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Mental health disparity is an emerging national concern with evidence suggesting individuals from non-dominant populations are less likely to seek and persist in mental health services compared to their dominant culture peers. In particular, African Americans may underutilize professional counseling services due to factors such as stigma, healthy cultural mistrust, and cultural values. To date, researchers have paid limited attention to ways to break through barriers to mental health equity. The purpose of this phenomenological study was to explore African Americans’ experiences and decision-making seeking professional counseling services. I addressed the following questions: How do African Americans make meaning of their decision to seek counselor services? What considerations are involved in decision- making with African Americans who decide to seek professional counseling services? Participants included 10 African American women who had attended counseling with a licensed professional counselor (LPC) or LPC Intern in the past three years. I identified six emergent themes through adapted classic phenomenological analysis: feelings prior to attending counseling, coping mechanisms utilized prior to counseling, barriers to treatment, motivation to attend counseling, characteristics of counselor, and post counseling experiences. Participants reported increased personal growth, insight, and desire to recommend counseling to others. Findings inform communities about what counseling is (and is not) as well as different types of support that can be obtained from a professional counselor. Limitations and future research directions are discussed.

The purpose of this study was to explore heterosexual bias in the diagnosis and treatment of gay males. Two hundred-fifty (134 males and 116 females) mental health professionals from the Division of Psychotherapy (29) of the American Psychological Association participated in the study. Participants were randomly assigned to one of two case history conditions, which presented a 35-year-old male seeking therapy. Both conditions were equivalent with regards to the presenting problem (i.e., diagnostic symptoms) with the exception of his significant other (i.e., gay vs. non-gay condition). Potential bias was measured through a diagnostic rating Likert scale and a treatment plan questionnaire. Other independent variables that could potentially have an effect on diagnostic ratings were explored, such as gender, year of graduation, and theoretical orientation of the respondents. Results of the statistical analyses failed to confirm evidence of heterosexual bias. Implications for further research and training are discussed.

Direct-care workers can provide an array of service types to children, adolescents, and their families in behavioral health treatment. They may also work in a variety of settings (e.g., group homes, inpatient units/hospitals, residential treatment, treatment foster care, day treatment, in-home treatment, etc.). Direct-care workers typically are involved in the supervision of youth and in the implementation of a treatment plan developed by the youth’s treatment team. For youth who are lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) and are receiving behavioral health services, such workers form a critical part of their therapeutic experience. However, little is known about these workers’ competencies related to working with LGBTQ youth. This study begins to fill that gap by developing and testing a measure that assessed LGBTQ cultural competencies related to behavioral health practice with youth and a measure that was relevant to the roles and responsibilities of direct-care (e.g., paraprofessional, front-line) workers. In order for direct-care workers to use LGBTQ cultural competency in their practice, more understanding is needed about their current level of LGBTQ-related cultural competency. The LGBTQ Youth Cultural Competency scale (abbreviated as LGBTQY-CC) provides a means to measure those competencies. An exploratory factor analysis found that the new scale consists of one primary factor which represents knowledge, attitudes, skill, and awareness of LGBTQ cultural competency. Cronbach’s alpha, correlations with other measures for concurrent validity, and correlation with a measure of social desirability all resulted in evidence that the LGBTQY-CC has good validity. Analyses examined how the new measure was related to constructs associated with training and competency in direct-care workers. Multiple regression analyses showed that higher levels of LGBTQ cultural competency (as measured by the LGBTQY-CC) were significantly related to age (younger), political ideology (more liberal), more social contact with LGBTQ individuals, and degree of religious belief about LGBTQ being a sin. A model including these factors explained 60% of the variance in LGBTQY-CC scores. The LGBTQY-CC was created with the long-term goal of creating training interventions for direct-care workers to improve their practice with LGBTQ youth. The measure could be used to assess training participants’ knowledge, attitudes, skills, and awareness and to evaluate the effectiveness of varying types and styles of training programs. Federal and state regulatory bodies have begun to require service providers to identify how they will address disparities faced by LGBTQ individuals, so service providers need to demonstrate how they are improving access to and quality of care for LGBTQ individuals. Therefore, the LGBTQY-CC may provide a means to gather data on efforts made by service providers to improve their behavioral health workforce’s capacity to serve LGBTQ youth.

