Though there is a high comorbidity between serious mental illness and substance use (dual diagnosis), little research has been conducted concerning the treatment of seriously mentally ill substance users. This study examined subjects (N=154) who participated in dual diagnosis treatment groups in a suburban out-patient community mental health center during a 10 year period, in order to determine the characteristics of subjects who responded well to outpatient group treatment. Data on 28 demographic, diagnostic, treatment and treatment participation variables were collected on each subject and the data was then analyzed by correlational, discriminant and multiple regression statistical procedures. Each of the procedures found that a more positive recovery status at admission combined with longer-term treatment and participation in additional treatment services were highly related to positive treatment outcomes. Four variables (more positive recovery status at admission, participation in a greater number of treatment groups, greater involvement in self-help groups and hospitalization while in treatment) were found significantly related to positive treatment outcome in all three statistical tests. There were also differences in gender and race/culture sub-groups concerning which variables contributed to positive treatment outcomes. / Master of Science

In British Columbia, individuals with a mental disorder can be hospitalised against their will under the Mental Health Act (1999), when a physician determines that "protection of the person or others" is an issue. Involuntary psychiatric hospitalisation involves a major infringement of an individual's civil liberty. When patients or their representatives disagree with the treatment teams about their involuntary hospitalisation, they can apply for an appeal hearing named the review panel under the Mental Health Act (1999). From a theoretical perspective, the traditional medical model and the social constructionist model, which offer different views concerning individuals with mental illness who are hospitalised against their will, are presented. This theoretical contrast underscores a major dilemma faced by mental health professionals in fostering client self-determination, while they are providing services on the principle of beneficent protection. An empowerment model of social work practice is then described to illustrate how services can be provided to help mental patients regain a sense of control over their lives. Concerns about the current legislation regarding involuntary hospitalisation are also discussed. To supplement the limited number of studies currently available on review panels, a quantitative descriptive study was conducted at Riverview Hospital, the only tertiary psychiatric hospital in British Columbia, surveying the experiences of 39 social workers and physicians with review panels. A questionnaire consisting of 22 Likerttype items was used. Four categories were identified: (a) patient-related issues, (b) effects of review panels on treatment teams, (c) role conflicts, and (d) operational issues. Despite the apparent lack of formal training, social workers and physicians generally reported having adequate knowledge of review panels. Social workers and physicians who were involved more frequently with review panels appeared to have more positive attitudes towards them. Their training pertaining to the Mental Health Act was also significantly related to their attitudes. Neither patients nor their families reportedly had adequate knowledge of the review panel process. Although some positive effects of review panels were acknowledged, staff generally had mixed attitudes about review panels. Guided by an empowerment model, these findings have important implications for social work practice. These include the need for further professional training, improved communication between health professionals and legal advocates, education for patients and families, and the support of patients' collective action, so that review panels can be a more empowering experience for mental patients.

In British Columbia, individuals with a mental disorder can be hospitalised against their will under the Mental Health Act (1999), when a physician determines that "protection of the person or others" is an issue. Involuntary psychiatric hospitalisation involves a major infringement of an individual's civil liberty. When patients or their representatives disagree with the treatment teams about their involuntary hospitalisation, they can apply for an appeal hearing named the review panel under the Mental Health Act (1999). From a theoretical perspective, the traditional medical model and the social constructionist model, which offer different views concerning individuals with mental illness who are hospitalised against their will, are presented. This theoretical contrast underscores a major dilemma faced by mental health professionals in fostering client self-determination, while they are providing services on the principle of beneficent protection. An empowerment model of social work practice is then described to illustrate how services can be provided to help mental patients regain a sense of control over their lives. Concerns about the current legislation regarding involuntary hospitalisation are also discussed. To supplement the limited number of studies currently available on review panels, a quantitative descriptive study was conducted at Riverview Hospital, the only tertiary psychiatric hospital in British Columbia, surveying the experiences of 39 social workers and physicians with review panels. A questionnaire consisting of 22 Likerttype items was used. Four categories were identified: (a) patient-related issues, (b) effects of review panels on treatment teams, (c) role conflicts, and (d) operational issues. Despite the apparent lack of formal training, social workers and physicians generally reported having adequate knowledge of review panels. Social workers and physicians who were involved more frequently with review panels appeared to have more positive attitudes towards them. Their training pertaining to the Mental Health Act was also significantly related to their attitudes. Neither patients nor their families reportedly had adequate knowledge of the review panel process. Although some positive effects of review panels were acknowledged, staff generally had mixed attitudes about review panels. Guided by an empowerment model, these findings have important implications for social work practice. These include the need for further professional training, improved communication between health professionals and legal advocates, education for patients and families, and the support of patients' collective action, so that review panels can be a more empowering experience for mental patients. / Arts, Faculty of / Social Work, School of / Graduate

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.

