A literatura especializada privilegiou os estudos sobre a tendencia antissocial em meninos, em razão da maior incidencia e consequente visibilidade. A presente pesquisa segue uma tendencia atual de considerar as manifestações da tendencia antissocial no sexo feminino, em especial a mentira, o roubo e a fuga, tendo como objetivos compreender as diferenças de gênero e verificar a pertinência do atendimento multidisciplinar em instituição de saúde mental voltada para a infancia e adolescencia, o Caps infantil. O método empregado foi o clínico-qualitativo, desenvolvido por Turato (2010) e a fundamentação teórica psicanalítica, ressaltando-se as contribuições de Donald Winnicott (1956), o qual considera a tendencia antissocial como um sintoma voltado ao ambiente como expressão de esperança em recuperar uma situação positiva outrora experimentada e perdida. Foram descritos os atendimentos de duas adolescentes que apresentavam a tendencia antissocial e a partir deste material estabeleceram-se duas vertentes principais para a analise dos resultados: o funcionamento psíquico e o tratamento. Com relação ao funcionamento psíquico destacaram-se os sentimentos de rejeição e abandono em relação à figura materna, os quais teriam dificultado o processo de identificação com o feminino, levando-se em conta a reedição edípica e as vivencias psíquicas características da adolescencia. Foram observadas experiencias de negligência e violencia intrafamiliar, fatores desencadeantes da tendencia antissocial, de modo similar aos achados de pesquisas referentes ao gênero masculino. No que se refere ao tratamento da tendencia antissocial na instituição, destacaram-se as técnicas de manejo e placement, consideradas fundamentais para a obtenção de resultados favoráveis para os casos estudados. Às manifestações da tendencia antissocial foram atribuídos sentidos diversos, a partir dos pontos de vista das adolescentes somados aos das contribuições psicanalíticas, as quais também proporcionaram uma compreensão dos aspectos transferenciais e contratransferenciais. / Specialized literature has favored studies on anti-social tendency in boys, due to its higher frequency and consequent visibility. This research was carried out as per present trends that analyze anti-social manifestations in females, specially lie, steal and escape, with the purpose of understanding sex differences and verifying the adequacy of multidisciplinary therapies in a mental health service Caps Infantil - specialized in child and adolescent issues. The study was performed according to the clinical-qualitative method, developed by Turato (2010) and psychoanalytic theoretical formulations, specially Donald Winnicotts contributions (1956), who considers the anti-social tendency as a process of searching the holding environment and a sign of hope of rediscovering good experiences that have been lost. Therapy sessions of two adolescents that presented anti-social tendency were described and this material provided two different approaches for the analysis of the results: psychic functioning and treatment. Regarding psychic functioning, marked feelings of rejection and maternal abandonment might probably have impaired the female self-identification process, tanking into consideration the revival of the Oedipus complex and typical psychic experiences in adolescents. Observed negligence and domestic violence are factors linked to anti-social tendency, similarly to the research findings in males. The treatment of anti-social tendency in the mental health service consisted of using mainly management and placement techniques, which were considered essential for the favourable results achieved in these cases. Manifestations of anti-social tendency were interpreted as having different meanings, be it from the adolescents point of views or from the psychoanalytical contributions. They also allowed the understanding aspects of transference and countertransference.

