The thesis grew out of the recognition that there is a dearth of information on the users of mental health services. It set out to describe the characteristics of users across a range of health settings and to consider the role of such characteristics in the mental health referral process. The early phases of this research project were strongly influenced by a model of the referral process developed by Goldberg & Huxley (1980). They conceptualized users of health care existing on 5 levels ranging from people living in the community to users in hospital. Hypothetical filters are said to operate between each level to govern who is referred on to the next level of services. This research project borrowed the notion of filters and their arrangement of services in a referral sequence. However, the focus of this research is on the characteristics of users, and not the detail of the filters per se. What is described is the effect of the referral process not the mechanism. This thesis also moves substantially beyond the five settings in the Goldberg & Huxley model to produce a uniquely comprehensive analysis of the users of all the main mental health care providers in one health district. The research project uses a wholly quantitative methodology. The challenge has been to design a range of compatible survey forms to collect data in seven separate study settings, to collate information on over one thousand one hundred users, to describe the user profiles in each study and to develop a comparative analysis of users across a range of settings. The emphasis throughout has been to align the research with contemporary developments in health care policy, and as the project has progressed, to make a practical contribution to the important debate about information systems in mental health service planning. The thesis has been divided into four parts. Part I introduces and sets the context of the research, and describes the methodology. In seven chapters, Part II of the thesis reports the .findings of each of the seven study settings. Part III of the thesis reports the demographic and utilization characteristics comparatively across all the study settings. The conclusions of the thesis are reported in Part IV of the thesis, where the theoretical, research and policy implications are discussed.The research project makes a contribution to knowledge on 4levels. Firstly, it identifies and describes the characteristics and the typical profiles of mental health service users in a range of study settings, in one area. Secondly, it identifies the differences between users in each study setting. Thirdly, it identifies the overlap in use of one service and another. It is argued that the findings have profound implications for both developing a clearer picture of the referral processes and for highlighting for planners, producers, and providers possible complementary or inefficient service utilization patterns. On the fourth and macro level, this research project has developed a revised model of mental health service referral routes. This model provides a framework for further investigation, and has potential as a planning tool in and beyond the geographical boundaries of the current study area.

No description available.

No description available.

The contemporary mental health profession is facing a crisis of recruitment and retention. Services provided are complex, practically and conceptually. On one hand, assessments and treatments are provided, but on the other, staff become responsible for the administration of coercive security discourses and arrangements. This complex phenomenon can leave mental health personnel vulnerable to criticisms in exactly how best they should discharge their duties within an occupational remit of duality. Working in the correct or most appropriate way is a constant challenge for staff as they must meet with approval from both managers and colleagues negotiating a path between formal rules and informal norms. This exploratory study was undertaken within a mental health NHS Trust in the North of England. It interviewed twenty participants from a range of areas of work, namely hospital wards, occupational therapy departments and the community setting. A narrative interviewing technique has been used to collect occupational histories and stories which have been used in an attempt to illuminate the contemporary issues facing clinical staff. Findings suggest that their contemporary care delivery is much more complex than previously known and that there is a diverse range of background and conceptual challenges which workers face in addition to their organisationally prescribed practical mandates of work. Six normative orders of work have emerged from data that has been collected; bureaucracy, risk management, competence, morality, physical environment and care versus control. Participant reflections on professional autonomy and responsibility shed light on the perceived rationality of policies and procedures and 'governance at a distance' taking place in response to bureaucratic and risk reduction imperatives. Indeed, such work is demanding and the management of a professional 'performance', and the self regulating and adaption of emotion have been seen to be an important dimension in the observation of occupational competence and work-based socialisation processes. Furthermore, personnel are engaged in a complex and fluid role duality where they must personally reconcile their role as care provider whilst also maintaining levels of physical security in a contemporary and technologically advanced healthcare environment. In this thesis, it is argued that these normative aspects of work typify the social nature of mental health work and, in addition, take place under the auspices of Goffmanesque theorisations of the 'total institution', 'mortification of self and 'social contamination'. These findings draw particular attention to an under acknowledged aspect of mental health based inquiry where the formal and informal spheres of work are observed to co-mingle within the environment of psychiatry. In doing so, questions arise over the rationality of some systems of work which 'shop-floor' staff are engaged within, yet, at times, have very little opportunity to shape as individual practitioners.

