This thesis explores the roles that medicine, human rights discourse, and the arts play in the project to improve the lives of patients suffering from severe forms of mental illness in the context of the post-socialist transformation of the Czech Republic. It is a study of the ways in which social solidarity and social exclusion intersect in the spaces of mental illness in a particular historical setting, and how the responsibility for care is negotiated between families, communities, the medical profession, and the state. The first part of the thesis focuses on the proposed reform of care for patients with severe mental illness that was put forward in the two decades after 1989. I examine the origins and aims of the attempted institutional change – the ‘humanization of psychiatry’ – in the context of the influential Charter 77 movement which demanded respect for the rights of those who are unable to claim them for themselves. I also trace how the re-establishment of a civil society that owed much to the concept of ‘apolitical politics’ and the process of the reintegration of Czech Republic into the European community impacted the attempted reforms. More than twenty years after the revolution, Czech Psychiatry still does not comply with international standards of care and, as I show, despite the explicit disclaimer with the totalitarian past and great hopes for change, there is in fact a clear continuation of many of the practices, ideas, interactions, as well as forms of governance of the preceding decades. These historical legacies, in combination with other factors, such as ideological disagreements within the psychiatric profession, a lack of political interest in this area, and a strong focus on other economic priorities have all contributed to the failure to improve mental health care. The second part of the thesis offers a complementary perspective on these processes – a view from ‘inside’ of the institutions that provide psychiatric care. The origins of institutional care in Central Europe date back to late nineteenth century, when large hospitals were built within parks as self-sufficient complexes surrounded by walls, outside of large cities. My research took place in two contrasting institutions: one a highly specialised clinical and research center for treatment of acute conditions, and the other a hospital for treatment of chronic conditions originally devoted to those with ‘incurable’ conditions. I show how the notion of ‘curability’ is a crucial factor in both the experience of the patients and the social responses to their conditions. In this part I also explore some epistemological issues in psychiatry, including knowledge, practices, and ideology, in the context of a strong scientific materialism where – unlike in many parts of the world – the tradition of psychoanalysis has been absent. Specifically, I examine the role of neurobiological paradigm in various interpretations of psychotic experience, its affect on patient’s self-understanding, and its role in the externalization of agency and responsibility. Finally I address the phenomenon of using ‘unclaimed bodies’ of psychiatric patients for anatomical teaching and research, and interpret this practice through notions of liminality, impurity, and sacrifice. I conclude the thesis by examining the ethical dimension of psychiatric care in the light of the writings by Emmanuel Lévinas.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-07-30T20:50:26Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) marisa_resende_parreira.pdf: 2105579 bytes, checksum: fbcfdd776f589313c461f62c6a25f031 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-10-01T17:46:44Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) marisa_resende_parreira.pdf: 2105579 bytes, checksum: fbcfdd776f589313c461f62c6a25f031 (MD5) / Made available in DSpace on 2018-10-01T17:46:44Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) marisa_resende_parreira.pdf: 2105579 bytes, checksum: fbcfdd776f589313c461f62c6a25f031 (MD5) Previous issue date: 2017 / A Rede de Aten??o Psicossocial (RAPS) se insere como uma das redes indispens?veis do cuidado nas Redes de Aten??o ? Sa?de (RAS) com a finalidade de criar, ampliar e articular os pontos de aten??o ? sa?de para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, ?lcool e outras drogas. Neste sentido, o funcionamento desta rede depender? da articula??o dos trabalhadores com outros que est?o inseridos nos diversos espa?os, bem como na comunidade. O presente estudo buscou analisar a RAPS do munic?pio de Diamantina, estado de Minas Gerais e sua funcionalidade. Trata-se de uma pesquisa com abordagem qualitativa que utilizou como recurso metodol?gico a Hist?ria Oral. Entrevistou-se os coordenadores e/ou colaboradores dos componentes da RAPS pactuados no munic?pio. A coleta de dados foi baseada com a pergunta norteadora: Relate como o servi?o em que voc? trabalha desempenha com outros servi?os da rede, a??es de assist?ncia ao usu?rio da sa?de mental? Os dados coletados foram