Wan, Suk Fan. / Thesis submitted in: December 2006. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 170-176). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.iv / Chapter Chapter 1 --- Introduction --- p.1 / Rationale of the Research Topic --- p.2 / Research Questions --- p.3 / Research Objectives --- p.4 / Overview of the Present Thesis --- p.4 / Chapter Chapter 2 --- Literature Review --- p.6 / The Vicissitudes of the Concept of Mental Health Problems in the Western Culture --- p.6 / The Development of the Concept of Children and Adolescents in the Western Culture --- p.12 / The Traditional Chinese Concept of Children and Parental Role --- p.19 / The Child Mental Health Problem in Hong Kong --- p.24 / Summary --- p.29 / Chapter Chapter 3 --- Theoretical Framework --- p.32 / Orientation of A Critical Social Work --- p.32 / "Discourse, Power / Knowledge" --- p.34 / "Discourse, Subjectivity and Human Problem" --- p.38 / Criticism from Foucault and Inspiration for the Theoretical Framework --- p.40 / Social Constructionism --- p.44 / Summary --- p.46 / Chapter Chapter 4 --- Research Methodology --- p.48 / Rationale of Selecting the Qualitative Research Method --- p.48 / Research Design --- p.50 / Methods of Data Collection and Analysis --- p.51 / The Setting of the Child Psychiatric Unit of the Alice Ho Miu Ling / Nethersole Hospital --- p.54 / Sampling Method and the Profile of the Participant Families --- p.56 / Quality of the Present Research and Its Measure --- p.62 / Summary --- p.65 / Chapter Chapter 5 --- The Results of Study : The Subjective Experiences of the Children and Adolescents --- p.67 / The Subjective Experience related to the Child Mental Health Problems: the Children and Adolescents´ة Perspective --- p.67 / "I have problems, but my problems were not necessarily a child mental health problem.'" --- p.67 / My school and family lives were disturbed not only by my problems; but by the treatment provided by the Child Psychiatric Unit too!´ة --- p.73 / Effects on School Lives --- p.73 / Effects on Family lives --- p.75 / "´بPerhaps the treatment improved my problems, but it was such a painful and meaningless process to me!´ة" --- p.81 / ´بThe Child Psychiatric Ward - a place I never want to go again!´ة --- p.81 / "´بNo one discussed with me about my progress and discharge plan, I felt like being trapped!´ة" --- p.90 / I had no part to play in my treatment!´ة --- p.91 / I was confused by too many helping professionals. They were unhelpful unless I was ready to help myself. ´ب --- p.94 / I had no choice! No one discussed with me before the decision was made!'´ة --- p.95 / Summary --- p.97 / Chapter Chapter 6 --- The Results of Study : The Subjective Experiences of the Parents --- p.99 / The Subjective Experiences related to their Children´ةs Mental Health Problems : the Parents´ةPerspective --- p.99 / ´بMy child does not only have child mental health problem but also problems with other aspects of his / her life.´ة --- p.99 / ´بWe were desperate; the services provided by the Child Psychiatric Unit were our last resource!´ة --- p.106 / "´بMy child's problem affected not only his / her well-being, but it also affected our family relationship, parenting, emotions and mental health!'´ة" --- p.109 / "´بFamily Relationships - it was not his problem only, my whole family was affected.´ة" --- p.109 / "Parenting -1 know I need to adjust my parenting in response to my child's problem, but I am uncertain in what way I should change.´ة" --- p.114 / "´بEmotions and Mental Health - although I was disappointed by my child, I blamed myself for his problem and worried that his future would be destroyed by his problem.´ة" --- p.120 / Who is going to take care of my emotions?´ة --- p.129 / I needed help; but Ifelt that I was not included from the treatment program!´ة --- p.129 / I need more than a pill for my child!' --- p.129 / "´بDoctor, would you listen to my opinions and difficulties in dealing with my child's problem before you design the treatment plan?´ة" --- p.133 / Visiting - the precious moment to show our support to my child but restricted by the hospital policy.' --- p.135 / Summary --- p.137 / Chapter Chapter 7 --- Discussion and Implications --- p.139 / The Constitution of Subjectivities --- p.140 / The Subjectivities of the Children and Adolescents --- p.142 / The Subjectivities of the Parents --- p.145 / Power Relations --- p.149 / Power Relations between Self and Discourse --- p.150 / Power Relations between Parents and Children --- p.151 / Power Relations between Services User and Helping Professionals --- p.152 / Power Relations between Service Users and Hospital Policies --- p.154 / Emergence of New Meanings and Creation ofAlternatives --- p.155 / Implications for Social Work Practice and Future Child Mental Service Development --- p.156 / Contributions and Limitations of this study --- p.160 / Contributions of this Study --- p.160 / Limitations of this Study --- p.161 / Directions for Further Study --- p.163 / Self-reflexivity : My Personal Change after Completing this Study --- p.163 / Conclusion --- p.165 / Appendices / Appendix 1 Guidelines for interview --- p.166 / Appendix 2 Letter to the family and consent form (Chinese version) --- p.168 / Bibliography --- p.170 / List of Tables: / Table 1: Summary of Erikson's Psychosocial Theory --- p.17 / Table 2: Details of the Data Collection Schedule --- p.53 / Table 3: The Socio-Demographic Data of the Six Families --- p.57 / Table 4: Diagnosis and Psychiatric Histories of the Six Children and Adolescents --- p.58 / Table 5: Details of Hospitalization of the Children and Adolescents --- p.59 / Table 6: Details of the Follow up Service Received by the Children and Adolescents --- p.59

Typescript (photocopy). / Digitized by Kansas Correctional Industries / Department: Regional and Community Planning.