<p> The relationship between social justice advocacy training, counselor competence in social justice advocacy and likelihood to advocate of counselor educators and counselor trainees who are in the practicum and internship phase of their training in Council for the Accreditation of Counseling and Related Educational Programs (CACREP)-accredited master's-level counselor education programs has not been researched. Developing an empirical understanding of these relationships is needed to inform counselor education practices related to preparation for social justice advocacy. The purpose of this study was to take a preliminary step toward filling the gap in current literature concerning counselor education and its role in preparing counselors to be social justice advocates. A convenience sample of 112 counselor educators and counselor trainees who are in the practicum and internship phase of their training in CACREP-accredited master's-level counselor education programs was utilized. The specific research design was a correlational survey research design utilizing multivariate linear regression analysis and correlational analysis using SPSS that examined the relationship between the variables of social justice advocacy training, ratings of competence in social justice advocacy, and the likelihood to advocate. It also examined the relationship in ratings of competence in social justice advocacy and the likelihood to advocate between counselor educators and counselor trainees. The findings indicate that there is a significant relationship between social justice advocacy training and ratings of social justice advocacy competence. It also appears that advocacy training leads to an increased likelihood to advocate particularly at community and societal levels. The findings further indicate that counselor trainees who report greater advocacy competence are more likely to engage in advocacy activities at the three levels of advocacy as defined by the ACA Advocacy Competencies (ACA, 2003). These findings taken together support the inclusion of social justice advocacy training in counselor education programs.</p>

No description available.

Research has found that 90% of those who complete suicide have a history of one or more psychiatric disorders. Mood disorders and substance use disorders (SUDs) are the key disorders related to suicide. This study not only replicates other data from previous research studies but examines other variables such as comorbid mood and SUDs associated with suicide, while also comparing different age ranges. We investigated three main domains. The first parallels work done by numerous groups comparing suicide completers to controls. The second, more novel approach, examined factors that differentiated those with MD/SUDs and those without it. The last approach, also unique to our study, focused on identifying factors associated with the two main age ranges (12-18 years old and 19-25 years old). Becoming aware of the increased risk of suicide completion within these domains can better prepare professionals when addressing treatment options. / Des recherches antérieures ont trouvé que 90% des individus décédés par suicide portent un historique d'un ou plusieurs antécédents psychiatriques. Les troubles de l'humeur ainsi que des troubles de consommation sont ceux qui sont principalement associés au suicide. La présente étude confirme les résultats mentionnés ci-haut et examine de nouvelles variables telles que la comorbidité entre les deux troubles et son association au suicide à travers divers groupes d'âge. Nous avons investigués trois domaines. Le premier présente le travail de plusieurs groupes de recherche ayant comparé le profil d'individus décédés par suicide à un groupe contrôle. Le second, abordé de façon plus novatrice, examine les facteurs qui permettent de différencier les individus souffrant d'un trouble de l'humeur ou d'un trouble de consommation à ceux qui n'en souffrent pas. Le troisième domaine exploré est aussi un qui est unique à notre étude. Par ce dernier, nous visons l'identification de facteurs associés à deux groupes d'âge spécifique, soit les 12 à 18 ans et les 19 à 25 ans. La connaissance de ces facteurs de risque permettrait aux professionnels d'être mieux équipés lorsque vient le temps d'offrir des traitements.

