PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / iii Abstract The Mental Health Act is the law which sets out when you can be admitted, detained, and treated in hospital against your wishes. It is also known as being “sectioned”. For this to happen, certain people must agree that you have a mental disorder that requires a stay in hospital. In South Africa, the Mental Health Act of 1973 was noted to have many gaps. Due to all the shortcomings, in 2004 the Mental Health Care Act No. 17 of 2002 came into being in order to protect human rights of the mental health care users. This study sought to determine the knowledge and explore the experiences of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002. Secondly, based on the findings, to develop a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors in Vhembe District. The population of this study consisted of all medical doctors working in Vhembe District Hospitals with mental health units and at a specialized mental health hospital as well as all documents completed by medical doctors during admission, care and discharge of mental health care users were purposively sampled. The study was conducted in two phases. In phase 1, where quantitative and qualitative designs were followed to do situational analysis. In phase 2, the programme was developed using results from phase 1, the theoretical framework and approaches outlined by Dickoff, James and Wiedenbach (1968); Chinn and Krammer (1999); Walker and Avant (1995). Individual in-depth interviews and questionnaires checklist were used to collect data which was analysed through opened coding method and SPSS. The findings of this study indicate that medical doctors have knowledge and skills deficit regarding implementation of the Mental Health Care Act No. 17 of 2002 during the admission, care, and discharge of mental health care users. Based on these, a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors during admission, care and discharge of mental health care users was developed. The study concludes that this is a significant contributor in supporting the vision of the National Department of Health to ensure improved mental health for all in South Africa. The study recommends a longitudinal study, tracking the impact of a developed programme, the knowledge of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002, and its contribution to the improvement of mental health for all should be conducted over a period of 5 (five) to 10 (ten) years

PhD (Nursing Science) / Department of Advanced Nursing Science / State patients are admitted to the psychiatric hospital after being declared as such by a court of law in South Africa. After successful rehabilitation of state patients at the psychiatric hospital, they need to be reintegrated into their families. Perceptions of family members of male state patients regarding reintegration including development of a model to support such reintegration, is not largely explored in the scientific body of knowledge. The aim of this study was to develop a model to support reintegration of state patients into their families in Limpopo Province, South Africa. A qualitative approach using descriptive, explorative, and contextual designs was adopted for this study. The study population was family members whose relatives are male state patients admitted and recorded in the admission register of Hayani Hospital, in Limpopo Province. The study was conducted in two phases of which phase one was a situational analysis, and phase two was the development of the model to reintegrate male state patients into their families. This study was conceptualized within the Social Ecological Model (SEM) of human behaviour (Stokols, 2013), the grounded theory for model development outlined in Dickoff et al. (1968), and the approaches outlined in Chinn and Kramer (2008); Walker and Avant (1995). Model evaluation was done by a group of health professionals, some of whom are advanced psychiatric nurses who are doing masters and doctoral studies, and one doctoral graduate who is also an advanced psychiatric nurse. Presentations were made to this group during peer review sessions who in turn gave critical comments regarding the developed model to support reintegration of male state patients until the final model was accepted. Non-probability purposive and convenient sampling were used to sample a hospital and 10 family members of Venda-speaking male state patients. In-depth individual interviews were used as the instrument to collect data which was pretested on one family member who did not form part of the study. Data was analysed using thematic analysis approach. Data was co-coded by an independent doctoral degree graduate to ensure trustworthiness. Conducting home visits by health professionals came up strongly during data analysis. Credibility, dependability, confirmability and transferability to ensure trustworthiness of the study, as well as ethical considerations were adhered to. The findings of the study yielded two themes, being perceptions of participants regarding reintegration of male state patients, and perceptions of participants regarding the support needed from family members to reintegrate male state patients. During phase one, the results indicated that family members accept reintegration and also that they indicated the kind of support needed, that lead to phase two of developing a model to reintegrate male state patients. The study was restricted to only one hospital in the Vhembe District out of the five districts of the Limpopo Province.The researcher acknowledges that this study was contextual and that only family members of male state patients were interviewed, the perceptions of family members of female state patients were not heard. The study concluded that there are perceptions that family members of male state patients have regarding reintegration of these patients into their families. Furthermore, family members of male state patients can describe the kind of support that they need in order to reintegrate male state patients into their families. This should be done using the developed model that should involve family members and the community. The study recommends that psychiatric hospitals should implement the model involving family members of male state patients. Furthermore, a longitudinal study should be conducted for a period of 3-5 years to check the effectiveness of the model. / NRF