O presente trabalho objetivou identificar as contradições e incoerências na práxis de trabalhadores de saúde mental em um Centro de Atenção Psicossocial propondo alternativas de mudança e transformação para as mesmas. Nosso estudo se respaldou pelo pensamento construído na Reforma Psiquiátrica brasileira de que era imprescindível a desconstrução tanto do aparelho físico do manicômio como do saber psiquiátrico. A desinstitucionalização da loucura reconduziria este fenômeno para o corpo social desfazendo o conceito de loucura como doença e des-razão. A investigação lançou mão da metodologia do Teatro do Oprimido aliado ao pensamento sociológico de Boaventura de Sousa Santos que ele intitulou de Sociologia das Ausências e das Emergências. Realizamos encontros com dinâmicas do Teatro do Oprimido, por meio dos jogos e cenas improvisadas foi possível visualizar conflitos e idéias do grupo, anotadas por meio de uma observação externa e outra participante. A análise dos dados contou com o trabalho de se pensar e dar sentidos às contradições e incoerências percebidas e vislumbrar possibilidades de mudança por meio de uma sociologia das emergências. Estas contradições se referiram ao posicionamento hierárquico de reputação dentro da instituição, à delegação de voz a um mesmo sujeito em posição considerada superior, em detrimento do compartilhamento de conhecimentos, idéias e ideais por meio da sedução e do contágio. Contradições também ligadas à manutenção de certos termos classificatórios ligados ao saber psiquiátrico tradicional foram descritos e discutidos, bem como a percepção e crítica da formação de um novo saber que substitui o psiquiátrico e que chamamos de psicossocial. O paradoxo da revoluçãoreforma nos possibilitou pensar o quanto já se instituiu do movimento revolucionário chamado Reforma e pensar ainda os desafios e possibilidades a frente. Sugerimos uma comunicação, que já vem se iniciando, entre saberes e práticas sociais e incrementamos o método do Teatro do Oprimido para viabilizar um Teatro das Emergências. Nossas considerações finais assinalaram que mesmo diante da dinâmica revolução-reforma que coloca a instituição a serviço da regulação a mesma ainda possui alguma autonomia diante de outros serviços inteiramente públicos que ficam a mercê das políticas federais e locais e nem sempre sustentam seus projetos e grupos. A autonomia do CAPS do terceiro setor o permite trafegar com maior liberdade pelo público, privado e pelo movimento social, sendo contemplado com recursos financeiros e humanos de setores distintos e podendo abrir estágios, pesquisas, cursos e práticas alternativas sem prestar contas de todas as suas ações. Ao mesmo tempo, que o convênio estatal garante o princípio do prazer, é fator de grandes tensões entre os sujeitos que são pressionados a cumprir com os protocolos burocráticos. Ainda assim mantém uma direção a favor da Reforma e singularmente resistente às cristalizações da mesma. / The present work aimed at identifying the contradictions and incoherence of the praxis of mental health workers in a Psychosocial Attention Center, proposing alternatives for their change and transformation. Our studies were based on the thought constructed by the Brazilian Psychiatric Reformation where it was allimportant the deconstruction of both the asylum physical institution and the psychiatric knowledge. The de-institutionalization of madness would lead this phenomenon back to the social body undoing the concept of madness as an illness and de-reason. The investigation laid hold of the Theater of the Oppressed methodology combined with the sociological thought of Boaventura de Sousa Santos who named it Sociology of the Absences and the Emergencies. We carried through meetings using the Theater of the Oppressed dynamics, and by means of games and improvised scenes it was possible to visualize the conflicts and ideas of the group, written down by means of external and participative observation. The analysis of the data counted on the work of thinking and giving sense to the contradictions and noticed incoherence, and to perceive possibilities of change by means of sociology of the emergencies. These contradictions related to the hierarchic positioning of reputation inside the institution, to the delegation of voice to a same person in a position regarded as upper, in detriment of the sharing of knowledge, ideas and ideals by means of seduction and contagion. Contradictions also linked to the keeping of certain classificatory terms that tend to lead back to the traditional psychiatric knowledge were described and discussed as well like a construction of a new knowledge, the psychosocial. The paradox of the revolution-reformation enabled us to think about the much we have already