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yes / The need to increase the capacity of developing countries to meet the mental health needs of their populations is widely acknowledged. This article examines some of the challenges associated with a British Council DelPHE project aimed at strengthening the capacity of mental health educators to prepare the mental health workforce in Zambia for a shift from an institutional to a community-based model of care. The analysis draws on data from two focus groups in which the participants were drawn from college educators who had taken part in workshops intended to enhance curriculum alignment to ensure that the education and training provided for clinical officers (psychiatry) and mental health nurses was "fit for purpose." In particular, the article highlights their perspectives on some of the tensions in focusing on mental health as opposed to broader health care and in ensuring appropriate opportunities for practice or field placements. The continuing impact of stigma and limited resources available for mental ill-health is acknowledged within the wider context of inequities in mental health care. Findings of this evaluation may be applicable to other sub-Saharan contexts, but should be understood only within the Zambian context.

This thesis examines the effects of community mental health care on the quality of life of mental health service users in Britain - especially Scotland - and Germany. The analysis is based on current developments in community care policy and practice in the countries of comparison and the perspective of mental health service users in relation to this. The research strategies adopted include qualitative and quantitative methods, in particular a questionnaire survey among mental health service users in Scotland and in Germany. The examination of outcomes in community care with a specific focus on the concept 'quality of life' shows that quality of life is useful as an outcome measure for the comparative evaluation of community care from a user perspective. The study develops a model of quality of life which highlights significant components of community care identified as health, housing, employment, finances, support and social contacts. The examination of some of the foundations of health care and social care in Britain and in Germany, and the comparison of specific mental health care policies and legislation emphasise distinct national characteristics and fundamental differences concerning themes and issues in mental health care. Most significantly, the analysis shows a different national emphasis on major policy objectives and concepts such as quality of life or on the role of the service user. Furthermore, the examination of significant components of community care shows how different national policies can affect support options and general availability in community mental health care. The analysis of the views of mental health service users indicates that their quality of life is directly affected by specific national developments and different national approaches in mental health care. This concerns the availability (or absence) of different support options, but also the role of service users as participants in service provision (Scotland) or rather as recipients of service provision (Germany). The comparison of different national support options and the analysis of user views in relation to this highlights specifically positive and negative effects on the quality of life of mental health service users. Most appreciated by service users are support options that provide opportunity for choice, independence, personal autonomy and fulfilment. The study shows that community based service provision and especially professional support is extremely important to mental health service users and has a direct and vital impact on their quality of life.

Older adults' attitudes toward mental health services have received little research attention. Overall, older adults are thought to hold relatively negative attitudes. In this study, Analysis 1 investigated historical shifts in attitudes toward mental health services among three independent samples of older adults, separated by 14-year and 9-year intervals (1977 sample, N = 90; 1991 sample, N = 101; 2000 sample, N = 99). Analysis 2 compared two samples of older and younger adults, each separated by a 9-year interval (Older Adults: 1991 sample, N = 93; 2000 sample, N = 91 and Younger Adults: 1991 sample, N = 131; 2000 sample, N = 147). Participants completed a questionnaire containing five, internally consistent scales assessing multiple dimensions of mental health attitudes (Openness, Biases, Range of Knowledge, Breadth, Help Seeking Attitudes). Analyses suggested that the 1991 and 2000 samples of older adults had more positive attitudes than did the 1977 sample. However, a sustained trend for more positive attitudes beyond 1991 was not seen. In fact, no differences existed between 1991 and 2000 samples with exception of two. Older and younger adults together had lower Biases and Breadth scores in 2000 than in 1991. Age effects, gender effects, and interactions were also examined. Possible historical influences were discussed along with implications for the delivery of mental health care to future cohorts of older adults.

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by Yau Mei-siu, Teresa. / Bibliography : leaves 141-147 / Thesis (M.S.W.)-Chinese University of Hong Kong, 1982