Animal models of complex heterogeneous disorders such as schizophrenia and autism are very valuable paradigms to understand etiological and patholphysiological mechanisms underlying the disorders, as well as to test novel therapeutics strategies. Based on the hypothesis that these disorders may have origins in aberrant brain development, neurodevelopmental animal models involving manipulations of environment during sensitive prenatal period have been extensively used. Epidemiological studies have confirmed an association between bacterial and viral infections during pregnancy and the higher incidence of schizophrenia and autism in the offspring. A number of animal models of maternal infection and immune activation have been established to show behavioural and neurochemical abnormalities in the adult offspring exposed to infection during prenatal life. My PhD thesis was designed to evaluate the extent to which prenatal infection at mid pregnancy precipitates structural, behavioural and cellular changes during postnatal brain development. To do so, I used a well-established rat model of immune activation by administration of lipopolysaccaride (LPS) at mid gestation. First, I assessed morphology of pyramidal neurons in medial prefrontal cortex (mPFC) and hippocampus at neonatal, pre and post pubertal ages. Our result showed significant structural changes in both regions starting at very early postnatal days, with some of the changes persisting through adulthood. Next, I examined the potential effects of prenatal immune activation on neonatal behaviour and maternal bonding in the neonate offspring using a standard battery of behavioural tests. Our observation of an attenuation in maternal attachment, communicative behaviours and associative learning as result of prenatal LPS treatment is relevant to the behaviours reported in autism and premorbid phase of schizophrenia. Using this model we further demonstrated that prenatal LPS treatment leads to pre and post pubertal alterations in the development of mesolimbic and mesocortical dopaminergic system. More specifically, I found a decrease in dopamine receptor-2 (D2R) expression in the GABAergic interneurons in the mPFC may be neuronal substrate for cognitive dysfunction already reported in prenatal infections models. Lastly, we found that while basic anxiety-like behaviour at pre pubertal age was similar between prenatal LPS and control offspring, , LPS treated offspring showed attenuated anxiety response in more stressful environments. These observations highlight that prenatal immune activation is involved in the control of emotionality at pre pubertal ages which might be relevant to behavioral reactivity reported in young individuals susceptible to neuropsychiatric disorders. Taken together, the data in my thesis have confirmed that prenatal LPS treatment is capable of inducing important morphological, behavioral and neurochemical changes in the brain of offspring some of them starting at early ages during postnatal life. / Les modèles animaux de troubles complexes hétérogènes comme la schizophrénie et l'autisme sont des paradigmes très précieux pour comprendre les mécanismes étiologiques de ceux troubles, ainsi que de tester de nouveaux traitements. Basé sur l'hypothèse que ces troubles peuvent avoir des origines dans le développement des cerveaux aberrants, des modèles animaux neurodéveloppementaux impliquant des manipulations de l'environnement pendant la période prénatale sensibles ont été largement utilisés. Des études épidémiologiques ont confirmé une association entre les infections bactériennes et virales pendant la grossesse et l'incidence plus élevée de la schizophrénie et l'autisme chez les enfants. Un certain nombre de modèles animaux d'infection maternelle et l'activation immunitaire ont été mis en place pour montrer des anomalies comportementales et neurochimiques dans la progéniture adulte exposée à l'infection pendant la vie prénatale. Ma thèse de doctorat a été conçue pour évaluer la mesure dans laquelle prénatale infection à la grossesse précipite des changements structurels, comportementaux et cellulaires durant le développement du cerveau postnatal. Pour ce faire, j'ai utilisé un modèle de rat bien établi de l'activation immunitaire par l'administration de lipopolysaccaride (LPS) à la gestation mi. D'abord, j'ai évalué la morphologie des neurones pyramidaux du cortex préfrontal (mPFC) et de l'hippocampe au nouveau-né, pré et post-pubertaire âges. Notre résultat a montré des changements structurels importants dans les deux régions à partir de très tôt jours après la naissance, avec certaines des modifications persistantes à l'âge adulte. Notre observation d'une atténuation de l'attachement maternel, les comportements communicatifs et d'apprentissage associatif, comme résultat du traitement LPS prénatale est pertinente pour les comportements rapportés dans l'autisme et la phase prémorbide de la schizophrénie. En utilisant ce modèle nous avons encore démontré que le traitement prénatal LPS conduit à des altérations pré et post pubères dans le développement du système dopaminergique mésolimbique et mésocortical. Plus précisément, j'ai trouvé une diminution de récepteurs de la dopamine-2 (D2R) expression dans les interneurones dans le mPFC peut être substrat neuronal des dysfonctionnements cognitifs déjà rapporté dans des modèles d'infections prénatales.Enfin, nous avons constaté que si l'anxiété de base-comme le comportement à l'âge de la puberté pré était similaire entre les LPS prénatale et la progéniture de contrôle, la progéniture LPS traités ont montré réaction d'anxiété atténué dans des environnements plus stressants. Ces observations mettent en évidence que l'activation prénatale immunitaire est impliqué dans le contrôle des émotions au pré pubères dont les âges pourrait être pertinente pour la réactivité comportementale signalés chez des personnes jeunes sensibles aux troubles neuropsychiatriques. Pris ensemble, les données de ma thèse ont confirmé que le traitement prénatal LPS est capable d'induire d'importants changements morphologiques, comportementales et neurochimiques dans le cerveau de la progéniture certains d'entre eux dès le jeune âge au cours de la vie postnatale.

