods, using descriptive statistics and thematic analysis, were used to compare groups’ responses. Athletes and coaches expressed different opinions and experiences of mental ill-health amongst elite athletes. However, both felt the pressure athletes place upon themselves is a significant contributing factor and that obsessive compulsive disorder (OCD) and anxiety may be particularly prevalent. Whilst associated stigma was thought to be a barrier to support seeking, both groups felt sport and clinical psychologists would provide the most appropriate support, with coaches playing an important role. Implications for coaches, clinical and sport psychologists are explored and suggestions for future research are presented.

Voice hearing has a diverse history but is currently understood as symptomatic of a disease within psychiatric frameworks. Alternatives to 'treatment' include peer-support 'Hearing Voices Network groups' (HVNGs) which have grown in popularity and exist alongside treatment-based hearing voices groups. Few studies have investigated processes underlying change in HVNGs. Established research into therapeutic factors and personal recovery may provide frameworks elucidating change processes. This study aimed to investigate how HVNG attendees experienced change within the group and how this change influenced their lives. A qualitative design was employed using interpretative phenomenological analysis (IPA) to elucidate group processes through immersion in the perspectives of group attendees. Semi-structured interviews were conducted with eight individuals who were purposively sampled from two HVNGs. Interviews lasted from 34 to 54 minutes, were recorded on a Dictaphone and later transcribed verbatim. Four superordinate themes emerged: 'healing', connecting with humanity; group as an emotional container; making sense of the voices and me; and freedom to be myself and grow. The study concluded that relationships, safety, exploration of voices and group ownership are key components of HVNG and fit into frameworks of therapeutic factors and recovery processes. Development of HVNGs should take these processes into account. Future studies should further elucidate processes.

Young people within the youth justice system experience three times higher rates of mental health problems than the general youth population yet are one of the least likely groups to seek help. Very little theory or research is available within this population to explain these high rates of unmet need. This study aimed to develop a theory about the barriers and facilitators that Youth Offending Team workers experience when supporting young people to access mental health services. Eleven semi-structured interviews were conducted with participants; eight youth offending team workers, two young people and a mental health worker. Interviews were audio-recorded and transcribed verbatim before being analysed using “grounded theory”. This method was chosen to allow the in depth exploration of participants experiences and the development of theory within an under researched area. The results showed that Youth Offending Team workers appeared to play a crucial role in supporting a young person’s help seeking from mental health services. A preliminary model was developed which demonstrated the complex relationships between six identified factors which influenced this role. The study concluded that Youth Offending Team workers would benefit from more support, training and recognition of the key role they play in supporting young people to become ready for a referral to mental health services. Mental health services could be well placed to provide this. Clinical implications are discussed. Further research is needed to develop our understanding of what influenced the help seeking of this vulnerable population.

Culture can often influence how psychological distress is experienced and where help is sought. South Asians are the largest ethnic minority group in the United Kingdom (UK). This paper aimed to explore how second-generation South Asian adolescents make sense of their experiences of psychological distress and the meanings attributed to help-seeking. Semi-structured interviews were carried out with nine second-generation adolescents aged 13-19 years. Interpretative Phenomenological Analysis was employed. Five superordinate themes emerged from the analysis: feeling distressed, negative impact of family and cultural ideals on the self, connectedness to others, perception of help-seeking outside the family and intergenerational differences in help-seeking. The results indicated that help is sought from families when participants perceive they are able to relate to the source of distress. However, when there is a lack of understanding of distress, participants sought this from external sources of help. Professional help-seeking appeared influenced by the interplay between not meeting family ideals, intergenerational differences in understanding of distress and the stigma of seeking help. Clinical and research implications are discussed.