M.A. / The research describes the different methods followed by traditional healers and western professionals in dealing with mental illness. The study is intended to provide an in-depth analysis of the process involved when the mentally ill patient consult a traditional healer in the community and a western professional at the local clinic in Emzinoni. The study also intends to examine whether or not the two approaches can complement each other. In this research, it was found that the mentally ill patient would consult either a traditional healer or a western professional worker. In some cases, when the patient has consulted the traditional healer and his/her condition does not improve, he/she resorts to western medicine. The same applies to the patients, who have consulted a western professional. If his/her condition does not improve, he/she consults the traditional healer. The study showed that patients who are mentally ill do not use medicines from both traditional healers and western professional at the same time. The patient chooses the treatment that makes him/her become better. It was recommended in the study that traditional healers and western professionals should develop a referral system.

Thesis advisor: Rocío Calvo / Hispanics are less likely than non-Hispanic whites to use mental health service, even after controlling for various social, environmental, and health factors. Mental health services disparities between Hispanics and non-Hispanic whites have been well-documented and consistent over time. However, very little is known about the impact mental health care organizations have on Hispanics’ access to mental health care, especially since the implementation of the Patient Protection and Affordable Care Act (ACA). The three papers in this dissertation utilize the 2010, 2014, and 2016 waves of the National Mental Services Survey (N-MHSS) to assess the impact of the ACA on Hispanics’ access to mental health care and mental health care organizations’ provision of integrated services. The N-MHSS is a national repository of data on the mental health organizations in the United States. This dataset was created to report the characteristics and client enrollment at mental health care organizations. Paper 1 uses the 2014 N-MHSS to describe the structural characteristics of mental health care organizations according to the proportion of Hispanics they serve and the organizations’ structural characteristics in Medicaid expansion and non-expansion states. Paper 2 uses the 2010, 2014, and 2016 N-MHSS waves to examines the impact of the ACA and the health safety net on Hispanic admissions at mental health care organizations. These three waves were merged together using a repeated cross-sectional design to assess whether Hispanic admissions increased after the implementation of the ACA. The final paper uses the 2014 and 2016 N-MHSS waves to assesses whether integrated care has increased at Hispanic-serving organizations compared with mainstream organizations two years after the implementation of the ACA. This paper also assessed whether the increased funding for integrated services under the ACA has disproportionately affected mainstream organizations compared with Hispanic-serving organizations. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Student Number : 8805489T - MA research report - School of Human and Community Development - Faculty of Humanities / A casual scan of workplace based mental health services in South Africa reveals a developing tendency and trend towards the outsourcing of this service. Most companies that previously boosted relatively huge integrated and comprehensive workplace mental health services have ceased offering these services internally in favour of sourcing them from external service providers. Most occupational social workers who previously worked in these departments are now part of the outsourced services. Occupational social work theory advocates for practitioners to go beyond focusing on the individual by also seeking to impact on the environment and the community in the quest to serve the needs of their clients. Some services, particularly if the practitioner seeks to change the host organisation, are easier to render when the practitioner is within the organisation. The present study investigated, using robust statistical methods, firstly, the desirability of comprehensiveness and integration in workplace mental health services, and, secondly, whether observed levels of comprehensiveness and integration in service delivery in a single organisation that uses outsourced workplace mental health services are in line with desired levels. The research results indicate that host organisations desire more comprehensiveness and integration in workplace mental health services than is currently observed from an outsourced mental health service.