transcritos e constitu?ram em material de an?lise de conte?do, originando-se assim tr?s eixos tem?ticos: 1) ?Rede existe, mas fragmentada?, resultando das subcategorias: os servi?os n?o se comunicam e aus?ncia de um sistema de governan?a; 2) ?Dificuldade de a??es de sa?de mental na APS? como consequ?ncia de aus?ncia de apoio matricial e triagem inadequada; 3) ?Acolhimento do usu?rio?, decorrentes das subcategorias car?ncia de recursos humanos e demanda excessiva de usu?rios. Os resultados desta investiga??o permitiram identificar aspectos que podem favorecer a consolida??o da RAPS, assim como, os seus principais desafios. A constru??o de redes apresentou-se como uma tarefa complexa, fazendo-se necess?rio, para sua consolida??o a??es em conex?o com outros servi?os e atores. Notou-se ainda que ? de fundamental import?ncia, para garantir o cuidado, que os profissionais desta rede compreendam seus prop?sitos e funcionalidades, fazendo necess?rio o retorno do apoio matricial e de um gestor municipal da sa?de mental que atue nas politicas p?blicas, coordena??o, planejamento e monitoramento das a??es, assim atrav?s da atua??o interdisciplinar que a Rede de Aten??o psicossocial se fortalecer? uma vez que j? existe. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / The Psychosocial Care Network (PCN) is one of the indispensable networks of care in the Health Care Networks (HCN) in order to create, expand and articulate the points of health care for people in pain or with mental disorder because of crack, alcohol and other drugs abuse. Thus, the operation of this network will depend on the articulation between workers with others inserted in the different fields, as well as in the community. In this work a description of PCN of Diamantina city in the state of Minas Gerais ? Brazil and its functionality were evaluated. It is a qualitative research with Oral History as methodology. The coordinators and/or collaborators of the PCN components agreed in the municipality were interviewed. Data collection was based on the guiding question: Relate how the service you work plays with other services of the network actions of assistance to the user of mental health? The collected data were transcribed and were constituted in material of content analysis, leading to three thematic axes: 1) the network exists, but it is fragmented. The interviewees consider that the lack of communication, absence of a system of governance and regulation can be a fragmentation factor; 2) difficulty of mental health actions in PHC was identified as a consequence of inadequate screening and absence of matricial support and; 3) incomplete crew and excessive demand of users are pointed as impediments of accessibility and resolution of actions. The results of this investigation allowed the identification of possible aspects that support the consolidation of PCN, as well as its main challenges. The construction of networks is a complex task, and actions in connection with other services and actors are necessary for its consolidation. It is of fundamental importance to insure that the care that the professionals of this network understand its purposes and functionalities. Therefore, it will be through interdisciplinary action that the Psychosocial Support Network will build articulation strategies that promote the strengthening of care and health production.

Magister Curationis - MCur / Mental health care for adolescents is currently provided in a range of settings world-wide. These include the pediatrics units, general hospitals and specialized in-patient units for adolescents. However, care in these specialized units has hitherto not been evaluated. A phenomenological approach as a method and design was chosen to enable participants to describe and explore the lived experiences of nurses caring for adolescents in specialized psychiatric units of the selected psychiatric hospital. A purposive sampling method was used to select respondents. In-depth interviews were conducted with nurses caring for adolescents with mental health problems. Data saturation was reached with seven respondents. Interviews were recorded with a tape recorder that was only accessible to the researcher. Data analysis followed Collazi’s style that included listening to the recorded data, transcribing, coding, and intuition, reflection, reducing and interpreting the data. Ethical clearance was obtained from University of the Western Cape Higher Degrees Committee. The researcher requested permission to conduct the study at selected Psychiatric hospital from the Medical Superintendent and research ethics committee. Informed consent was also sought for those who agreed to participate in the study. Participants remained anonymous as their identity was not revealed. Only information related to the study was collected. Anonymity was assured by omitting names from transcripts as participants were given numbers only rather than using their names. The in-depth interviews were conducted in a quiet office to ensure privacy and confidentiality.