Thesis (M Social Work)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Mental health is a fundamental aspect of social functioning which affects a significant portion of the population. The movement toward deinstitutionalization became the core focus of mental health policies such as the White Paper (1997) and the Mental Health Care Act (17 of 2002) post-apartheid. However, this process was implemented at a rapid rate, with poor corresponding development of necessary outpatient and community-based facilities and services. Social, cultural, and economic conditions have significant and measurable effects on both individual health status and the delivery of health care. As a result, there is a growing recognition of the need for social work services within the mental health outpatient and community-based care context. Research regarding the role of the social worker within mental health care, particularly within a South African context is poor and therefore a research gap with regard to examining the views of social workers on their role in mental health outpatient and community-based services exists. The overall objective of the study was to, in light of the above, examine the views of social workers on their role in mental health outpatient and community-based care. A combination of both qualitative and quantitative research approaches was employed for the study, with a stronger emphasis on the use of qualitative data. A combination of exploratory and descriptive research designs was utilized as the framework for the implementation of the research approach. This was appropriate for the utilization of both quantitative and qualitative design elements. A purposive sample of twenty social workers was compiled, and data was collected through the means of semi-structured interviews; a pilot study was implemented to test the measurement instrument with two social work participants. Two literature chapters are presented, focusing on the topic of mental health and its related policy, as well as expanding on mental health care and service rendering according to an ecological perspective. These chapters served to achieve established objectives of the study. Chapter four is a presentation of the empirical study. Data which was collected was both relayed and analyzed, in accordance also with the literature study. Data was analyzed, through both quantitative and qualitative analysis and was presented according to identified themes, sub-themes and categories. Relevant tables, figures and participant narratives were used to further substantiate the analysis of data. Chapter five gives an overview of relevant conclusions and recommendations, in terms specifically of the role of the social worker in mental health outpatient and community-based care, in light of the empirical study and data analysis. Five specific roles were identified as being significant for the social worker in mental health care, with regard to their role in therapeutic intervention, working with clients and families in a one-on-one, counseling capacity; supportive services, through linking of clients to necessary resources; advocacy, through fighting for, and protecting the rights of clients and related vulnerable groups within mental health; relational role, recognizing the importance of social and interpersonal aspects on the functioning of mentally ill clients; and finally their role as a holistic worker within a multidisciplinary team, incorporating key aspects of the ecological perspective into assessments and interventions. / AFRIKAANSE OPSOMMING: Geestesgesondheid is ʼn fundamentele aspek van maatskaplikefunksionering wat ʼn beduidende gedeelte van die bevolking affekteer. Die beweging na deïnstitusionalisering het die kern fokus van verwysings na geestesgesondheidsbeleide soos vervat in die Witskrif (1997) en die Wet op Geestesgesondheidsorg (17 van 2002) geword. Hierdie proses is teen ʼn vinnige tempo geïmplementeer, wat die ooreenstemmende ontwikkeling tussen dienste aan buitepasiënte en gemeenskapsgebaseerde fasiliteite en dienste benadeel het. Maatskaplike, kulturele en ekonomiese toestande het ʼn groot en meetbare uitwerking op beide individue se gesondheidstatus en die lewering van gesondheidsorg. As gevolg hiervan, is daar ʼn groeiende erkenning van die behoefte aan maatskaplike dienste in die geestesgesondheidsorg van buitepasiënte en binne ʼn gemeenskapsgebaseerde konteks. Navorsing oor die rol van die maatskaplike werker in die geestesgesondheidsorg, veral binne ʼn Suid-Afrikaanse konteks is onvoldoende. ʼn Gaping bestaan veral in navorsing oormaatskaplike werkers se rol in geestesgesondheidsorg met betrekking tot buitepasiënte en die gemeenskapsgebaseerde dienste. Die oorkoepelende doel van die studie was om, in die lig van die bogenoemde, ondersoek te doen oor die sienings van maatskaplike werkers met betrekking tot hul rol in geestesgesondheidsorg van buitepasiënte en gemeenskapsgebaseerde dienste. ʼn Kombinasie van beide kwalitatiewe en kwantitatiewe navorsingsbenaderings is gebruik vir die studie, met ʼn sterker klem op kwalitatiewe navorsing. ʼn Kombinasie van verkennende en beskrywende navorsingsontwerpe is gebruik as ʼn raamwerk vir die implementering van die navorsing benadering. 'n Doelgerigte steekproef, bestaande uit twintig maatskaplike werkers is saamgestel, en data is ingesamel deur middel van semi-gestruktureerde onderhoude met behulp van ʼn onderhoudskedule. Loodsonderhoude met twee deelnemende maatskaplike werkers is gevoer ten einde die onderhoudskedule te toets. Twee literatuurhoofstukke word aangebied, wat fokus op die onderwerp van geestesgesondheid en verwante beleide, sowel as geestesgesondheidsorg en -dienslewering volgens ʼn ekologiese perspektief. Hierdie hoofstukke dien as fondasie om die doelwitte van die studie te bereik. Hoofstuk vier dien as ʼn verslag oor die empiriese studie. Die data wat ingesamel is, is op grond van die literatuurstudie ontleed. Data is geanaliseer deur middel van beide kwantitatiewe en kwalitatiewe analise en is aangebied volgens geïdentifiseerde temas, sub-temas en kategorieë. Toepaslike tabelle, figure en narratiewe is gebruik om die analisering van data te substansieer. Hoofstuk vyf bied relevante gevolgtrekkings en aanbevelings aan in terme van spesifiek die rol van die maatskaplike werker in geestesgesondheidsorg met betrekking tot buitepasiënte en gemeenskapsgebaseerde dienste. Vyf spesifieke rolle is geïdentifiseer as belangrik vir die maatskaplike werker in geestesgesondheidsorg: maatskaplike werkers se rol in die terapeutiese intervensie met betrekking totberading van individue en gesinne; ʼn ondersteunende rol wat kliënte met die nodige hulpbronne in verbinding bring; ʼn voorspraakrol, deur te beding vir die beskerming van die regte van kliënte en verwante kwesbare groepe in geestesgesondheidsorg; ʼn verhoudingsrol in die erkenning van die belangrikheid van sosiale en interpersoonlike aspekte in die funksionering van geestesgesondheidskliënte; en die rol as ʼn holistiese werker binne ʼn multidissiplinêre span, waarin belangrike aspekte van die ekologiese perspektief in assessering en intervensie geïnkorporeer word.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work