In partial fulfilment of the requirements for the degree Master of Arts (Migration and Displacement) by Coursework and Research Report, August 2017 / In Zimbabwe, the past two decades have been characterized by a growing flow of refugees into the country from other parts of the continent such as Burundi, Sudan, the Democratic Republic of Congo (DRC), Rwanda, and Somalia. Drawing from the biomedical model, prevailing discourses about mental health posit that after going through traumatic experiences in the wartorn regions of the world, refugees and asylum seekers are particularly vulnerable to developing mental health problems and are, therefore, in need of counselling and psychosocial services. This assumption has guided, and has subsequently been supported by, several studies conducted in the Global North, and there is generally a lack of local literature and research that either confirm or challenge the assumption in Southern Africa. This research was prompted by such a substantial research gap and therefore seeks to examine the perceptions of refugees regarding mental health and access to care. The study identified Tongogara Refugee Camp as the study site and targeted adult individuals aged 18 and above, residing in the camp, as well as officials from the Zimbabwean Ministry of Public Service, Labor and Social Welfare, United Nations High Commissioner for Refugees (UNHCR), Christian Care, Jesuit Refugee Services (JRS), International Committee of the Red Cross (ICRC), clinic officials as well as faith-based leaders. The access to health care framework (McIntyre, Thiede, & Birch, 2009), was used as the basis and theoretical framework for this research to explore the various factors determining availability, affordability and acceptability. The overall methodology employed was the qualitative approach and the case study research design. Respondents were recruited through the purposive sampling method and semi-structured interviews were used for data gathering. Thematic content analysis yielded participants’ perceptions of mental health and access to care through their descriptions of pre-migration trauma and post-migration stress as the major causes of mental illness, and expressions of mental illness such as sadness, worrying, wandering aimlessly through the camp, talking too much and violence. The study sheds light on the problems of medicalizing distress and human suffering, particularly the limitations of the biomedical model of mental health treatment. Camp residents mainly rely on spirituality and social support for coping with mental health. Several issues, relating to all the dimensions of the concept of access were identified, including language barriers, temporary solution to a permanent problem, lengthy waiting times, as well as ill-treatment at the camp clinic. Recommendations include the key need to be cautious about the importation of Western biomedical approaches, the need to pay more attention to the prevention of mental health problems and the promotion of mental health through action on the social determinants of health, the need for language interpreter services at the camp clinic, the need for improved engagement with refugee families, and the need for resettlement. Such information may help add to the body of available literature on refugee and asylum seekers’ access to health services and to literature that is exploring the development of appropriate responses to mental wellbeing in the Southern African context. / XL2018

O Juqueri, oficialmente denominado Departamento Psiquiátrico II, conjunto pertencente à Secretaria de Estado da SaÚde, foi inaugurado em 1898 e situa-se nos municípios de Franco da Rocha e Caieiras, no Estado de São Paulo, dentro da área metropolitana da Grande São Paulo. O Juqueri tem uma area de 2.983,425 ha, área construída de 11.288,62m e possuía, em outubro de 1981, populção de cerca de 4.200 internos e 3.400 servidores. Os pacientes estavam localizados em 3 tipos de estabelecimentos: 21,8 por cento no Hospital Central, destinado a agudos; 62,8 por cento nas Colônias de Reabilitação, destinadas aos crônicos ou sem possibilidades de retorno social e 15,4 por cento no Manicômio Judiciário, destinado aos alienados criminosos ou em observação à disposição da Justiça. Uma série de serviços de infraestrutura necessários às duas populações, além das funções clássicas de hospital psiquiátrico, faz com que o conjunto tenha características de cidade com área rural contígua. O trabalho tem sua finalidade e metodologia descritas nos capÍtulos I e II, aborda a evolução histórica da instituição, sua organização atual e a