Magister Scientiae (Occupational Therapy) - MSc(OT) / Return to work is a recognised goal of rehabilitation by the occupational therapy discipline that is addressed through vocational rehabilitation as a key feature of work practice. Programmes that fall under the umbrella of vocational rehabilitation include work preparation and training, work hardening and supported employment. In the case of mental health care users (MHCU), meaningful employment contributes to their sense of identity and the prevention of relapse. Vocational rehabilitation is thus important in preparing MHCU for self-employment or employment in the community after they are discharged from the hospital. There is however a dearth of literature pertaining to how vocational rehabilitation programmes particularly in a rural setting, is experienced by MHCU in South Africa. Therefore, the aim of this study was to explore the experiences and perceptions of MHCU regarding the usefulness of the vocational rehabilitation programme at a rural hospital in enhancing their worker roles. A qualitative research approach and exploratory descriptive research design was utilised. Purposive sampling was used to select participants for the study. Semi-structured interviews were conducted with ten MHCU participants as well as two focus groups. Semi-structured interviews were furthermore conducted with two key informants. All interviews and the focus group discussion were audio-recorded, transcribed verbatim and analysed through thematic data analysis. Strategies implemented to ensure trustworthiness included member checking and peer review. Ethics clearance was obtained from the UWC Research Committee and permission to conduct the study at the hospital was requested from the Mpumalanga Provincial Health Ethics Committee and hospital management. Three themes originated from the findings of this study. Theme one describes the barriers experienced by people with mental illness while returning to work. Theme two describes the programme factors that influence return to work in respect of work habits, work skills, and community re-integration. Theme three captures the value of participating in the work programme as experienced by the participants. The findings of the study is related to the Model of The Ecology of Human Performance (EHP) to show how the vocational rehabilitation programme effected the MHCU’s return to work. The findings show that the context as well as the person’s skills and abilities are very important factors in reintegrating the user back to work. The study illuminated recommendations for the further development of the vocational rehabilitation programme.

Pediatric bipolar disorder (PBD) is a growing public health problem in the United States, especially among adolescent children. Despite awareness of the diagnosis and the effects that it has on the child, little attention has been given to the effects that PBD has on the guardian. The purpose of this qualitative phenomenological study was to explore the factors influencing guardians' experiences related to PBD. Penchansky and Thomas' Theory of Access and Family Systems Theory were used in this study to explore guardians lived experiences of PBD, its effects on the entire family system, and mental health service treatment. This approach was composed through interviewing 6 guardians caring for adolescents diagnosed with PBD. Interviews were conducted, transcribed and coded using NVivo12 software. The findings revealed the emergent themes as follows: disbelief of initial diagnosis, coping mechanisms, advice, barriers, burdens, stressors, and challenges. The themes described the experiences of guardians that led to feelings of denial, frustration, embarrassment, and resentment. Damaged relationships, medical problems, and financial hardships are only some of the challenges that guardians expressed during the interview. The issues that the guardians experienced provide evidence to fill the gap in the literature regarding effects on guardians. Further research into mental health services and guardians' perceptions on PBD is needed. This study promotes social change by informing mental health providers of the feelings and stressors of the guardians of PBD patients, which may lead to improved care for the family unit.

Thesis (M.A. (Clinical psychology)) --University of Limpopo, 2012 / A number of studies have indicated that help-seeking pathways followed by individuals suffering from mental disorders and other conditions of ill-health are not random, but are structured by a range of psychosocial and cultural factors. The quality and seriousness of the distress provide the impetus to the pathway, but its direction and duration is shaped by the convergence of psychosocial and cultural factors. This study explored the help-seeking pathways followed by patients receiving mental health care services in Polokwane-Mankweng Hospital Complex (PMHC) in Limpopo Province (South Africa). A qualitative approach was followed and participants were selected through purposive sampling. Ten participants (5 males and 5 females) who are receiving mental health care services at PMHC and were apsychotic at the time were recruited to the study. Data were collected using semi-structured interviews and analyzed using content analysis. The following psychological themes emerged from the study: participants’ subjective notions of the events or factors that could have led to their mental illness; their explanations of mental illness; the reasons for entering the mental health care system; the pathways they followed before receiving mental health services in the hospital; concurrent use of hospital mental health services and other services; their experiences of living with mental illness; and, the role of significant others in this regard. The study revealed that various agencies and providers of health care are visited by individuals suffering from mental illness and that there is also some evidence of concurrent use of these services, i.e., Western and African. The findings emphasize that help-seeking pathways are mainly determined by the perceived causes of the illness, which are derived from cultural ideologies.