A atual política de saúde mental brasileira aponta o hospital geral como parte integrante da rede de serviços substitutivos ao manicômio. É preconizado por essa política que os serviços substitutivos levem em consideração, entre outras premissas, o acolhimento, o vínculo e a integralidade na prestação do cuidado. Frente a isso, optou-se por estudar o atendimento ao louco no hospital geral. Este estudo foi realizado no setor de emergência do Hospital Estadual Pedro II, situado na cidade do Rio de Janeiro. O objetivo era analisar as práticas assistenciais ao louco em um hospital geral e os seus efeitos para integralidade. Para isso, buscou-se, especificamente, a) situar a unidade hospitalar e sua relação com a rede de serviços de saúde, destacando os aspectos sociais, políticos e culturais que se inserem; e b) compreender os sentidos e significados sobre integralidade, acolhimento e vínculo atribuídos pelos sujeitos envolvidos nas práticas assistenciais a clientela com transtorno psiquiátrico; e c) identificar a existência de nexos entre essas práticas e as diretrizes do movimento de reforma psiquiátrica, além de mapear os dispositivos de poder e seus efeitos nas práticas assistenciais. Optou-se pelo recurso metodológico do Estudo de Caso. Os dados foram obtidos através de observação, análise documental, entrevista e conversas do cotidiano. Identificou-se que o hospital funciona como a única emergência da região, além de ser a única porta aberta às emergências psiquiátricas. O espaço físico da emergência em pouco favorecia o desenvolvimento de uma atenção acolhedora, resolutiva e humanizada, seja ao louco ou a qualquer outro paciente. As práticas assistenciais ainda eram predominantemente pautadas pelo modo asilar. Acolhimento, vínculo e integralidade faziam parte do discurso, mas ainda não se materializaram nas práticas assistenciais. O estigma atribuído à doença mental foi percebido como empecilho a práticas acolhedoras. A noção de vínculo foi atrelada à responsabilidade. Porém a prática de alguns profissionais da emergência e do próprio serviço de saúde mental não revelou essa responsabilização na coprodução de saúde. As relações de poder no campo seguiam o modelo biomédico hegemônico, com centralidade na figura do médico. Elas foram consideradas empecilho à materialização da integralidade. A fim de possibilitar a concretização do hospital como parte da rede de serviços substitutivos julgou-se necessário investir em novos arranjos institucionais que coloquem o usuário como centro dos modos de produção de atos de saúde; inserir a dimensão cuidadora na formação e qualificação dos profissionais de saúde e, investir especificamente na dimensão sociocultural da reforma psiquiátrica para que o ideário reformista deixe de circular somente os guetos psiquiátrico e garanta um outro lugar para o louco na sociedade. / The politics of Brazilian mental health points the general hospital as an integrant of services net that substitutes to the lunatic asylum. There is expectancy that the care given of the substitutes services take into consideration, among others premises the shelter, bond and integrality. This study takes place through into Hospital Estadual Pedro II emergency, in the Rio de Janeiro city; it was looked to analyze the practical aid to the insane person in a general hospital and the completeness effect. For this, searched: to point out the hospital unit and its relation with the net of health services, detaching the social aspects, politicians and cultural that is insert; to understand the directions, meanings and voices of the involved citizens in the practical assistances the patient with psychiatric upset that looks the emergency on integrality, shelter and bond to identify to the existence of nexuses between these practical and the lines of direction of the movement of psychiatric reform, beyond map the devices of power and its effect in the practical assistances. Was opted the Case Study resource. The data had been gotten through comment, documentary of the region. The only open door to the psychiatric emergencies. The physical space of emergency in little favors an attention receiver, resolute and humanized, either to insane person or any another patient. The practical assistances still predominantly are ruled for shelter way. Shelter, bond and integrality are part of the speech, but not yet they are materialized in the practical assistances The stigma attributed to the insanity was perceived as obstruction the practical receivers. The bond to the insanity was perceived as obstruction the practical receivers. The bond notion was harness to responsibility. However the practical one of some professionals of the emergency and the proper service of mental health did not disclose this responsibility in the health coproduction. The relations of power in the field had followed the hegemonic biomedical model, with centrality on the doctor. They had been considered obstruction integrality materialize. Alike to make possible the concretion of the hospital as part of the net of substitute services was judged necessary to invest in new institution arrangements the place the user as center in the ways of production of health acts; to insert the care dimension in the formation and qualification of the health professionals reform so that the reformist idea leaves of only circulating the psychiatric ghettos and guarantees one another place for the insane person in the society.