inclusão na paisagem metropolitana (Capítulo III), estuda a população de internados (CapÍtulo IV) e a população de servidores (CapÍtulo V) e faz considerações finais (Capítulo VI). As conclusões, no CapÍtulo VII, baseadas nas análises e pesquisas realizadas são: (a) o Juqueri tem estado ausente da reformulação das polÍticas públicas de saÚde mental, de planejamento de saúde e de planejamento geral da área metropolitana; (b) a instituição tem grande pobreza organizacional e de recursos humanos quando comparada com outras similares; (c) suas características de cidade demandam modelos e condições excepcionais dentro da Administração Pública; (d) a instituição tem estado permanentemente sob crítica em dois campos em crise: o encarceramento e a hospitalização psiquiátrica, sem que lhe sejam dadas condiçÕes para um melhor desempenho. / The \"Juqueri\", officially called Psychiatric Department II, a complex belonging to the Health State Department, was installed in 1898. It is located in the Franco da Rocha and Caieiras municipalities, in the state of são Paulo, within the Metropolitan area of the Great São Paulo. The \"Juqueri\" covers an area of 2,983.425 ha, having 118,288.62m of constructed area and, in October 1981, it held populations of about 4200 inpatients and 3400 workers. The patients were assigned to three kinds of settlements: 21.8 per cent in the Central Hospital, addressed to acute cases; 62.8 per cent in Rehabilitation Colonies, addressed to chronic patients or those with no possibility of a social regress, and 15.4 per cent in the Judicial Lunatic Asylum addressed to the alienated criminals or those under observation on the hands of Law. A number of infrastructure services, needed by both populations, beside the traditional functions of a psychiatric hospital, gives the complex characteristics of a city with its rural area next. The paper has its goal and methodology described on Chapters I and II; broaches the institution historical evolution, its current organization and inclusion within the metropolitan picture (Chapter III); studies the inpatient population (Chapter IV) and the workers population (Chapter V) and makes final recommendations on Chapter VI. The conclusions, based on the analysis and researches worked out, are presented on Chapter VII; they are as follows: (a) the \"Juqueri\" has been absent from the public policy re-orientation of mental health, health planning and general planning regarding the Metropolitan Area; (b) the institution, when compared with similar ones, presents a great poorness concerning its organizational and human resources; (c) its city-like characteristics demand models of outstanding conditions within the Public Administration; (d) the institution has been constantly under the criticism of two fields in crisis - the psychiatric confinement and hospitalization - without being provided of any conditions to achieve a better performance.

A Interconsulta Psiquiátrica é considerada uma área da Psiquiatria, que trabalha no Hospital Geral compondo uma equipe (Psiquiatria de Ligação) ou prestando seus serviços a uma equipe solicitante (Consultoria Psiquiátrica). O Serviço de Interconsulta em Psiquiatria (SIP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) teve início em março de 1978 e a Terapia Ocupacional passou a integrar esta equipe em 1999. O cotidiano hospitalar tem uma marca própria com obrigações como usar vestimentas, ter horários previamente estabelecidos para se alimentar, para cuidar de sua higiene e para receber visitas, inclusive dos familiares. Os terapeutas ocupacionais, como profissionais que lidam com o cotidiano do indivíduo, têm sido inseridos nas equipes multiprofissionais do Hospital Geral, contribuindo com seus conhecimentos teóricos e técnicos específicos para cuidar de pessoas hospitalizadas. Apesar das várias funções que a Terapia Ocupacional (TO) pode exercer no Serviço de Interconsulta, existe escassez de estudos publicados sobre o perfil sócio-demográfico dos pacientes atendidos, o que prejudica o planejamento de ações e o levantamento da necessidade de recursos humanos para aquele Serviço. O objetivo deste trabalho foi realizar um estudo retrospectivo dos Pedidos de Interconsulta (PIs) para a TO do Serviço de Interconsulta em Saúde Mental (SISMen) do HCFMRP - USP no período de janeiro de 2000 a dezembro de 2005. Os sujeitos foram os indivíduos que estiveram internados nas enfermarias do campus do hospital universitário e para quem foi solicitada a assistência do Serviço de TO naquele período, perfazendo um total de 633 pacientes e 709 PIs. Os dados foram coletados mediante