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

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The American Psychiatric Association criteria for differential psychiatric diagnoses (DSM III-R) do not exhaust the list of socially problematic behaviors displayed by the mentally ill. The extent to which such behaviors influence a person's "career" as a deinstitutionalized patient is the major topic of this study. Fiscal crises and changing public commitments have reduced support to those with severe mental illness who are deinstitutionalized, increasing the importance of understanding how degrees of competence at activities of daily living and the extent of socially problematic behaviors affect their participation in the community. The concept Interactive Competence was developed on the basis of the writer's clinical experience and a review of the literature on community adjustment of persons with severe mental illness. The concept characterizes the social functioning of persons diagnosed as mentally ill, and includes demonstration of self-care (ADL) skills and self-management skills (trouble in relationships). Secondary analysis was performed on data from a 1984 probability sample of clients in Community Support Programs for seriously mentally ill adults. Factor analysis reduced items in the original instrument, The Uniform Client Data Instrument, to scales measuring Interactive Competence. Only persons with the diagnosis of Schizophrenia or Affective Disorders were studied (n=824 of 1053), excluding diagnoses which were diverse in nature and infrequent in occurrence. Bivariate correlation and regression techniques were used to test the major hypotheses: 1) Schizophrenics demonstrate less Interactive Competence than those with the diagnosis of Affective Disorder; 2) the greater the chronicity (length of time in the social role as a patient from point of first diagnosis) the less Interactive Competence; 3) lower level of Interactive Competence is associated with a lower level of mental health service utilization. Monitoring Interactive Competence self-care (ADL) skills and selfmanagement skills (trouble in relationships) provides new insights about the service utilization of the severely mentally ill and their families. Schizophrenics had less the Interactive Competence than those with Affective Disorders; those with lower scores on Interactive Competence used more services; family involvement influenced clients' use of crisis assistance services and urgent care services. / 2999-01-01

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

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

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