Thesis (MOccTher)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: The high number of mental health care users requiring care, the quick turnover in psychiatric hospitals and the scarcity of community-based mental health services are some of the factors that have led to a dramatic increase in the number of high frequency users of in-patient psychiatric services. In an attempt to address these issues, an occupational therapy-led day treatment centre was established at Stikland Hospital in the Western Cape province of South Africa. The aim of this study was to determine whether attendance at an occupational therapy-led community day treatment centre for mental health care users affects the use of in-patient services in the Western Cape Province of South Africa. Methods: A pre-test/post-test quasi-experimental study design was used to determine the benefits of the occupational therapy-led day treatment centre. Total population sampling was used. Forty four mental health care users participated in the study. The number of admissions and number of days spent in hospital before and after occupational therapy intervention were compared using statistical analysis. Results: The analysis showed a significant difference in the number of admissions (p = .00) and the number of days spent in hospital (p = .00) before and after the occupational therapy intervention. There was a decrease in the number of admissions of 62.3% after intervention. Twenty-five participants (56.8%) had fewer admissions after intervention than before. Total days spent in hospital for the group showed a decrease of 74.6% after intervention. Days spent in hospital became shorter by up to 7 months after occupational therapy intervention. This indicated a medium effect size (r = .436) for number of admissions and a large effect size (r = .504) for number of days spent in hospital after intervention. The frequency of attending the day treatment centre had no influence on number of admissions (p = .410) or on the number of days spent in hospital (p = .579) after intervention. Conclusion: The findings suggest that an occupational therapy-led day treatment centre is effective in reducing the use of in-patient services within the Western Cape, South Africa. In addition providing a range of opportunities for meaningful participation may be more important than the intensity of treatment when promoting recovery. / AFRIKAANSE OPSOMMING: Agtergrond: Die groot hoeveelhied persone wat psigiatriese sorg benodig, die vinnige omset in psigiatriese hospitale asook die tekort aan gemeenskaps psigiatriese dienste is van die faktore wat lei tot ‘n toename in persone wat gereëlde heropname benodig. As moontlike oplossing vir die probleem is ‘n dagbehandelingsentrum geopen by Stikland Hospitaal in die Wes-Kaap provinsie van Suid Afrika. Die doel van die studie was om vas te stel of ‘n dagbehandelingsentrum, onder leiding van ‘n arbeidsterapeut, effektief is in die Wes-Kaap provinsie van Suid Afrika vir persone met psigiatriese siektes. Metode: ‘n Voortoets-natoets kwasi-eksperimentele studie metode is gebruik om die voordele van ’n arbeidsterapie gedrewe dagbehandelingsentrum te bepaal. Totale bevolking steekproef is gebruik. Vier en veertig persone met ‘n psigiatriese diagnose het deelgeneem aan die studie. Die hoeveelheid opnames asook hoeveelheid dae spandeer in die hospitaal voor en na die arbeidsterapie intervensie is vergelyk. Resultate: Resultate het getoon dat daar ‘n beduidende verskil was tussen die hoeveelheid opnames (p = .00) en die hoeveelheid dae in die hospital (p = .00) voor en na arbeidsterapie intervensie. Die groep se hoeveelheid opnames het met 62.3% gedaal na intervensie. Vyf en twintig deelnemers (56.8%) het minder opnames gehad na intervensie as voor intervensie. Data toon ‘n medium effekgrootte (r = .436). Die totale dae in die hospitaal vir die groep het met 74.6% afgeneem na intervensie. Dae spandeer in die hospitaal het met tot 7maande verkort na arbeidsterapie intervensie. Dit toon‘n groot effekgrootte (r = .504). Die frekwensie van bywoning het geen invloed getoon op die hoeveelheid opnames (p = .410) of hoeveelheid dae in die hospitaal (p = .579) nie. Gevolgtrekking: Die studie het gevind dat, in die Wes-Kaap, ‘n arbeidsterapie gedrewe dagbehandelingsentrum ‘n effektiewe en uitvoerbare opsie is om die druk op binne-pasiënt dienste te verlig. Die studie het verder getoon dat betekenisvolle deelname aan aktiwiteite moontlik belangriker is vir herstel na ‘n psigiatriese siekte as intensiteit van behandeling.