consulta dos PIs e dos prontuários dos pacientes. A maioria dos sujeitos consultados foi do sexo feminino, com ensino fundamental incompleto e houve distribuição equilibrada entre os solteiros e casados. Quanto à idade e à situação laboral, a média de idade dos pacientes foi de 39,2 anos e a maioria deles era autônoma ou aposentada, seguida de dona de casa. Verificou-se que a Clínica Médica foi a responsável por mais do que um terço dos Pedidos de Interconsulta feitos para o Serviço de TO, seguida das clínicas Unidade Metabólica e Psiquiatria respectivamente; o tempo médio de internação dos pacientes encaminhados para esse Serviço foi de 51 dias, sendo que a média de internação no HCFMRP-USP foi de 6,4 dias. Consequentemente, o gasto desses pacientes variou entre uma e 2,4 vezes mais do que os pacientes internados nesta instituição. A taxa média de encaminhamento para a TO do SISMen foi de 0,5%, sendo que o motivo de solicitação mais freqüente esteve relacionado aos aspectos emocionais do indivíduo, seguido por fatores referentes à hospitalização. Estes dados, de modo geral, estão de acordo com a literatura nacional e internacional dos SIPs. Concluiu-se que há necessidade de um instrumento padronizado para avaliar a população atendida pelo Serviço de Interconsulta de TO e que alguns pontos merecem estudos mais detalhados como a possibilidade de existência de associações entre dados sócio-demográficos e clínicos e o encaminhamento dos pacientes para esse Serviço. / Consultation Liaison Psychiatric is considered to be an area of Psychiatry which is part of a General Hospital, involving a team (Liaison Psychiatry) or providing services to a team that requests them (Psychiatric Consultation). The Consultation Liaison Psychiatric Service (CLPS) of the University Hospital, Faculty of Medicine of Ribeirão Preto (HCFMRPUSP) was started in March 1978 and Occupational Therapy became part of this team in 1999. The daily hospital routine has specific rules such as wearing specific clothing and taking meals, caring for ones hygiene and receiving visits, including those of relatives, at pre-established times. Occupational therapists, as professionals who deal with the daily routine of an individual, have been inserted into the multiprofessional teams of the General Hospital, contributing their specific theoretical and technical knowledge to the care of hospitalized persons. Despite the various functions Occupational Therapy (OT) can perform in the CLPS, there is a scarcity of published studies on the sociodemographic profile of attended patients, impairing the planning of actions and the determination of the human resources needed for that Service. The objective of the present investigation was to conduct a retrospective study of the Requests of Consultation Liaison (RCLs) sent to the OT of the Service of The Consultation Liaison in Mental Health (SCLMH) of HCFMRP-USP during the period from January 2000 to December 2005. The subjects involved were the individuals who had been admitted to the wards of the University Hospital and for whom the assistance of the OT Service had been requested during that period, for a total of 633 patients and 709 RCLs. The data were collected from the RCLs and the medical records of the patients. Most of the subjects involved were women with incomplete elementary schooling, with a balanced distribution of single and married subjects. Mean patient age was 39.2 years and most patients were self-employed or retired, followed by the housewife category. Internal Medicine was responsible for more than one third of the RCLs sent to the OT Service, followed by the Metabolic Unit and Psychiatric clinics. The mean time of hospitalization of the patients referred to this Service was 51 days, with the mean duration of hospitalization at HCFMRPUSP being 6.4 days. Consequently, the expenses with these patients ranged from one to 2.4 times more than those for the patients hospitalized in this institution. The mean rate of referral to the OT of the SCLMH was 0.5%, with the most frequent reason for the request being related to the emotional aspects of the individual, followed by factors related to hospitalization. These data, in general, agree with the Brazilian and international literature about the CLPS. We conclude that there is the need for a standardized instrument for the evaluation of the population attended at the Consultation Liaison Service of OT and that some points need more detailed studies regarding the possibility of the existence of an association between sociodemographic and clinical data and the referral of these patients to the OT Service.