Background: Acute inpatient stays are decreasing. Evidence for music therapy in mental healthcare exists but practice varies. Short admissions and therapy frequency (usually weekly), limit access, yet acceptability of increased frequency to patients is unknown. Research to model processes and outcomes of intensive provision may identify how best to provide for acute contexts informing clinical practice and future research. Methods: 114 patients admitted to hospital with acute mental health problems were recruited. Patients attended group music therapy 1-3 times per week during admission. Repeated measures assessing patient experiences, session appraisal, motivation and commitment were completed. Questionnaire thematic analysis identified important processes which were coded from session recordings. Multilevel modelling was used to examine associations between music therapy components, session appraisal, motivation, commitment and subsequent attendance. End of therapy interviews with 16 patients explored changes experienced and views on therapy frequency. Results: Attendance was 3 times greater for patients with 3 sessions per week. The majority found increased frequency acceptable and beneficial. Processes of engagement, emotional expression and social connection suggested active music-making, synchrony and singing to be important for group cohesion. Singing was significantly associated with appraisal and motivation. Musical initiation by group members was associated with motivation and commitment. All three outcomes were associated with each other, with session appraisal and increased frequency independently associated with subsequent attendance. Patient attributions for change included creativity, experiential learning and therapist directed reflective discussions. Conclusion: Intensive group music therapy is acceptable to the majority of patients, perceived as beneficial and increases access. Intensive provision is associated with greater engagement and positive experiences, which in turn, are associated with group commitment. Patient experiences can inform practice. Further research should examine effectiveness of intensive provision. Therapists should continue to prioritise engagement through active music-making and singing, and services consider implementation of intensive provision.

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Made available in DSpace on 2016-04-29T13:31:10Z (GMT). No. of bitstreams: 1 Aline Alves da Silva Travaglia.pdf: 989678 bytes, checksum: 3fae9b0f0e9ffd9d13b73713dcd94847 (MD5) Previous issue date: 2014-03-25 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Within the topic of mental health and the field of psychoanalysis, we shall think about the children s assistance and the position of the analyst, with that practice as inserted in the institutional environment. Taking as a ground the method of clinical vignettes, we will use some clinical cases as markers to put in question the position of the psychoanalyst s position before the child's suffering. It is mandatory the understanding of some clinical tools as well as their expansion to the analyst s political job, in public and institutional spaces, it is necessary to furnish the idea of an ethical and political listening. We proceed then criticizing the hegemonic understanding of mental healthcare and their references in contemporary psychopathology, in order to understand the addressing of the subjects using the medical speech to prompt care via mental health institutions. Charting a critique of contemporary psychopathology, we intend to comprehend how the symptoms becomes something difficult to be evaluated when the suffering is obturated into diagnostic nomenclatures, but instead, the work of the analyst appears as a hearing that raises the subject to put himself in his uniqueness. To welcome the complaint referred to the medical and psychiatric field and to put ahead the uniqueness of a symptom, as something that returns and which has no name provided in the DSM this is one of the roles of the analyst in a mental health institution. We intend to elaborate how the attention and the management of transferential position are necessary for the child's treatment, both the transfer with responsible adults and the transfer at the institutional level, with the team which also takes care of her. To face the transferring in a broad clinical listening becomes essential to remove the reference to the individual clinic and to provide theoretical and technical information to understanding the analyst s social, collective and political role. Children s assistance in the institutional context demands from us to doubly bending toward a broadening of the analytical listening: first because the child brings with her other people who speak about her and for her; secondly because, in the institutional environment, the treatment happens in the polyphony of various knowledges. To hear these diverse voices in the clinical work is what we consider essential both for the subject to be contemplated and for the analyst s activity to reach a scope beyond the individual, understanding the child as a subject of desire formed in a close relationship with the familiar, social and political context she is immersed / Dentro do tema da saúde mental e do campo da psicanálise partimos pra pensar a posição do analista com sua práxis no espaço institucional e o atendimento à infância. A partir do método de vinhetas clínicas usaremos alguns casos como balizas para questionar a posição do analista diante do sofrimento da criança. A compreensão de algumas ferramentas clínicas assim como a ampliação destas para o trabalho político do analista nos espaços públicos e institucionais se faz necessário, para com isso aparelhar a proposta de um escuta ético-política. Procederemos com a crítica à forma hegemônica de compreensão de saúde mental assim como as referências em psicopatologia contemporânea, para com isso compreender a forma de endereçamento dos sujeitos que usam do discurso médico para solicitar cuidados na saúde mental. Traçando uma crítica à psicopatologia contemporânea pretendemos compreender como o sintoma se torna algo difícil de ser visado na medida em que o sofrimento se obtura em nomenclaturas diagnósticas, mas que nesse interim o trabalho do analista se marca como uma escuta que suscita o sujeito a se colocar em sua singularidade. Acolher a queixa referida ao campo medico-psiquiátrico e aí colocar a singularidade de um sintoma, como algo que retorna e que não tem nome previsto no DSM, esse é um dos papéis da escuta do analista na instituição de saúde mental. Pretendemos elaborar como que a atenção e o manejo da posição transferencial são necessários para o tratamento da criança, tanto a transferência com os adultos responsáveis por ela quanto a transferência no âmbito institucional com a equipe que dela também se ocupa. Pensar a transferência numa escuta clínica ampliada se torna fundamental para desmontar a referência à clínica individual assim como nos fornece subsídios teóricos e técnicos para compreender o papel social, coletivo e político do analista. O atendimento às crianças no âmbito institucional nos convoca duplamente a pensar em direção a uma ampliação da escuta analítica, primeiramente porque a criança trás consigo outras pessoas que falam dela e por ela, segundamente porque no meio institucional o tratamento se dá na polifonia de vários saberes. Escutar essas diversas vozes no trabalho clínico é o que consideramos fundamental para que o sujeito seja visado e para que a atividade do analista alcance um âmbito para além do individual, compreendendo a criança como um sujeito do desejo que se forma em íntima relação com contexto tanto familiar, quanto social e político em que está imersa