instituted of the revolutionary movement called Reformation and yet to think the forthcoming challenges and possibilities. We suggested a communication, that is starting already, between knowledge and social practices and we also elaborated the Theater of the Oppressed method so as to make the Theater of the Emergencies feasible. Our final considerations indicated that even with the dynamic revolution-reformation that places the institution at the service of the regulation, it still has some autonomy compared to other entirely public services that are at the mercy of the federal and local policies and that not always support their projects and groups. The CAPS autonomy of the third sector allows it to transit with wider freedom by the public and private sectors as well as by the social movement, being provided with financial and human resources from distinct sectors and being able to open probation periods, research, courses and practical alternatives without requesting for the state licence or reporting on all its actions and objectives. At the same time that the state accord assures it, the principle of pleasure is a factor of great stress among people who are pressed to meet with the bureaucratic protocols. Nevertheless they keep a direction in favor of the Reformation and particularly resistant to its crystallizations.

Thesis. 1976. M.C.P.--Massachusetts Institute of Technology. Dept. of Urban Studies and Planning. / Microfiche copy available in Archives and Rotch. / Bibliography: leaves 120-122. / by Victor John Franckiewicz, Jr. / M.C.P.

Introdução: O atual modelo de saúde mental infantojuvenil tem como um dos seus pilares a transformação da postura dos profissionais da área. Espera-se que eles se coloquem de corpo inteiro e se impliquem subjetivamente no trabalho. Esses profissionais têm papel fundamental nas direções tomadas ao longo dos anos, contudo são historicamente desvalorizados e pouco estudados. Objetivo: Descrever e analisar a subjetividade, as experiências de formação e a trajetória de vida de trabalhadores de Centros de Atenção Psicossocial Infantojuvenis (CAPSi) e suas relações com o processo de inserção e prática nesse campo. Método: Foi realizado um questionário com perguntas semi abertas e entrevistas narrativas com 8 trabalhadores de diferentes categorias profissionais lotados em 2 CAPSis do Município de São Paulo, um deles gerenciado diretamente pela Prefeitura e outro por Organização Social de Saúde (OSS). Para análise das entrevistas narrativas foi utilizada a proposta de Shutze. O Referencial Teórico foi construído a partir de diferentes autores que dialogam entre si, dentre eles Dejours e Schwartz. Resultados: Constaram-se importantes diferenças entre os trabalhadores do CAPSi gerenciado por OSS e pela Prefeitura no que se refere ao perfil profissional, às motivações para o trabalho, ao tipo de formação que buscam e aos sentidos atribuídos ao trabalho. No entanto, todos os trabalhadores revelam características comuns: impacto recíproco que a vida pessoal e o trabalho na saúde mental exercem entre si; passagem prévia por hospital, escola ou consultório, de forma que essas instituições marcam sua atuação profissional; carência de capacitação oferecida pelos serviços e grande distância entre as necessidades reais do serviço e os treinamentos oferecidos. Conclusão: A tendência atual do mundo do trabalho caminha em sentido oposto às propostas da Reforma Psiquiátrica, fazendo com que os profissionais mais antigos encontrem dificuldades e os mais jovens se afastem dos pressupostos da Reforma Psiquiátrica. Junto a isso, a complexidade das propostas de tratamento nos CAPSis e a falta de espaços de discussão e potencialização do trabalho, que deviam ser oferecidos pelas instituições, faz com que ambos os grupos de profissionais sintam-se perdidos e sozinhos. A formação transcende o espaço técnico no qual ela se delimita inicialmente e se espraia para diversos setores da vida do indivíduo / Introduction: The current model of child and adolescents Mental Health Care are in transformation concerning the professionals approach. It is expected that they get deeply involved in a subjective way in their work. These professionals are very important in the directions taken in that field over the years, however, they are historically unevaluated and understudied. Objective: Describe and analyze subjectivity, as well as training experiences and life trajectories of employees of Psychosocial Care Centers for Children and Adolescents (CAPSi) and their relation to the process of professional insertion and practice in this field. Method: A semi-structured questionnaire and narratives interviews were conducted with 8 workers from 2 CAPSi from São Paulo City, Brazil; one managed