Magister Curationis - MCur / Background: Psychiatric observation units are the units where 72-hour psychiatric observations are conducted in the district and in some of the regional hospitals. These hospitals were selected under the Mental Health Care Act No. 17 of 2002 (MHCA 2002) to admit patients suspected to be mentally ill, ascertain the cause of symptoms, exclude medical illness as a cause of the symptoms, treat and rehabilitate these patients; and at times transfer the patients to tertiary psychiatric hospitals. These units are often overcrowded as only about 30% of patients are transferred to the tertiary psychiatric hospitals. These units are fraught with challenges such as shortage of crucial facilities like seclusion rooms, specialised staff, resources and minimal budget is allocated to these units. Nursing staff in these units are faced with a number of challenges such as shortage of staff, patient overflow, prolonged patient stay, psychologically disturbed patients who can be agitated and violent, and are working long hours. Therefore, Compassion Satisfaction may be affected and these nurses are prone to Compassion Fatigue, which can lead to low Professional Quality of Life. Aim & objectives: The aim was to investigate Professional Quality of Life among nurses working in psychiatric observation units in Metropole District Health Services in the Western Cape Metropole. The objectives were to measure Compassion Satisfaction, to measure levels of Burnout and determine levels of Secondary Traumatic Stress among nurses working in psychiatric observation units in the Metropole District Health Services. Method: A quantitative research approach using a descriptive design was used to determine the Professional Quality of Life of nurses working in psychiatric observation units in the Metropole District Health Services. A self-administered survey using a structured questionnaire, the Professional Quality of Life version 5 (ProQoL 5) was used to collect data from an all-inclusive sample of 175 nurses, yielding a response rate of 93% (n=163). Data was analysed using the Statistical Package of Social Services (SPSS) version 24. Findings: The findings of this study showed that respondents experienced moderate Compassion Satisfaction, moderate Burnout and high Secondary Traumatic Stress. Advanced psychiatric nurse practitioners and registered nurses reported lower Compassion Satisfaction, higher Burnout and higher Secondary Traumatic Stress than enrolled nurses and enrolled nursing assistants. Recommendations: Qualitative research studies need to be conducted on nurses working in psychiatric observation units in order to understand experiences and factors affecting Professional Quality of Life among nurses. Qualitative research studies need to be conducted in order to understand factors affecting Professional Quality of Life of advanced psychiatric nurse practitioners and general registered nurses in psychiatric observations units.

One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed. / In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance. / This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.

<p>The dissertation takes as its starting-point the dichotomies between origin and modernity, periphery and centre. This is particularly the case in Astrid Väring’s novels Frosten (1926) and Vintermyren (1927), in which the author pays tribute to the homestead and the rural community in contrast to the industrial community, whilst her novels also express an ambivalent attitude towards modernity. Astrid Väring bases her works on a Norrland literary tradition, which often stood in opposition to the central power despite being dependent on it. In this respect, a similarity with postcolonialism is evident.</p><p>Access to a wealth of archive material, which has not previously been used in literary scholastic research, has resulted in a natural combination of a biographical method and socio-literary reading. When analysing the novels, the same external circumstances that had signifi cance for the author when the work was drafted, for example economic, social and political conditions, have therefore been taken into account.</p><p>With reference to the novel Katinka (1942), the view of popular literature during the 1940s is dealt with. The pejorative view, prevalent in those days, is compared with a contemporary understanding of it. Today, neither the canon nor popular literature stand out as particularly homogeneous categories. Katinka was written at the start of the Second World War. A comparison is made in the dissertation between Vilhelm Moberg’s Rid i natt! (Ride this Night) (1941) and Katinka in order to ascertain the novels’ attitude towards the offi cial Swedish position of neutrality. In Ride this Night rebellion against the enemy is encouraged, in Katinka a cautious, wait and see attitude is urged.</p><p>I som här inträden… (1944) is a novel with a purpose. In this novel Astrid Väring directs a harsh attack against the mental health care at Swedish mental hospitals. The dissertation contains a genre discussion concerning the various genres related to the novel with a purpose, for example roman à thèse. It can be concluded that theoretical work concerning the novel with a purpose is rare. But, when the issue pursued in the novel is no longer relevant, the novel with a purpose is often destined to be forgotten. Furthermore, Astrid Väring had the bad luck of falling in the shadow of Sara Lidman’s modernistic West-Bothnian accounts of the 1950s, which contributed to the fact that her entire works quickly fell into oblivion. This dissertation is the fi rst scholastic work on Astrid Väring’s works.</p>