This thesis provides a comprehensive criticism of the current models of understanding and caring for the mentally ill in a western context. I will outline the debates surrounding the conceptualization, diagnosis and treatment of mental illness. The western, psychiatric, biologically based understanding of mental illness is the dominant model of understanding and treating mental illness, despite the evidence that it encompasses an incomplete understanding of the causation and nature of mental illness. I will outline the difficulties in the creation of a cohesive definition of mental illness, including philosophical and cultural perspectives. I will examine the impact of historical, societal and capital pressures on the creation of these definitions. I will describe the practical issues and ethical tensions inherent when a definition or diagnosis of mental illness is created and taken up by mental health practitioners, who use this definition to develop treatment plans for the mentally ill. I will conclude that these issues result in a system of conflicting values which leads to less than ideal care for a uniquely vulnerable population. In this light, I conclude that the exclusive use of the DSM diagnoses as an objective basis for the creation of treatment plans is ethically questionable. I call for a new model of professional practice based on individualized treatment and primarily I call for a reduced focus on diagnosis in the care of the mentally ill. / Cette thèse propose une critique complet des modèles actuels de compréhension et d'empathie pour les malades mentaux dans un contexte occidental. Je vais chercher à décrire la compréhension actuelle de l'Ouest et débats entourant le diagnostic et le traitement de la maladie mentale. Le western, psychiatrique, la compréhension fondée sur la biologie de la maladie mentale est augmentation de la prévalence et de l'influence dans le monde. Cependant, je vais montrer que d'autres modèles et de leurs les traitements associés ont le potentiel, et le font souvent, générer améliorée résultats. Je crois que ce que j'appelle le modèle occidental medical de la maladie mentale englobe une compréhension incomplète de la causalité et le traitement de la maladie mentale. Je vais mettre en lumière les problèmes pratiques et des tensions éthiques inhérentes quand une définition ou le diagnostic de la maladie mentale est créé et utilise par les praticiens de santé mentale , qui utilisent cette définition à élaborer des plans de traitement pour les malades mentaux. Je exposer les difficultés dans la création d'une définition cohérente de la maladie mentale, y compris les perspectives philosophiques et culturels. Je vais examiner l'impact des pressions sociétales sur la création de ces définitions. Je vais conclure que le modèle occidental répandue médical, tout en étant utile en tant qu'outil, est imparfait comme une approche exclusive de soins de santé mentale. Cette faiblesse est observé lorsque l'on prend note de la variation incroyable dans le diagnostic et l'expérience de la maladie mentale chez les individus. Dans cette optique, je conclus que l'exclusivité, l'utilisation aveugle des diagnostics comme une base objective pour la création de plans de traitement est éthiquement discutable. Je suggeste à un nouveau modèle de pratique professionnelle basée sur le traitement individualisé et je demande une moindre accent sur le diagnostic dans la prise en charge des malades mentaux.