directly by the City and one managed by Social Health Organizations- OSS. The narratives interviews have been subjected to Shutze analysis techniques. The Theoretical Framework was built from different authors who interact with each other, including Dejours and Schwartz. Results: It was found important differences between work team from CAPSi managed by the OSS and CAPSi managed directly by the City concerning professional profile, motivations for work, type of training searched and meanings attributed to work. However, all employees reveal common features: reciprocal impact that personal life and work in mental health influences on each other; previous works in hospitals, schools and office, so these institutions marked their professional performance; lack of training services and large distance between the real needs of the service and the training offered. Conclusion: It was found that the current trend in the field goes in opposite direction to the proposals of the Psychiatric Reform, causing the older professionals do not fit in and younger professional deviate from the Psychiatric Reform proposed. Along with this, the complexity of treatment proposed in CAPSi and lack of opportunities for discussion and empowerment work team of labor, which should be offered by institutions, makes both groups of professionals feel lost and alone. The technical training transcends space in which it delimits initially and spreads to various sectors of the life of the individual

Objective: Some Veterans who recently served in the military report significant psychological problems based on their experiences in the military. Stressors that these Veterans face when they transition out of the military can exacerbate these problems and negatively impact their long-term physical and psychological well-being. We are conducting a randomized controlled trial (RCT) to evaluate the efficacy of providing Veterans who are transitioning back into their civilian communities trained, peer mentorship (Pro Vetus) and membership in a Veteran Support Organization (VSO- Team Red, White, and Blue) to reduce transition stressors, maintain psychological and physical health, reduce suicides and reduce criminal incidents. Method: Six hundred, New York City area Veterans who transitioned out of the military since 2002 will be randomized to one of three study arms (1. Team Red, White and Blue membership plus trained, peer Pro Vetus mentorship; 2. Team Red, White, and Blue membership; and 3. Waitlist control). Intent-to-treat analysis will compare changes in transition stressors (proximal measures) as well as psychological and physical health, suicide, and criminal incidents (distal measures). For this preliminary investigation of the full RCT, the results of 58 Veterans who completed the pre-intervention and post-intervention were analyzed. For the analysis, the first and second study arms were combined into one intervention arm because of the unbalanced nature of the arms. Results: The preliminary results indicate that Veterans in the combined intervention arm experienced less transition difficulties and had higher levels of social support at the four month post-intervention assessment. Though promising, there are still extensive limitations to the inferences that can be drawn from this research. These limitations will be reduced as data points increase and more Veterans participate in the research study. Keywords: Veterans, transition, peer mentorship, Veteran Support Organization, PTSD, suicide

This study explores mental health advocacy among individuals with psychiatric disabilities in the New York State (NYS) adult home system. This system has garnered longstanding public concern over the unsafe and unjust conditions in which its residents live. In New York City (NYC) a unique organization, Adult Home Advocates (AHA), supports a group of residents (called peer advocates) to advocate for their rights. I integrate literature on health and mental health advocacy and movements with the concept of mental health recovery to consider how AHA participation may impact recovery for peer advocates and others living in the adult home system. I use Brown et al.'s (2010) policy ethnography approach to study sociolegal, organizational, and individual contexts in which peer advocates work and live. From May 2013 to August 2017 I conducted peer advocate (n=36) interviews and member checks, participant observations (n=154), archival document research, and initiated policy advocacy work. This study is guided by four research questions: 1) How may the sociolegal and organizational environments - - including an unfolding shift in the sociolegal environment - - influence mental health advocacy among individuals with psychiatric disabilities? (Chapter 