published_or_final_version / Social Work / Master / Master of Social Work

This project represents a descriptive study of 35 chronically mentally ill (CMI) adults enrolled in a community-based vocational rehabilitation program during the 1981 calendar year. As part of their first month in the program, subjects were administered a screening battery consisting of the Trail Making Test, Reitan-Indiana Aphasia Screening Test, Reitan-Klove Sensory Perceptual Examination, Valpar Independent Problem Solving Work Sample (IPSWS) and Wide Range Interest Opinion Test (WRIOT). Correlations were derived among these and with other variables, including the Work Adjustment Rating Form, schizophrenic versus nonschizophrenic psychiatric diagnosis, time in program and period of competitive employment resulting from program involvement. The issue of medication and its potential for impacting on subjects' performance in the program was also addressed. The neuropsychological measures in the battery were significantly correlated among themselves and discriminated between schizophrenic and nonschizophrenic CMI subjects in the sample with 100% accuracy. However, results on neuropsychological tests did not predict whether or not a subject would realize competitive employment during the year of the study. Both schizophrenic and nonschizophrenic subjects produced average performances in the impaired range of functioning according to published criteria for the neuropsychological instruments, although schizophrenic subjects consistently performed closer to the normal population. Vocational instruments included in the battery appeared to measure a more heterogeneous set of functions than the neuropsychological tests, and did not appear to represent a vocational factor. Two scores from these vocational instruments, Valpar IPSWS and WRIOT Negative Bias, were combined with Trail Making Test (Part A) scores in a discriminant function that classified subjects with 81% accuracy on attainment of competitive employment status. Over half (56%) of the people who participated for three months or more experienced some competitive employment, and 39% of those who completed three months or more were able to maintain full-time or part-time competitive employment for longer than 60 days. These results supported the effectiveness of Fountain House Model programs in achieving vocational rehabilitation goals with the difficult CMI population. Support was also provided for community-based research to study both social programs and their clientele.

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

Zion Lutheran Church in Portland has had contact with a number of neighborhood residents who have been released from mental institutions but who have had little community support. The Church has felt the need for some time to develop a residential program for former patients in the area they serve. The authors of this report agreed to conduct a needs assessment and to develop a program relative to the results of the assessment. A needs assessment identified the target population, attempted to determine what services they would use and how such services might best be delivered. The assessment was conducted in Northwest Portland because this is the general area which interests Zion Lutheran Church. It was designed to discern whether a residential program for released mental patients would be used in the area designated, and, if so, how such a program would best be formulated. However, it was also designed to allow respondents to express interest in other types of programs and services.

published_or_final_version / Gerontology / Master / Master of Social Sciences

published_or_final_version / Architecture / Master / Master of Architecture

Interest in the ability of people to recover from a severe mental illness has a long history. During the 1980s, however, there was a paradigm shift away research driven by clinicians immersed in the quantitative, objective microcosm of anatomy and physiology towards understanding recovery from a consumer perspective. Even so the experiences of consumers has remained relatively unexplored, with the lion's share of research emanating from the United States of America. At the time of writing the proposal for this study in 2000, there was not even one Australian study of a mental health consumer perspective of recovery from severe mental illness reported in the literature. The principal aim of conducting this research was to address this need. The author, therefore, undertook this grounded theory study to: (a) explore what recovery from the effects of a severe mental illness meant to the consumers in Western Australia; (b) identify what consumers of mental health services in Western Australia wanted in their lives; and thus (c) develop a substantive theory of recovery. Fifteen participants diagnosed with either an affective disorder or schizophrenia were each interviewed and the resultant data were analysed using the constant comparative method. Comparative analysis is a long-held method of analysing data in sociology. Analysis is achieved by asking questions such as what, when, where, how, of the data and comparing similarities and differences with the various concepts within and across sets of data. The findings revealed that the basic social psychological problem (BSPP) for participants was LOSS. In order to address this problem, participants engaged in the basic social process (BSP) of OVERCOMING LOSS. The BSP is a title given to the central theme that emerges from the data and illustrates that a social process occurs overtime. The BSP emerged as a process comprising three phases: First Recuperation, second Moving Forward and third Getting Back. The analysis further revealed that the participants viewed recovery as either