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurobehavioral disorder with a complex etiology implicating both genetic and environmental factors. Although it is now established that multiple genes are involved in ADHD, no single risk gene has been identified. Furthermore, several environmental factors, such as maternal smoking, alcohol use, and stress during pregnancy, have been consistently associated with this disorder. This thesis will describe how maternal smoking during pregnancy (MSDP) is indexing a more homogenous subgroup of ADHD children. By studying behavioral and neurocognitive characteristics in these children, we found that exposure to MSDP is associated with a form of ADHD characterized by more severe clinical manifestations and poorer neuropsychological performance. Subsequently, we stratified children with ADHD by MSDP to investigate the implication of candidate genes in increasing the risk for ADHD. This strategy allowed the uncovering of differential associations between single nucleotide polymorphisms (SNPs) within the norepinephrine transporter gene (SLC6A2) and a number of endophenotypes in patients according to their exposure to MSDP. Finally, we used comorbidity as a tool to investigate several SNPs identified through genome-wide association studies (GWAS) of smoking behavior, a phenotype comorbid with ADHD. These SNPs were investigated in relation to ADHD diagnosis, as well as behavioral and neurocognitive traits relevant to ADHD, and we found that an allele of rs1329650 may be increasing risk for ADHD and smoking behavior through a common mechanism. This work identifies a phenotypic signature associated with MSDP that may help to identify a more homogenous subgroup of children with ADHD and highlights significant associations between the SLC6A2 gene and ADHD in children exposed to MSDP. Moreover, this is the first report of SNPs identified through GWAS of smoking behavior shown to be tentatively associated with ADHD. / Le trouble de déficit de l'attention avec hyperactivité (TDAH) est un désordre neurocomportemental répandu avec une étiologie complexe impliquant des facteurs génétiques et environnementaux. Bien qu'il soit maintenant établi que plusieurs gènes sont impliqués dans le TDAH, aucun seul gène de risque a été identifié. De plus, plusieurs facteurs environnementaux, tels que le tabagisme maternel, l'abus de l'alcool, et le stress maternel, ont été fortement associé à cette maladie. Cette thèse décrira comment la cigarette durant la grossesse est un indexe pour un sous-groupe plus homogène d'enfants atteints d'un TDAH. En étudiant les caractéristiques comportementales et neurocognitives chez ces enfants, nous avons remarqué que l'exposition à la cigarette durant la grossesse est associée à une forme de TDAH, caractérisée par de graves manifestations cliniques et une plus basse performance neuropsychologique. Par la suite, nous avons stratifié notre échantillon d'enfants atteints d'un TDAH par l'exposition à la cigarette pour enquêter sur l'implication des gènes candidats à augmenter le risque pour le TDAH. Cette stratégie nous a permis de découvrir des associations différentielles entre des polymorphismes nucléotidiques simples (SNP) du gène transporteur de la noradrénaline (SLC6A2) et un certain nombre d'endophénotypes chez les patients en fonction de leur exposition à la cigarette. Enfin, nous avons utilisé la comorbidité comme un outil pour étudier plusieurs SNPs identifiés par des études d'association de l'ensemble du génome (GWAS) du comportement des fumeurs, un phénotype de comorbidité avec le TDAH. Ces SNPs ont été étudiés en relation avec le diagnostic du TDAH, ainsi que des traits comportementaux et neurocognitifs pertinents pour le TDAH, et nous avons observé qu'un allèle du rs1329650 pourrait augmenter le risque pour le TDAH et le tabagisme par le biais d'un mécanisme commun.Bref, ce travail identifie une signature phénotypique associée à la cigarette durant la grossesse qui pourrait aider à identifier un sous-groupe plus homogène d'enfants atteints d'un TDAH et met en évidence des associations significatives entre le gène SLC6A2 et le TDAH chez les enfants exposés à la cigarette durant la grossesse. De plus, ceci est le premier rapport où des SNPs identifiés par des GWAS de tabagisme ont démontré une association avec le TDAH.