Thesis (M. A. (Clinical Psychology)) --University of Limpopo, 2018 / Studies by the World Health Organisation have shown that mental illness is an international health concern across the globe, with one in four people (25%) suffering from mental disorders in both developed and developing countries. In many African countries traditional health practitioners are the health care providers of choice for individuals, families and communities. The aim of this study was to explore methods used by Shona speaking traditional health practitioners in the prevention of mental illness in Bulawayo, Zimbabwe. A qualitative research design was used in the present study. Ten Shona speaking traditional health practitioners (male=9; female=1) were selected through purposive sampling and requested to participate in the study. Data was collected using semi-structured interviews and analysed through thematic content analysis. It was found that traditional healers tend to commonly understand and conceptualise mental illness in terms of the causes instead attaching nosological labels to these conditions. The findings of the study also show that most of the traditional health practitioners interviewed had similar methods of preventing mental illness both in families and individuals. Culture was found to be central in shaping how the traditional health practitioners understand and prevent mental illness. Ancestors were found to be pivotal in specifically determining the methods to prevent mental illness for each client. The study is concluded by recommending closer collaboration between the dominant Western health care system and traditional healing in order to improve mental health care provision in Zimbabwe.

Thesis (M.A. (Clinical Psychology)) --Univesity of Limpopo, 2013 / South Africa has a growing rate of mental health care users. Because of the lack of health resources and personal beliefs many of these mental health care users consult with their church leaders. The treatment of mental illness by clergy in South Africa is largely undocumented. The aim of the study was to explore and describe the treatment of mental illness by Afrikaans speaking church leaders in Polokwane, Limpopo Province. To gain a deeper understanding of the views held by the Afrikaans-speaking church leaders, a qualitative approach was utilized. Ten participants agreed to participate in the study. The results tend to suggest that most of the respondents use a combination of supportive therapy and teachings from scripture to treat some mental illnesses, and that they feel positive towards collaboration with other mental health care professionals. Lastly the results indicated that most respondents emphasized the importance of homophily in referral criteria. Key Concepts Mental illness; Christian church; Afrikaans speaking; church leader; treatment

This pilot study examined the effects of single sessions of music therapy on the level of anxiety in older persons with psychiatric disorders. The studied intervention was a 30 minute music therapy group and the control intervention was a verbal therapeutic intervention in the form of a reminiscence group. Participants acted as their own control. The measurement tool was the state part of a “State Trait Anxiety Inventory”. It was administered a total of four times, pre- and post- the music therapy intervention and preand post- the reminiscence therapy (control) group. A total of 9 participants were recruited for the study. The results indicated that single sessions of music therapy significantly reduced the level of anxiety for older persons with psychiatric disorders [t(8)=4.626, p<0.0017] as compared to the control intervention as measured by the state part of the “State Trait Anxiety Inventory”. There was no evidence for a significant carryover effect since the baselines prior to each intervention did not differ significantly (p=0.55). These results can be considered to be a part of a pilot study and early inquiry into this field since methodological difficulties and the time limitation of the research resulted in some necessary deviations from the original protocol. A major limitation of the study was the choice of a measurement tool, which required the client to be cognitively high functioning. Thus these results are limited to cognitively able clients, which is a relatively small proportion of this client group that could potentially benefit from music therapy. It is suggested that for future research with this client group the measured variable be physical relaxation, rather than anxiety.

Aims: It is argued that one’s sense of self is threatened and eroded by mental illness. According to the narrative perspective, one’s personal life narrative is displaced and maintained by a story of illness. However, dialogical self theorists argue that mental illness limits the number of ‘I’ positions available within an individual, resulting in the positions/voices becoming rigid and being dominated by a singular, monological position. The aims of this qualitative study are to attempt to understand and examine psychiatric inpatients’ personal lived experiences of an art group. The goal of the study is to focus on the impact of the art-making process on these patients with regards to the construction of their sense of self. Design: A qualitative research design was used in the study. Method: Four psychiatric in-patient art group members – three male and one female, between the ages of 27 and 40 – were interviewed. A semi-structured interview schedule consisting of sixteen questions focusing on the interviewees’ experiences of the art group was used. The interviews were analysed using an interpretive phenomenological analysis. Results: Three superordinate themes emerged: What the Participants Gained From the Art Group, Sense of Community and Leaving a Mark, and The Experience of Self in the Art group. All three Superordinate themes fall within the participants’ experience of the art group. Conclusion: All four of the participants expressed positive feelings and enjoyment towards the art group. Participation in the art group provided the participants with a sense of pride, achievement and hope within their lives. As a result of participation on the art group, one of the four participants was able to construct a thin alternative experience and sense of self.