O cuidado às famílias das/os usuárias/os dos serviços de saúde mental é aspecto valorizado pelo modelo de atenção biopsicossocial e importante para efetivação da Reforma Psiquiátrica brasileira. Apesar disso, ainda é um desafio no cotidiano dos serviços. Para atender a esta necessidade, a literatura aponta a Educação Permanente em Saúde (EPS) como um recurso para o desenvolvimento desse cuidado, junto às/aos profissionais de saúde. Esta pesquisa tem como objetivo geral entender como o processo conversacional contribui para o desenvolvimento da proposta da EPS e para a formação profissional para o cuidado às famílias de usuários/as de serviços de saúde mental. Para tanto, foram realizados dois processos formativos, com base na proposta da EPS, com dois grupos de profissionais de dois serviços públicos de saúde mental de um município de médio porte do estado de São Paulo. Ao todo, 18 profissionais participaram da pesquisa. A partir desses encontros, as conversas foram gravadas, transcritas e analisadas, utilizando a perspectiva construcionista social como guia teórico-epistemológico. A análise foi realizada com os seguintes objetivos específicos: identificar momentos críticos na interação, como marcos do processo conversacional, que indicam a ocorrência de reflexões e transformação de sentidos com relação à prática com famílias em saúde mental; analisar o uso de Registros Reflexivos como recursos conversacionais para a promoção de reflexões e transformação de sentidos. Com isso, cada um dos processos de EPS realizados foi nomeado a partir de características do seu processo conversacional e, para cada um deles, momentos críticos foram delimitados. No processo Caixa de marimbondo as conversas do grupo em torno das dificuldades do trabalho com famílias provocaram na facilitadora um sentimento de paralisação que, quando explicitado, gerou um momento crítico que permitiu ao grupo refletir sobre os espaços de reunião e seus efeitos. Já no processo Primavera entre os dentes as conversas sobre diferentes questões relacionadas ao cuidado às famílias promoveram transformações de sentido relacionadas à importância do trabalho desenvolvido pelas profissionais, à possibilidade de participação das famílias, à prática interdisciplinar e à importância do processo de EPS desenvolvido. Com isso, é destacada a centralidade do processo conversacional para que a EPS ocorra, sustentando a tese de que a facilitação pautada na responsividade fornece a base para construção de contextos de formação para o trabalho com famílias em saúde mental. / The Brazilian Psychiatric Reform predicts family care as a central aspect for treatment of people who suffers with psychiatric disorders. Nevertheless, it is still a challenge in everyday services in Brazil. To meet this need, literature and health policy point to Permanent Healthcare Education (PHE) as a way to promote this care. This research aimed to understand how conversational process contributes to develop the PHE proposal and to promote professional formation for taking care of family members in mental health services. To do so, two educational processes were carried out, based on the PHE policy and proposal, with two groups of professionals from two public mental health services in a medium-sized municipality in the state of São Paulo, Brazil. In total, 18 professionals participated in the research. The conversations were, then, recorded, transcribed and analyzed, using the social constructionist perspective as a theoreticalepistemological guide. The analysis was performed with the following specific aims: identify critical moments in the interaction, considered as landmarks of the conversational process, which indicate the occurrence of reflections and transformation of meanings regarding the practice with family members in mental health care; analyze the use of Reflexive Records as conversational resources to promote reflections and transformation of meanings. Thus, each of the PHE-processes was named from the characteristics of its conversational process and, for each of them, critical moments were delimited. In the \"Hornet\'s nest process the group\'s conversations about the difficulties of working with family members provoked a feeling