Thesis (M.S.W.)--University of Hong Kong, 1980.

Thesis (M.A.)--York University, 2001. Graduate Programme in Geography. / Typescript. Includes bibliographical references (leaves 109-129). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ66394.

The literature has documented the contention that economic, cultural, and structural barriers have led to lower utilization of mental health services by Latinos when compared to other ethnic groups. With the growth of older Hispanics, the number of people affected by the barriers to health care will grow. Despite barriers, a small number of older Latinos access mental health services. A gap exists in the literature to explain how some older Latinos access mental health treatment. Using qualitative exploration, this dissertation answers the central question what factors influence help-seeking behavior and mental health service utilization of older Mexican Americans. The researcher used a purposive sample and interviewed 20 older Mexican Americans, who completed outpatient mental health services located in Texas. Green’s (1999) Adapted help-seeking behavior model guided the ethnographic content analysis. Respondents experienced a multiplicity of stressors and behavioral signs of mental distress. Among labels used for the problem were depression or depresion, anxiety, nervios or ansiosa, also soledad, tristeza and coraje. The meaning of the language respondents used was important; often times had multiple meanings. Factors that influenced respondents’ help-seeking behavior and mental health service use included family with the daughter being most instrumental. Community factors doctors, nurses, social workers, support groups, and housing authority. An overarching theme was the significant relationships with the interaction of these factors. The relationships were characterized as close, family like. The physician was central to the respondents. Agency staff and the group members helped with utilizing services, resolving their problem, and continuing treatment. Other themes included challenges such as lack of education of mental illness and mental health services, language preference, costs of medication, and stigma of mental illness. Recommendations include expanding the workforce of bilingual/bicultural providers and Spanish-speaking providers; community education of mental illness and reduce the cultural distance between older Hispanics and health care providers. Future research should focus on exploring the relationship with the primary care physician, and the language that research and treatment programs use, attitudinal barriers to the treatment of depression among ethnic minorities, effective culturally competent interventions and improving treatment adherence with older Latinos. / text

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

published_or_final_version / Public Health / Master / Master of Public Health

Section A consists of a review of the literature relating the therapeutic use of creative writing. It highlights gaps in the literature and suggesting potential avenues of further research. Section B presents the findings of a phenomenological study which aimed to explore the experience and significance of creative writing at times of personal difficulty through the analysis of written accounts. Method. Twenty one people who had personal experience of creative writing in the context of difficult life experiences submitted written accounts. These were analysed using Interpretative Phenomenological Analysis (IPA) (Smith, Larkin & Flowers, 2009). Results. Four main themes were identified: 1) Struggle with a difficult experience, 2) Turning to creative writing, 3) Dealing with it ‘as a matter of words’ and 4) Rejoining the world. A conceptual model illustrating how these master themes are related is presented. Conclusion. Creative writing was deemed to have played an important and meaningful role in helping participants to integrate and move beyond difficult life experiences. Limitations and clinical implications of the study are discussed and suggestions are made for future research. Section C involves a critical appraisal of the study presented in Section B. Reflections on the process of the study, as well as further implications and clinical applications are discussed.

Section A. This paper opens with a broad overview of theoretical and empirical literature on refugee mental health. It highlights a relative weakness in the understandings of post-migration mental health, particularly in the context of female refugees. The paper then focuses on three areas of refugee women's mental health, critically evaluating theoretical and empirical literature: 1) risk factors and prevalence of mental health difficulties 2) coping strategies, 3) mental health service utilisation. Gaps in the extant literature are highlighted and suggestions are made for future research. Section B. This paper describes a qualitative study which aimed to explore refugee women's experiences of distress and their encounters with mental health services in the UK. Refugee women do not utilise UK mental health services as frequently as might be expected owing to their vulnerability to mental health problems. The study investigated the mental health experiences of refugee women who have encountered mental health services in the UK in order to contribute to understandings about factors affecting service utilisation. A grounded theory qualitative methodology was employed. Ten refugee women were recruited from a local non-governmental organisation and participated in semi-structured interviews about their experiences of distress, coping strategies and encounters with UK mental health services. A two-staged model emerged from the data. The first model depicted women’s experiences of distress predominantly in the context of post-migration experiences and how they coped, drawing notably from spiritual and social resources. The second stage of the model indicated how mental health service encounters were varied and a process of engagement involved evaluation and re-evaluation at particular stages. The study concluded that understanding refugee women’s utilisation of mental health services demands a multi-factorial, dynamic appraisal. Section C. This paper offers a critical appraisal of the study reported in Section B. The paper reflects on the research skills and abilities developed by the principal researcher and considers areas for development in terms of future clinical and research work in this field.

Section A consists of a literature review which explores the concept of recovery and its relevance for women who have been detained in a secure setting and diagnosed with a personality disorder. Section B presents the findings of a study to explore the concept of recovery in women diagnosed with personality disorder in a secure unit. Six semi- structured interviews, conducted with women diagnosed with personality disorder and experience of being detained in secure accommodation, were analysed using Interpretative Phenomenological Analysis. Analysis of the transcripts revealed five master themes: recovering; centrality of relationships; assuming responsibility for own care; evolving an identity; understanding of the mental health experience. The study concludes that, as far as is consistent with a secure setting, women should be given maximum opportunity to participate in decisions about their own care. Staff should be creative in providing opportunities for the women to engage in meaningful activities that promote a positive identity. Education with respect to personal recovery and the presentation and aetiology of personality disorder may support more caring and hopeful relationships between staff and service users, within which recovery can be facilitated. Section C involves a critical appraisal of the study.

Despite the profession’s putative reflexivity, little theoretical or empirical literature addresses British clinical psychologists’ beliefs about the nature of their profession and its relationship with the wider mental health system. This study examined attitudes towards one new development – the adoption of compulsory powers – in order to discover the implicit beliefs that clinical psychologists draw upon in practice. Written comments from 292 clinical psychologists responding to an earlier questionnaire survey were analysed using Grounded Theory, together with data from a focus group. Two contrasting constellations of belief emerged. Some clinical psychologists appeared to believe in the profession’s ability to transform services from the inside by opportunistically accreting power. Others appeared to believe in a need to defend the profession against assimilation, by maintaining separate spaces for more collaborative relationships. These overarching beliefs were associated with different beliefs about specific issues, namely professional identity, its compatibility or otherwise with coercion, where power is located and what drives organisational change. These findings suggest a need for greater professional self-examination. They are considered with reference to organisational, sociological and psychological literature. Limitations and areas for further research are discussed.

Section A is a review of the literature on the psychological and social implications of cochlear implants (CIs) in deaf children and adolescents. The literature is critically evaluated in relation to health-related quality of life, quality of life, psychological and emotional well-being, social well-being and identity. Relevant theories are outlined and discussed. Methodological limitations and gaps in the literature are discussed, and the review concludes with recommendations for further research. Section B describes a study using Interpretative Phenomenological Analysis to explore adolescent experiences of receiving and living with sequential cochlear implants (SCIs). Semi-structured interviews were conducted with eleven adolescents. The master and sub-themes are presented and the results are discussed with consideration of previous research findings and theoretical, clinical and research implications. Most participants enjoyed improved confidence and social well-being following their SCI, and felt that two CIs were superior to one. The majority identified themselves as hearing and deaf, but not culturally Deaf, as they strived to live in the hearing world. However, this was not without challenges and many young people experienced feelings of difference in the hearing world. These findings have clinical implications in terms of the role of clinical psychologists in CI clinics, and in providing information to families making decisions about CIs. These findings add to the emergent deaf identity development literature in young people with CIs.