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The capacity of district hospitals to accommodate the decentralisation of mental health services: a cross sectional study of five government district hospitals in BotswanaGarrett-Walcott, Simone Alison 16 July 2008 (has links)
ABSTRACT
Introduction
In Southern Botswana, an expected advantage of the decentralisation and integration of
mental health services into general health services was the potential to allow for the district
hospitals to manage a larger number of mentally ill patients thus decreasing the patient load
of Lobatse Mental Hospital. However, the number of admissions to the referral hospital for
the south of Botswana is increasing. The objective of the study was to describe the
capacity of district hospitals to care for mentally ill patients in terms of the provision of
relevant inpatient, outpatient and outreach mental health services as well as the availability
of trained workers who agree with the principles of decentralisation of mental health
services.
Materials and methods
This was a descriptive cross sectional study involving a self-administered questionnaire
survey of key informants and health care providers conducted in five district hospitals in the south of Botswana. There were a total of 5 Chief Medical Officers, and 75 ward staff
(12 doctors and 63 nurses) in the study.
The quantitative data was entered using the Statistical Package for Social Scientists (SPSS
version 13) and analyzed by this software. The qualitative data was coded and thematically
analysed and reported.
Results
In all five hospitals, all the doctors and nurses had undergraduate training in psychiatry and
were expected to manage mentally ill patients. There were eighteen health workers (1
doctor and 17 nurses) with postgraduate training in psychiatry/mental health.
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The fiscal response of Oregon counties to mental health grantsSavage, John F. 18 December 1978 (has links)
State and federal aid payments to local governments have grown explosively
over the last fifteen years. One reason for this growth is
that the donor governments can alter a local government's budget choices
through grants. Grants have not remedied social problems, however, because
the local governments' responses to grants were not anticipated.
Economists have broadened our understanding, but debates remain about
the proper modeling of local buur grant impact knowledge. Accordingly,
this study examined the effects of thdgeting and, because researchers used
aggregated data, gaps exist in oree types of mental health grants
on the budget allocations for Oregon counties.
The theoretical literature on the expenditure effects of grants
was first reviewed. The constrained maximization, median voter, and
budget maximization models of local fiscal decision-making were described
and then compared as to their predictions about the effects of different
grants. It was concluded that too little was known about budgetary
processes to use or compare the models' predictions.
Empirical studies were then reviewed. Researchers, largely using
demand frameworks, found that grants significantly affected local
spending and that different grants induced different spending responses. Their estimates of the stimulus differed, though. Moreover, little or
no research was undertaken on the employment, wage, and output effects
of grants. The theoretical and statistical problems with these studies
were examined. These problems were: (1) the misspecification of aid
variables; (2) the aggregation of government units and public services;
(3) the lack of institutional and political realism.
A theoretical model of Oregon counties' expenditure and production
decision-making for mental health services was developed based on the
insights and criticisms of existing models. The model consists of
eleven equations; some describing the "expenditure stage" of the budget
process, others describing the "output stage". It was argued that
county commissioners make the expenditure decisions, and that mental
health administrators make the production decisions. The framework
allowed us to examine the effects of mental health grants on expenditures,
wages, staff numbers, patient numbers, and output and to study
the determinants of grant participation.
Using regression analysis, the equations were estimated from the
observations for 31 Oregon counties in fiscal year 1975-1976. Ordinary
least squares was used in the expenditure and grant participation equations.
Two-stage and three-stage least squares were used in the rest.
Regressions were run for western and eastern Oregon counties when possible.
For all observations, the major findings suggested that a dollar of
state matching mental health aid per capita stimulated per capita mental
health expenditures by $1.37, increased the professional staff by .556
to .762 persons per 10,000 county residents and increased average professional
salaries by $2,173. A dollar of federal matching aid per
capita appeared to have an expenditure effect of $1.03, an employment effect of .722, and no salary effect. A dollar of non-matching aid per
capita had an estimated expenditure effect of $1.00, an estimated employment
effect of .35, and no salary effect.
In eastern Oregon, the major findings indicated that the marginal
expenditure effect of federal aid was $1.41, the marginal expenditure
effect of non-matching aid was $.96, and that state matching aid had no
expenditure effect.
In western Oregon, a dollar of state matching aid per capita had
an estimated expenditure effect of $2.23, a professional employment
effect of 1.25, and no significant salary effect. A dollar of non-matching
aid per capita had an estimated expenditure effect of $1.67,
and no significant employment or salary effects.
In all regressions, the mental health grant estimates were not
statistically different from one another. Finally, a production function
for mental health services was unsuccessfully estimated and discussed. / Graduation date: 1979
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Sense-making and authorising in the organisation of mental health care.Ormrod, Susan. January 2002 (has links)
Thesis (Ph. D.)--Open University. BLDSC no. DX219994.
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Pathways into psychiatric care : user characteristics, settings and the referral processHorne, David January 1990 (has links)
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.
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A formative evaluation research into the use of psychology service by adolescents and young people : a preliminary investigation ito attendance/non-attendanceNgah, Zahari January 1998 (has links)
No description available.
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Patient and staff perceptions of medication administration and locked entrance doors at psychiatric wards /Haglund, Kristina, January 2005 (has links)
Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 5 uppsatser.
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The collaborative integration of mental health services with primary care a professional cultural and language perspective /Alfuth, Richard. January 1998 (has links) (PDF)
Thesis, PlanB (M.S.)--University of Wisconsin--Stout, 1998. / Includes bibliographical references.
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A voice in the wilderness a needs assessment of a developing rural community /Winters, Krysta. January 2002 (has links)
Thesis (Psy. D.)--Wheaton College Graduate School, 2002. / Abstract. Includes bibliographical references (leaves 88-94).
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National resident movement statistics of public and community residential facilities in 1977Kudla, Mary J. January 1980 (has links)
Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 83-88).
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A voice in the wilderness a needs assessment of a developing rural community /Winters, Krysta. January 2002 (has links) (PDF)
Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2002. / Abstract. Includes bibliographical references (leaves 88-94).
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