of paralysis in the facilitator which, when expressed, generated a critical moment which led the group to reflect on meeting spaces and their effects. In the \"Holding the spring\" process, conversations about different issues related to care practices with family members promoted changes in meanings related to the importance of care practices developed by professionals, to the possibility of participation of family members, to interdisciplinary practices and to the importance of the PHE process developed. With this, the centrality of the conversational process in order to PHE to occur is highlighted, supporting the thesis that facilitation based on responsiveness provides the ground for building educational contexts for working with family members in mental health services.

Philosophiae Doctor - PhD / The mental health care environment is a stressful environment because of the environment, perceived unpreparedness of students and the emotional demands placed on the students which are inherent in the nature of the work. The use of the self as a therapeutic tool also presents challenges for students. Whilst researchers have identified supportive interventions and strategies to address students support needs in mental health care settings, these interventions/strategies focus on meeting clinical learning objectives with the assumption that if the student learning needs are met, they will feel emotionally supported. Literature and experience indicates that it is imperative that in this field of study, students should be prepared to cope emotionally with the demands of mental health work. The aim of this research was to develop a model of emotional support for student nurses working in mental health care settings. A theory-generating design based on a qualitative, explorative and descriptive research approach was used to achieve the aim of the study. Purposive sampling was employed to select participants namely: students, educators and clinical staff who met the eligibility criteria. A sample of 40 students, nine educators and nine clinical staff who worked in the four psychiatric hospitals and community mental health clinics in the Western Cape participated in the study. Data collection was by means of focus group interviews (students) and indepth individual interviews (educators and clinical staff). Data was analysed by means of Tesch’s method of content analysis. The model was developed by means of the four steps of the theory generation process. Step one was concept development which consisted of two sub-steps namely concept identification and concept definition. A total of 22 concepts were identified which was further synthesised into six main concepts. The main concepts which were used to develop the model were: positive self-concept; positive work environment; academic and professional development; effective communication; formal and informal supportive interventions and collaboration between the Higher Education Institution and the mental health care setting. Step two of the theory generating process was model development. These main concepts were placed in relation with each other which formed an emotional support model for students working in mental health care settings. Step three was model description. The model was described using the three phases of interpersonal communication namely orientation phase, working phase and the termination phase. A visual application of the model which depicts the main concepts, the process and the context was shown. Step four dealt with the development of the guidelines for the implementation of the emotional support model. A critical reflection of the model was done using five criteria for model evaluation according to Chinn & Kramer. Trustworthiness of the data was ensured by means of applying Guba’ model of truth value, applicability, consistency and neutrality. Reflexivity was used by the researcher to further enhance trustworthiness. Permission to conduct the study was obtained from the relevant authorities. The ethical principles of respect for human dignity, beneficence and justice were applied throughout the study. Limitations were identified and ecommendations for nursing practice, education concluded the study.