This thesis attempted to examine stressors associated with the psychiatric technician profession and levels of burnout amongst them. This was accomplished through the use of a survey which included demographic data, the Maslach Burnout Inventory Human Services Survey (MBI‑HSS), an adaptation of the Nursing Stress Scale (NSS) and a self‑care assessment tool. A total of three research questions were examined statistically including levels of burnout on subcategories (personal accomplishment, emotional exhaustion and depersonalization), most common stressors identified by psychiatric technicians and percentage of participants who utilized therapy to cope with work related stress. The survey was made available via survey monkey and posted on the website for the California Association of Psychiatric Technicians website and via links posted on Union Chapter social media pages. A total of 123 Psychiatric Technicians participated in the study. Results indicated high levels of emotional exhaustion, depersonalization and personal accomplishment among psychiatric technicians. Results indicate that extended work hours and staffing minimums were significant issues impacting union members. Also significant among participants, was high level of difficulty attending work due to work related stress during the last three months. For future research, it is recommended that similar studies of psychiatric technicians be conducted to provide further insight into burnout, how it happens and how to avoid it.

The overall aim of this thesis was to deepen knowledge of what it means to be a parent of an adult child who suffers from long-term mental illness. Data collection in studies I-III consisted of qualitative interviews with 26 parents. In study I, 16 mothers and, in study II, 10 fathers were interviewed about the way in which their everyday life was affected when an adult child suffers from long-term mental illness. Data were analysed using qualitative content analysis. In study III, the same 26 parents participated as in studies I-II. The aim of the study was to investigate parents’ conceptions of the mental health care. Data were analysed by means of the phenomenographic method. Study IV is based on questionnaires completed by 151 parents. The aim was to investigate mothers’ and fathers’ health related quality of life (HRQOL) focusing on self-rated symptoms of anxiety, depression and burden as well as their experiences of encounters with the mental health services. Data were analysed for the most part by means of non-parametric method. The mothers’ everyday life was characterized by constant preparedness to adapt their life situation to the needs of their child (I). The fathers’ inherent ongoing struggle to ensure the child’s well-being required both strength and courage. Fathers attempted to maintain a good balance in life; this balancing act depended on collaboration between those involved in the child’s life, the family, the healthcare services and other authorities (II). The parents described feeling excluded from professional care and questioned its quality and accessibility (III). Mothers’ self-rated HRQOL was lower and they were also affected by burden and mental ill health to a greater extent than the fathers (IV). The results highlight shortcomings in the interaction between parents and mental health professionals. This highlights the importance of interventions that support and strengthen cooperation between parents and mental health professionals in the care of children who suffer from mental illness.

abstract: Approximately one-third of Iraq and Afghanistan veterans develop mental health problems, yet only 35-40% of those with mental disorders are seeking mental healthcare (Hoge, et al., 2004; Vogt, 2011). Military spouses may be an important resource for facilitating treatment seeking (Warner, et al., 2008), especially if service member mental health issues are impacting the marriage. Military spouses might be hesitant to encourage service member help-seeking, however, due to perceived threat of adverse military career consequences. For this study, 62 military wives completed an online survey. As part of the survey, participants were randomly assigned to one of four vignettes containing a description of a hypothetical military husband with mental health symptoms. Each vignette presented different combinations of marital conflict (high versus low) and service member concerns about adverse career consequences (high versus low). Wives rated on a five-point scale how likely they were to encourage the hypothetical military husband to seek help. It was hypothesized that spouses would be more willing to encourage help-seeking when concerns about adverse military career consequences were low and marital distress was high. No main effects or interaction effect were found for marriage and career. Perceived stigma about seeking mental health treatment in the military, psychological identification as a military spouse, and experience and familiarity with military mental healthcare policies failed to moderate the relationship between marital conflict, career concerns, and encouragement of help-seeking. Correlational analyses revealed that (1) greater experience with military mental healthcare (first- or secondhand), and (2) greater perceptions of stigma regarding seeking mental healthcare in the military each were associated with decreased perceptions of military supportiveness of mental healthcare. Therefore, although the experimental manipulation in this study did not lead to differences in military spouses' encouragement of a hypothetical military service member to seek mental health services, other findings based on participants' actual experiences suggest that experiences with military mental healthcare may generate or reinforce negative perceptions of military mental healthcare. Altering actual experiences with military mental healthcare, in addition to perceptions of stigma, may be a useful area of intervention for military service members and spouses. / Dissertation/Thesis / M.S. Psychology 2013