Mental illness remains one of the most devastating condition affecting the social functioning of individuals and families. The affected individuals and their caregivers expressed dissatisfaction in mental health service delivery. The mental health system is medically oriented and does not involve caregivers as partners in the provision of mental health services. Although the developmental approach has been adopted to guide the provision of services recognising human rights and social justice, the medical model remains a challenge in the provision of comprehensive mental health services. This is compounded by the Mental Health Care Act (Act No. 17 of 2002) that is silent on the role of families in the mental health system. Additionally, social workers are unable to provide adequate services due to lack of resources. A qualitative study using the exploratory, descriptive and contextual designs was undertaken. Purposive sampling was used to select 28 participants from three groups, namely ten MHCUs, nine caregivers and nine social workers. The goals of the study were to understand the experiences of MHCUs, caregivers and social workers in mental health service delivery; and to proffer guidelines for social work practice to enhance partnership between the family and mental health care providers. Data was gathered through semi-structured interviews and analysed according to Tesch’s (in Creswell, 2009:186; 2014) framework. Data verification was guided by Lincoln and Guba’s (in Krefting, 1991:214-222) model to enhance trustworthiness. The findings suggest that MHCUs and caregivers received inadequate psychosocial support which is attributed to lack of involvement in service delivery. Furthermore, social workers lack adequate training to provide effective mental health care. As a result, guidelines were developed for the establishment and enhancement of partnership between families and mental health service providers to offer comprehensive and sustainable mental health services. Future exploration of the role of the family in mental health services is required. / Social Work / D. Phil. (Social Work)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs. / Health Science / M.A.(Nursing Science)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs. / Health Science / M.A.(Nursing Science)

The system of care for persons suffering from mental retardation is in a state of upheaval. Considering the mentally handicapped as holistic beings, this study explored and assessed the needs of those residing in the community of District 22 (sub-district 222), KwaZulu-Natal, thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on Maslow's hierarchy of needs theory was carried out, using 167 respondents. The study revealed that despite being mentally retarded, they were still regarded as valuable members of the community, their needs did not differ from the needs of others in the rest of the world and that mental retardation is still rated low in the prioritization of health problems, hence the lack of resources and support needed for the rehabilitation of such persons. / Health Studies / M.A. (Health Studies)

In this study, guidelines were developed for used by social workers to provide emotional support to children in foster care. The child in foster care as well as the services rendered in respect of such a child have been discussed in a literature study. The principles of Gestalt therapy were also discussed as these were used as part of the empirical study and as basis for the guidelines for social workers. A qualitative research design was used to complete the empirical study and case studies were used. Children between six and twelve years who have been in foster care for less than two years and who needed emotional support were selected for the study by means of a purposeful test sample. The research results showed that children in foster care are in need of emotional support. To provide such emotional support to the child in foster care, guidelines have been developed for social workers which they can apply when providing services to the child. These guidelines also serve as the conclusions and recommendations of the study. / Social Work / (M. Diac. (Play Therapy))

Adolescent substance abuse is a major problem facing the world today. In order to understand the reasons for adolescent substance abuse behaviour, various theoretical perspectives were utilised and strategies to curb substance use were also identified. The study was conducted in the rural areas of Zeerust, North West province of South Africa. The participants included 12 male adolescents, whose ages ranged from 12 to 15 years. A qualitative, explorative research design was employed. Data was gathered using semi-structured interviews, genograms and observations. Thematic analysis was used to analyse audio-taped data. The study found that substances abused by the participants include alcohol, nicotine, cannabis and heroin. Their reasons for using these substances include individual, family and environmental factors. However, peer group pressure was identified as the primary factor for adolescent substance use. This study emphasises the painful nature of substance abuse among adolescents, yet at the same time it succeeds in highlighting the strategies that can be employed to address substance abuse among adolescents. In addition, this study recommends a concerted effort by all the stakeholders in addressing the substance abuse problem. / Psychology / M.A. (Psychology)

This study examined the validity of the South African Police Service (SAPS) multiple stressor intervention. The multiple stressor was developed for members of their specialised units to address Post Traumatic Stress Disorder (PTSD). Unfortunately, the SAPS multiple stressor intervention lacks scientific evidence to support its possible effectiveness in addressing PTSD. In the current study a deployment and intervention group was compared which employed a pre- test post-test design. The Davidson Trauma Scale and the Revised Impact of Event Scale measured PTSD globally, but also the PTSD dimensions of Intrusion, Avoidance/Numbing, and Hyperarousal. The Wilcoxon signed rank test results indicated that the intervention and deployment was both effective in addressing PTSD although the intervention group revealed the greatest improvement in their overall PTSD scores. The intervention group made significant progress in dealing with all three PTSD symptoms while the deployment group made less progress with their Intrusion and Avoidance/Numbing symptoms, but made significant progress with their Hyperarousal symptoms. The Mann-Whitney u test revealed no significant differences between the post intervention test scores of the two groups, either globally or on the three PTSD dimensions. It appears that deployment was just as effective as the multiple stressor intervention in addressing PTSD. / Psychology / M.A. (Psychology)

The purpose of the study was to investigate Grade 12 learners’ perceptions of their vulnerability to HIV infections in order to gain insight of their experiences on HIV and AIDS at schools in the Eastern Cape. This was done by using a mixed method approach where focus-group discussions and questionnaires were used to gather data. This study found that the teaching of HIV and AIDS or Life Skills is not adequate. It is possible that the lack of learner involvement in the design and implementation of the programmes could be one of the reasons why there is low participation by learners in intervention programmes in schools, as noted in this study. There is need for strong advocacy on the use of condoms as a preventive measure against unwanted pregnancies, and sexually transmitted diseases (STIs) including HIV. More involvement in extra-curricular activities would help learners to develop self-esteem and the ability to resist drugs and other risky sexual behaviours. / Social Work / M.A. (Social Behaviour Studies in HIV & AIDS)