Orientador: Rosana Teresa Onocko Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T00:00:56Z (GMT). No. of bitstreams: 1 Santos_DeivissonViannaDantasdos_D.pdf: 4666096 bytes, checksum: 747ecbfd3091d236f7eeb842b855abe6 (MD5) Previous issue date: 2014 / Resumo: No contexto atual, onde o saber científico se sobrepõe ao saber experiencial, a inclusão das posições dos usuários de serviços de saúde no direcionamento dos seus tratamentos ainda está distante da realidade. Esta tese reporta aspectos de uma pesquisa qualitativa que teve a oportunidade de intervir em práticas de cuidado em 10 serviços de saúde de dois municípios do Estado de São Paulo (Campinas e Amparo). Seguindo o princípio da Reforma Psiquiátrica brasileira da defesa dos direitos do usuário em participar das decisões sobre seu tratamento, utilizou-se a estratégia da gestão autônoma da medicação, de 2011 a 2012. Tal estratégia tem como proposta "empoderar" os usuários quanto ao uso de medicamentos em seus projetos terapêuticos. A partir de entrevistas semi-estruturadas com os moderadores destes grupos, antes e depois da intervenção, construiu-se narrativas sob os preceitos da hermenêutica gadameriana. Os trabalhadores que experimentaram a estratégia assumiram um papel mais crítico quanto suas próprias práticas clínicas. Identificaram na metodologia horizontal, grupal e direcionada para uma escuta não filtrada pelas categóricas científicas do campo da saúde uma ferramenta para a valorização da voz dos usuários. Relataram que a individualidade de cada sujeito foi fonte de um saber capaz de promover uma clínica mais flexível e propícia para uma construção conjunta de ações de saúde. Perceberam também que os usuários puderam repensar o papel dos medicamentos em suas vidas e, apesar das resistências institucionais, autorizaram-se a negociar seus tratamentos com seus prescritores / Abstract: In a context where scientific knowledge overlaps the experiential knowledge, the practice of sharing decisions with patients is still far from reality, despite the consensus that physicians must base their recommendations on the patient¿s values rather than on their own. This study reports aspects of a qualitative research that had the opportunity to intervene in care practices in 10 health facilities at two Brazilian cities (Campinas and Amparo). Following the principle of Brazilian Psychiatric Reform, defending users' rights to participate in decisions about their treatment, we worked with the gaining autonomy and medication (GAM) guide in order to seek the empowerment of the users regarding the use of psychotropic medication in their therapeutic projects. Semi-structured interviews were conducted with the GAM Group¿s moderators before and after the intervention, the material collected was transformed in narratives according Gadamer¿s hermeneutic principles. From the analysis, among other things, the workers attested the difficulty of avoiding the exercise of power over users via administration of psychotropic drugs. Besides, the health workers began to take a more critical approach to their own clinical practices. They also reported to practice a more flexible clinic, making shared decisions with their patients regarding their treatments / Doutorado / Política, Planejamento e Gestão em Saúde / Doutor em Saude Coletiva

Thesis (M. Sc.) Nursing Sciences)) -- University of Limpopo, 2016

The goal of this study was to determine the bio-psychosocial treatment needs of dual diagnosis patients with depressive episodes and alcohol misuse. In order to achieve this goal, a qualitative research approach was adopted to gain a holistic understanding of dual diagnosis, as well as to explore and to describe the bio-psychosocial treatment needs of these individuals. This research study aimed to contribute towards solving a practical problem in practice by offering recommendations for a multidisciplinary team approach with regard to the treatment of patients diagnosed with depressive episodes and alcohol misuse in South African treatment centres. To this end, the collective case study design guided the research study. A two-stage sampling strategy was implemented in the study. Firstly, purposive sampling was used to identify potential participants, and it was followed up with, secondly, volunteer sampling to recruit 10 individuals with co-occurring depressive episodes and alcohol misuse from a private psychiatric clinic in Pretoria, which formed the research sample. Furthermore, a semi-structured one-on-one interview, guided by questions contained in an interview schedule, was used as a data collection method. The researcher implemented the qualitative data analysis process of Creswell (1998, in Schurink, Fouché & De Vos, 2011) to extrapolate themes and sub-themes from the raw data through thematic analysis. The trustworthiness of the data interpretation was confirmed through peer debriefing, member checking, as well as the assurance of confidentiality. An analysis of two