Psychiatric inpatient services provide important care for individuals with serious mental health problems. Studies show that passivity and social disengagement prevail in inpatient settings, and the transition to outpatient care is associated with increased suicide risk. Behavioural Activation is an intervention that targets depression by increasing personally meaningful activities. Preliminary research shows that Behavioural Activation can be used in inpatient settings. The overall aim of this thesis was to evaluate the feasibility and effectiveness of Behavioural Activation for individuals in psychiatric inpatient settings, and in the transition between inpatient and outpatient care. Study I investigated inpatient activities and associated experiences. Study II was a pilot single-case experimental study of the feasibility and effectiveness of inpatient Behavioural Activation. Study III, was an interrupted time series evaluation of nursing-adapted Behavioural Activation across three wards. In Study IV Behavioural Activation in the transition from inpatient to outpatient care was compared to Supportive Therapy in a randomised controlled trial with 64 participants. The primary outcome was that of self-reported depressive symptoms and participants were followed up 12 months after treatment completion. Doing nothing was the most common inpatient activity, along with meal related activities. Passive and solitary activities were associated with negative distress and reward profiles. The preliminary evaluation of Behavioural Activation found high patient and staff satisfaction, and four of six participants showed improvement in depressive symptoms and functioning. After nursing-adapted Behavioural Activation was implemented on three wards, engagement increased. Avoidance decreased but later returned to baseline levels. Depressive symptoms and global clinical severity did not improve after nursing-adapted Behavioural Activations was introduced. The randomised controlled trial found that adding Behavioural Activation in the transition to outpatient care had a small, short-term, advantage over Supportive Therapy for self-reported depression. In conclusion, inpatient disengagement is associated with distress, and Behavioural Activation is a feasible intervention in inpatient settings that can be used by both trained therapists and nursing staff to increase patients’ treatment engagement. Behavioural Activation seems useful in targeting depressive symptoms in the transition from inpatient to outpatient care, a period associated with increased risk of suicide and clinical deterioration.

Since 2019, therapy content from both mental health professionals and social media users has proliferated on both TikTok and Instagram, a phenomenon some have called Tiktok and Instagram therapy. This study explores two different facets of social media therapy. It explores how individuals with a history of depression engage with these accounts in order to cope with their condition. It also explores the content about depression this study's participants consume in the process, which knowledges about depression are privileged and which remain obscured. Based on qualitative content analyses of in-depth semi-structured interviews and collected social media posts from Instagram and Tiktok, this thesis adopts Foucault's theoretical approaches to Technologies of the Self and Power/Knowledge to reveal the complexities of social media therapy in the context of neoliberal mental healthcare and the dominance of psychiatric and psychological knowledge about depression. The findings show that social media therapy is a valuable tool for this study's participants through the careful curation of their social media therapy content and, thus, allowing them to gain better (self-)knowledge, tools for self-care and a sense of community to better cope with depression. However, participants' practices reveal a tension between the notions of agency and neoliberal imperatives of self-management operating simultaneously within the current mental healthcare context. The findings further show that social media therapy reinforces the stronghold of the medical and psychological sciences on conceptions of depression and reproduces neoliberal imperatives of self-responsibility and individualization, disregarding the social and structural determinants of depression. This study thus concludes that while social media therapy is a site of contradictions, its appeal and helpfulness in the current neoliberal mental healthcare context cannot be denied. Nevertheless, there is a need to bring more awareness to social and structural conditions leading to depression.

Yes / There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study. / This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant reference no. RP-PG-0611-20004). Professors Siobhan Reilly, Richard Byng and Max Birchwood are partially supported by the NIHR Applied Research Collaboration (ARC) for North West Coast, Care South West Peninsula and West Midlands, respectively.

The area of healthcare has a lot of challenges and restrictions when it comes to design. There is no access to one of the users. A research on this topic resulted in the creation of Robbi – an interactive toy that supports communication between a child and psychologist during their therapy sessions.Children (patients) as stakeholders are a very vulnerable party of this project and as they were not involved in the process directly; there was no opportunity for intervention, observation or action research. When the therapeutic session is happening, the setting of the environment has to be as comfortable for the client as possible and the presence of a third person at the session would disturb the result in a severe way.I would argue here that the therapists can act as proxies in the projects related to design for MHC clients. Psychology therapists are skilled and experienced observers and area experts. In many cases we actually have to think: who is the real end user of our design? What relationships are there between the stakeholders and the solution are? As the project involves therapists as participatory design actors it is fair to say that the therapists are primary users of the design concept that is to be created. It has to fit all the needs of the doctor, enable them to make the therapy sessions more efficient, engaging and profound. At the same time the concept has to be developed in the framework of interaction for children in terms of visuals, tangibility, emotional content and usability.