Reports of people with mental disorders without access to treatment are a major occurrence in prisons outside and within Africa. An estimated 450 000 000 people worldwide suffer from mental or behavioural disorders. The disproportionately high rate of mental disorders in prisons is due to several factors. The factors include the widespread misconception that all persons with mental disorders are a danger to the public; the general intolerance of many societies to difficult or disturbing behaviour, the failure to promote treatment, care and rehabilitation, and above all the lack of or poor access to mental health services in many countries. Many of these disorders may be present before admission to prison and may be further exacerbated by the stress of imprisonment. However mental disorders may develop during imprisonment itself as a consequence of prevailing conditions. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2011. / http://www.chr.up.ac.za/ / nf2012 / Centre for Human Rights / LLM

The ability to monitor client change in psychotherapy over time is vital to quality assurance in service delivery as well as the continuing improvement of psychotherapy research. Unfortunately, there is not currently a comprehensive, affordable, and easily utilized outcome measure for psychotherapy specifically normed and standardized for use in psychology training clinics. The current study took the first steps in creating such an outcome measure. Following development of an item bank, factor analysis and item-response theory analyses were applied to data gathered from a stratified sample of university (n = 101) and community (n = 261) participants. The factor structure did not support a phase model conceptualization, but did reveal a structure consistent with the theoretical framework of the research domain criteria (RDoC). Suggestions for next steps in the measure development process are provided and implications discussed.

During the mid-nineteenth century, the citizens of Texas were forced to keep their mentally disturbed family members at home which caused stress on the caregivers and the further debilitation of the afflicted. To remedy this situation, mental health experts and Texas politicians began to create a system of healing known as state asylums. The purpose of this study is to determine how Texas mental health care came into being, the research and theories behind the prevention and treatment programs that asylum physicians employed to overcome mental illness, in addition to the victories and shortcomings of the system. Through this work, it will be shown that during the 1850s until the 1920s institutions faced difficulty in achieving success from many adverse conditions including, but not limited to, overcrowding, large geographical conditions, poor health practices, faulty construction, insufficient funding, ineffective prevention and treatment methods, disorganization, cases of patient abuse, incompetent employees, prejudice, and legal improprieties. As a result, by 1930, these asylums were merely places to detain the mentally ill in order to rid them from society. This thesis will also confirm that while both Texas politicians and mental health experts desired to address and overcome mental illness in Texas, they were unable to do so due to arguments, selfishness, corruption, failures, and inaction on the part of both sides. However, this thesis will ultimately reveal it was lack of full support from Texas legislators, deriving from the idea that this system was not one of their top priorities among the state’s concerns, that led to the inability of the Texas mental health care system to properly assist their patients.

Indiana University-Purdue University Indianapolis (IUPUI) / People with severe mental illness (SMI) often suffer from comorbid physical conditions that result in chronic morbidity and early mortality. Physical health decision-making is one area that has been largely unexplored with the SMI population. This study aimed to identify what factors contribute to the physical healthcare decision-making autonomy preferences of persons with SMI, and to identify the impact of these autonomy preferences on medication adherence. Ninety-five adults with SMI were recruited from an integrated care clinic located in a community mental health center. Fifty-six completed a three-month follow-up. Multiple linear regression for hypothesis 1 (n=95) and hierarchical regression for hypothesis 2 (n=56) were used to analyze data on personal characteristics, physical health decision-making autonomy preferences and medication adherence. For the open-ended questions, thematic analysis was used to uncover facilitators and barriers to medication adherence. With this sample, being male predicted greater desired autonomy, and having less social support predicted less desired autonomy. When background characteristics were held constant, autonomy preferences and perceived autonomy support from the physician only contributed an additional 1% of the variance in medication adherence. Lastly, participants reported behavioral factors and having family/personal support to take medications as facilitators to medication adherence for physical health care, while citing financial and other resource limitations as barriers.

This study explored the Object Relations of a sample of 45 subjects who were using alcohol and were diagnosed with co-morbid Depressive or Bipolar disorders and/or Personality disorders. All subjects were receiving treatment at a government psychiatric hospital in South Africa. The similarities and differences in the Object Relations of these individuals were identified. A biographical questionnaire, the Alcohol Use Disorder Test (AUDIT), which was used as a screening measure, and the Bells Object Relations and Reality Testing Inventory (BORRTI) were administered to obtain information from a purposive sample. Descriptive and inferential statistics were used to analyse the results of the assessment measures. Analysis of the BORRTI data indicated a high rate of depressive and personality disorders within this sample. Results of the sub-sample (n=29) whose scores were included in the Pearson’s Correlation Coefficient analysis indicate that higher levels of alcohol consumption result in increased levels of hallucinations and delusions. Other correlations were identified between high levels of alcohol consumption and heightened levels of reality distortions and more uncertainty in the perceptions of these individuals. Significant differences in the scores of the male and female participants were identified. With the female participants, the higher the level of alcohol consumption, the lower the individuals scored in terms of pathological levels of egocentricity, uncertain perceptions, insecure attachments, alienation, social incompetence as well as hallucinations and delusions. Alternatively, in the male sample, higher levels of alcohol consumption result in increased hallucinations and delusions, reality distortions, uncertainty in perceptions, alienation, social incompetence and egocentricity. / Psychology / M.A. (Research Psychology)