different sources of data, namely the literature review and interviews, was used to answer the following research question: What are the bio-psychosocial treatment needs of dual diagnosis patients suffering from depressive episodes and alcohol misuse? The key findings indicated that persons suffering from a dual diagnosis of depressive episodes and alcohol misuse have idiosyncratic biological, psychological and social treatment needs. On a biological level it was found that patients with a dual diagnosis lead a less active and an unhealthy lifestyle and are therefore more prone to the development of chronic illnesses, such as hypertension and cardiovascular disease. It was also found that these individuals exhibit addictive behaviours apart from the alcohol misuse. With regard to psychological needs, the research found that dual diagnosis patients experience difficulties in expressing their needs and emotions to others. In this regard the research indicated that these individuals have poorly developed coping mechanisms and limited resources for gaining an improved sense of well-being. Identified areas in which these individuals may need assistance on a psychological level include: general coping mechanisms, communication skills, problem solving skills, and conflict management. With regard to violent and aggressive behaviour, it was found that these individuals are more likely to internalise their frustration and aggress towards themselves. On a social level it was found that individuals with a dual diagnosis of depressive episodes and alcohol misuse experience more relationship breakdown and less social support. Additionally, on a social level these individuals experience difficulties in coping in the workplace, as well as having problems with financial management. It is recommended that the multidisciplinary team participate in the development of psycho-educational groups that focus on the education of dual diagnosis patients regarding their needs on each level of functioning. Furthermore, it is recommended that effective clinical communication patterns are in place to prevent fragmented service delivery to individuals with a dual diagnosis. It is recommended that service delivery takes place in all forms of service delivery, including individual therapy, psycho-educational groups, group work activities, as well as family counselling. Further research could focus on the following: 1) Extending the research population to areas outside the Gauteng Province, or even South Africa, in order to determine if these findings can be generalised to all patients with a dual diagnosis of depressive episodes and alcohol misuse; 2) Conducting the research in public health care centres to determine if the findings of this study are also prevalent in lower socio-economic classes (taking into consideration that the present study was conducted at a private psychiatric clinic); 3) Repeating the study with different combinations of psychiatric illnesses, as well as substances of abuse, to determine if the conclusions drawn from this study can be made applicable to dual diagnosis in general, or only to dual diagnosis with depressive episodes and alcohol misuse in particular. / Dissertation (MSW)--University of Pretoria, 2014. / tm2015 / Social Work and Criminology / MSW / Unrestricted

This thesis is concerned with determining whether South African mental health law and its application in practice is in need of reform. In order to reach its objectives, the thesis measures mental health legislation and criminal law that affect the mentally ill individual or offender against international and local human rights standards, and generally accepted principles and scientific principles applicable in the mental health profession. Particular focus is placed on the admission of a mentally ill person as a voluntary, assisted or involuntary mental health care user, State Patient or mentally disordered prisoner in terms of the Mental Health Care Act 17 of 2002 (?MHCA?), as well a critical review of the MHCA forms used to translate the Act?s provisions into practice. The thesis critically discusses the regulation of mental health care practitioners in terms of the Health Professions Act 56 of 1974, including psychology and psychiatry and the expert witness, and the new Traditional Health Practitioners Act 22 of 2007 and its regulations. An outline of the role of the National Health Act 61 of 2003 in the administration of the health system is provided.The thesis analyses the manners in which mental health affects criminal liability, and Chapter 13 of the Criminal Procedure Act 51 of 1977. Finally a desktop study into the current state of mental health care provision and the implementation of legislation in practice is conducted, followed by conclusions and recommendations for reform to legislation, policy, and the MHCA forms where anomalies have been identified. / Thesis (LLD)--University of Pretoria, 2016. / Public Law / LLD / Unrestricted