The dissertation takes as its starting-point the dichotomies between origin and modernity, periphery and centre. This is particularly the case in Astrid Väring’s novels Frosten (1926) and Vintermyren (1927), in which the author pays tribute to the homestead and the rural community in contrast to the industrial community, whilst her novels also express an ambivalent attitude towards modernity. Astrid Väring bases her works on a Norrland literary tradition, which often stood in opposition to the central power despite being dependent on it. In this respect, a similarity with postcolonialism is evident. Access to a wealth of archive material, which has not previously been used in literary scholastic research, has resulted in a natural combination of a biographical method and socio-literary reading. When analysing the novels, the same external circumstances that had signifi cance for the author when the work was drafted, for example economic, social and political conditions, have therefore been taken into account. With reference to the novel Katinka (1942), the view of popular literature during the 1940s is dealt with. The pejorative view, prevalent in those days, is compared with a contemporary understanding of it. Today, neither the canon nor popular literature stand out as particularly homogeneous categories. Katinka was written at the start of the Second World War. A comparison is made in the dissertation between Vilhelm Moberg’s Rid i natt! (Ride this Night) (1941) and Katinka in order to ascertain the novels’ attitude towards the offi cial Swedish position of neutrality. In Ride this Night rebellion against the enemy is encouraged, in Katinka a cautious, wait and see attitude is urged. I som här inträden… (1944) is a novel with a purpose. In this novel Astrid Väring directs a harsh attack against the mental health care at Swedish mental hospitals. The dissertation contains a genre discussion concerning the various genres related to the novel with a purpose, for example roman à thèse. It can be concluded that theoretical work concerning the novel with a purpose is rare. But, when the issue pursued in the novel is no longer relevant, the novel with a purpose is often destined to be forgotten. Furthermore, Astrid Väring had the bad luck of falling in the shadow of Sara Lidman’s modernistic West-Bothnian accounts of the 1950s, which contributed to the fact that her entire works quickly fell into oblivion. This dissertation is the fi rst scholastic work on Astrid Väring’s works.

The Austrian mental health care system has been characterized by reform initiatives since the 1970s. The reform strategies can be summarized under the term 'community mental health care'. The thesis focuses on an analysis of the reform (context) and the related challenges for mental health care financing with respect to its interdependencies with service provision in the process of change. In a qualitative research process, firstly, reform documents and transcripts of qualitative interviews have been analyzed via a discourse-analytical approach. Secondly, secondary data on mental health care financing in Austria and in western European countries have been collected. An analytical framework was, finally, applied to analyze the interrelations between mental health care financing and reform discourse with respect to its impact on the micro-level and on the macro-level of the mental health care system. The results show that the reform discourse reflects broader welfare state transformation processes. Yet, financing issues have hardly been addressed in reform discussions. Nevertheless, discursive elements are either explicitly or implicitly associated with financing issues or are even linked to specific financing models. A central impact from the restructuring processes on the micro-level is an increasing (financial) responsibility for people who are affected by a mental disorder and/or their relatives. On the macro-level, the processes of change are related to decreasing (financial) responsibility for the sector 'state' while responsibility for the sectors 'family' and 'voluntary/community' is rising. The international development shows similar characteristics. The thesis finishes with some recommendations for developing an alternative financing model and provides a guideline for a comprehensive discussion of alternative mental health care financing approaches. (author´s abstract)

Aim of the study: to evaluate teenagers mental health care needs and correspondence to their expectations. Methods: Participants were 15-16 years old (9-10 form) schoolchildren from Kaunas town and region secondary schools. Respondents were interviewed by anonymous questionnaire. We examined 1000 participants. The response was 80,8 percents, but 759 cases were analysed. There were used Epi-Data and SPSS 11.5 statystical programs to count the data. Chi-criteria and correlated analysis methods were used to ensure statistical reliability. Statistical conclusion was confidential at p £0,05. Results: Teenagers mental health conception and official mental health definitions were different. In qualitying mental health schoolchildren mostly emphasized inner shape; 21,6 percent associated it with reason, 10 percent- with behaviour and reaction to surroundings, 8 percents- brains and nervous activity. Some of respondents mixed up mental health concept with mental non-health and then they emphasized particular physical complaints, malfunction of nervous system and etc. The fifth (23 percent) of schoolchildren had various mental health complaints, 16,3 percent- problems in family, 12,8 percent- in school and 10,8 percent had difficulties in relations with friends. Teenagers didn’t attributed subjective problems to the problems group, which would be the reason to go to specialists. Girls used specialists favours more often as boys. Teenagers, who lived in region, had bigger needs... [to full text]

SUMMARY In the process of undertaking of health care reform, a network of ambulatory mental health centres (MHC) was created in Lithuania and legislative acts, which regulate the activity of the centres were adopted. However there is lack of data on spread, character and consumers of services, which are provided in practice in the mental health centres. Aim of the study- to analyse the structure of services, aimed at children and provided in the Mental Health Centre, and the data of children, who are applying for the help (their sex, age, the indications of their visits). Objectives:1) to determine the number and conditions of children who apply for the help to the Mental Health Centre; 2) to describe demographic structure of children who apply for the help to the Mental Health Centre; 3) to assess services provided for children with mental disorders in the Mental Health Centre. Methods: The Mental Health Centre of Kaunas Center Outpatient Department, which services about 50 000 habitants, was chosen for the research. Case-histories of 663 children from 0 to 18 years old were investigated. On the ground of visits of children, who depend to the provided district, the spread and morbidity of mental disorders was identified. Quantitative indicators of children visits to the mental health specialists were analysed. Data analysis was performed using the statistical package of SPSS 10.03. Results: In the years 2002 – 2004, 6,1 percent from all served children applied to the... [to full text]