3, p.41) 2) How may individual characteristics - - specifically, mental health recovery characteristics - - influence mental health advocacy among individuals with psychiatric disabilities? (Chapter 4, p.90) 3) What are the motivations for mental health advocacy among individuals with psychiatric disabilities? (Chapter 5, p.134) 4) What are the impacts of mental health advocacy among individuals with psychiatric disabilities? (Chapter 6, p.182) I use conventional content analysis (Hsieh & Shannon, 2005), with mental health recovery as a sensitizing concept, to organize and analyze data. I report on findings from the sociolegal to individual levels. First, the sociolegal environment includes patterns of unsafe, unhealthy, and socially isolating conditions within adult homes; even as a legal settlement (O’Toole v. Cuomo) helps residents move out, troubling implementation practices perpetuate these unjust conditions. AHA enters this environment with a commitment to help adult home residents advocate for themselves, though it is a small organization in terms of budget, staffing, and scope. Its size is both a key strength and limitation, as it furthers its mission-driven work, yet impedes training and support for peer advocates. I also report on findings specific to peer advocate participants (n=36). I use six mental health recovery domains - - including a sociolegal domain I develop to explore justice and rights issues - - to describe recovery as heterogeneous and dynamic across both individual domains and individual participants. Participants’ motivations for advocacy are also heterogeneous, with three types salient: 1) self-advocacy, 2) purpose, and 3) identity. Further, these motivations lead to four types of advocacy activities: 1) self-advocacy, 2) self-help, 3) advocate leader, and 4) advocate activist. Finally, I find that advocacy involvement does impact participants, both positively and negatively. I return to the six recovery domains used above to discuss how mental health advocacy brings into relief potential means of furthering mental health recovery for individuals with psychiatric disabilities.

This thesis follows the paper-based format and papers one and two have been prepared for submission to Attachment and Human Development and the British Journal of Clinical Psychology, respectively. The relevant submission guidelines are included in the appendices (Appendix A and B).Attachment theory (Bowlby, 1977a) has prompted a wealth of empirical research in its contribution to adult attachment patterns and subsequent psychopathology in mental health (Holmes, 2001; Wallin, 2007). More recently, attachment theory has been proposed as a suitable framework by which to inform the organisation, design and delivery of mental health services (Goodwin, 2003; Seager et al., 2007) but it is unclear what this would look like in practice. Adopting an attachment-informed service model has key implications for individual and service outcomes and the two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications. Paper one is a narrative overview of the literature discussing the practice implications of services adopting an attachment-informed framework, and describes how this might be conceptualised in front-line service delivery. Articles reviewed described the influence of attachment theory in predominantly inpatient, secure forensic and/or psychiatric rehabilitation services, and its application within more generic community mental health services was explored. Paper two aimed to investigate the importance of individual attachment and service attachment to client psychopathology, quality of life, service utilisation and service costs in community-based mental health services. The final section, the Critical Review, critiqued the literature review and aimed to place the research within a wider context. This section considers the findings from the research and the limitations of the study, while also highlighting important issues for services, with implications for clinical practice and future research.

The overall aim of the research is contribute to a reduction in suicides within mental health services. This study will explore the learning process for mental health services following patient suicides in Northern Ireland (NI). It will focus on how the recommendations contained in Serious Adverse Incident reports, which are completed following all patient suicides, are translated into practice. The study will examine all SAI reports completed from January 2015 to December 2016. Focus groups with mental health professionals throughout NI will then be used to increase understanding of the enablers and barriers to effective implementation of these recommendations within mental health services.