Recognising the enormous challenges in South Africa confronting the nursing of the mentally ill, the project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perception of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff using a self-administered tool. The study looked at four different types of perceptions guided by categories of conceptual framework proposed by Mavundla (2000:1569-1570), namely perception of self, perception of patients, perception of environment and perceived feelings. The study found that the majority of professional nurses have a predominantly positive self- perception of nursing mentally ill people in a general hospital, although a significant number have a negative perception of patients, the nursing environment and perceived feelings. Lack of knowledge, skill and experience affect the nursing care of mentally ill people in the general hospital. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore the role of family members in support of their relatives who are mentally ill and to develop guidelines for the support of mentally ill relatives by their families in a rural community. The research design was qualitative, explorative, descriptive and contextual. The research population consisted of families of mentally ill relatives collecting their monthly medications at the Jane Furse Gateway Clinic. Purposive sampling was used to draw the sample. Data was collected by individual in-depth semi-structured interviews that were tape-recorded. The study revealed that families provide physical, psychosocial, financial and developmental support to their relatives. Furthermore, families are faced with frustrations when providing support to their mentally ill relatives / Health Studies / M.A. (Health Studies)

This study was undertaken to identify the biographical characteristics, attitudes and perceptions of informal family care-givers caring for patients with mental illness in Dennilton. Data were gathered from 48 care-givers by using a cross-sectional survey approach in which structured questionnaires were completed. The results revealed that a sizeable proportion of the care-givers were 60 years and older. Only 10% were employed and a quarter married, suggesting that the care burden influenced their life choices. Many care-givers were mothers or female family members. Half of the patients cared for suffered from depression. Violent, aggressive behaviour was reported as a symptom that care-givers found difficult to deal with. Less than half of the care-givers reported that the patients accepted their health situation. / Sociology / M.A. Soc.

The promulgation of the Mental Health Care Act of 2002 in South Africa came with challenges or changes in the nursing of mentally ill people. One of the changes required that mental patients need to be observed and assessed for a period of 72 hours in a general or medical ward before being transferred to a specialist hospital. Sometimes the person remains in the ward for more than the 72 hours. This means that nursing students doing their comprehensive four year diploma (R425) are exposed to nursing people with mental illness in their first, second and third year of training, which is prior to the mental health nursing/psychiatric nursing module undertaken in the last semester of the fourth year. The purpose of this study was to explore student nurses’ narratives on nursing mentally ill people in a medical ward. Narrative inquiry was used as the research methodology. Purposive sampling was used to select 5 participants for this study. The inclusion criteria specified that participants had to be second year students participating in the four year Comprehensive Nursing Diploma Programme (R425) who have nursed, or been in contact with a mentally ill person, for a period of eight weeks. The study was conducted before the participants were exposed to the psychiatric module, which is undertaken in fourth year of the diploma course. Data collection took place through a total of 5 sessions of focus groups which took place in a boardroom. While personal names were excluded, participants were required to fill in certain demographic details. Data analysis was undertaken using narrative data analysis, which looked at narrative strings, which are presenting commonalities and narrative threads which are major emerging themes. The narrative strings or commonalities that were identified were in the area of beliefs, with the dominant beliefs regarding the causes of mental illness being culturally or socially based. Emotions such as fear, sadness and frustration were identified, as well as ignorance which leads to stigmatising attitudes. The narrative threads or emerging themes that were identified were: making sense of experiences; moments of awakenings; breaking free moments; and acceptance of a known person with mental illness. The following themes were identified: moments of awakenings or realisation, where the participants started seeing the mentally ill person in another light; and moments of strengths/unique outcomes, where participants recognised their own strengths in dealing with a mentally ill person. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Recognising the enormous challenges in South Africa confronting the nursing of the mentally ill, the project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perception of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff using a self-administered tool. The study looked at four different types of perceptions guided by categories of conceptual framework proposed by Mavundla (2000:1569-1570), namely perception of self, perception of patients, perception of environment and perceived feelings. The study found that the majority of professional nurses have a predominantly positive self- perception of nursing mentally ill people in a general hospital, although a significant number have a negative perception of patients, the nursing environment and perceived feelings. Lack of knowledge, skill and experience affect the nursing care of mentally ill people in the general hospital. / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore the role of family members in support of their relatives who are mentally ill and to develop guidelines for the support of mentally ill relatives by their families in a rural community. The research design was qualitative, explorative, descriptive and contextual. The research population consisted of families of mentally ill relatives collecting their monthly medications at the Jane Furse Gateway Clinic. Purposive sampling was used to draw the sample. Data was collected by individual in-depth semi-structured interviews that were tape-recorded. The study revealed that families provide physical, psychosocial, financial and developmental support to their relatives. Furthermore, families are faced with frustrations when providing support to their mentally ill relatives / Health Studies / M.A. (Health Studies)