The goal of mental health delivery system is to allow the individual with severe and persistent mental illness to live and function effectively in the community and to ensure that the consumers and their families have access to accurate information that promotes learning, self-monitoring and accountability (Stuart & Laraia, 2005:710). In community-based health care, the persons living with severe and persistent mental illness (SPMI) are in their natural environment in the context of the family and the community. The goals of care are focused around maximizing the person living with SPMI’s quality of life (Hunt, 2001:15-16). In South Africa, an integrated package of essential Primary Health Care (PHC) services has been made available to the entire population in order to provide the solid foundation of a single unified health care service (Department of Health, 2000:4). The assessment of health care needs of persons living with SPMI is a dynamic on-going process that is used to collect information, recognise changes, analyse needs and plan health care to provide baseline information to help evaluate the physiological and psychological normality and functional capacity of persons with SPMI (Hunt, 2001:100). There is insufficient information from the Department of Health to either satisfy the enquiry of whether the health care needs of persons living with SPMI are being met comprehensively or whether the practitioners rendering community-based health care are knowledgeable and comply with PHC norms and standards developed by this Department. The researcher is interested in understanding how the persons living with SPMI and their families experience the community-based health care provided by PHC nurses. The purpose of this research study is to develop strategies that would assist the PHC nurses in the selected rural areas of the Eastern Cape to facilitate community-based health care and to render a health care service relevant to the health care needs of the persons living with SPMI and their families. To achieve the objective of the study, the research design was based on a qualitative, exploratory, descriptive, contextual research approach. Phase one includes describing and selecting the research population and the sampling process prior to conducting the field work which comprises individual interviews with persons living with SPMI and their families as well as PHC nurses. According to Dickoff, James and Weidenbach (1968:422) and Chinn and Kramer (1995:78), this strategy involves identifying concepts from fieldwork and creating conceptual meaning to provide a foundation for developing strategies to facilitate community-based care for persons living with mental illness. Phase two of the research design will focus on development of conceptual framework in order to allow better understanding of the phenomenon of interest, as the major concepts will be simplified by connecting all related concepts together by means of statements. This was done by making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008:237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, applicable and relevant to the nursing practice have been developed for use by Department of Health and Primary Health Care to facilitate the multifaceted role of the PHC nurses.

Since the deinstitutionalisation of chronic mentally ill patients, there has been an increase in the number of relapsed chronic mentally ill patients who become acutely mentally ill and need to be re-admitted for acute care in psychiatric institutions. Professional nurses working at rural primary healthcare clinics find it difficult to care for these individuals because they lack the necessary knowledge and skills. Chronic mentally ill patients who have been admitted to acute care facilities are stabilised by rendering care, treatment and rehabilitation and then released into the care of the professional nurses working at rural primary healthcare clinics. These patients live in the community and have to make use of the primary healthcare clinics nearest to their homes to provide them with their prescribed medication and care. Furthermore the patients’ mental conditions do not always remain stable, possibly because of a knowledge deficit, at times about their mental status. Patients may become non-compliant, resulting in the recurrence of symptoms, and thus need to be re-admitted to the acute care facility. However, the problem leading to re-admission is not clear for all admissions. It may be that patients do not make use of the primary healthcare clinics. It also seems that the professional nurses in the primary healthcare clinics are unfamiliar in dealing with chronic mentally ill patients living in rural communities. The aim of this study was therefore, to explore and describe the experiences of these professional nurses in caring for chronic mentally ill patients living in a rural community. The researcher used qualitative, explorative, descriptive, and contextual research design. The research population consisted of professional nurses working at primary healthcare clinics. Non-probability purposive sampling was used to identify participants for inclusion in the study. Data collection was conducted using one-on-one, semi structured interviews, observations and field notes and interviews were tape-recorded and transcribed. Data analysis was conducted using Tesh’s method of content analysis to identify themes and sub-themes. A literature control was done to compare the findings to the current published research. Trustworthiness was ensured by using Gubas’s model (1985) of trustworthiness. A pilot study, conducted by interviewing a small sample prior to the start of the main study, determined whether the sampling and interviewing techniques of the researcher as well as the research questions were adequate for data collection. The researcher ensured that the study was of a high ethical standard by taking into consideration values that guide the principles of autonomy, beneficence, non-maleficence and justice. The findings of the study was categorised into three main themes and 13 sub-themes. The main themes were as follow: Professional nurses experience problems when they have to take care of psychiatric patients attending rural primary healthcare clinics. This theme had six sub-themes which were discussed in details in chapter three. The second theme was that professional nurses experience that psychiatric patients in rural communities experience problems which affected their well-being. This second theme has got five sub-themes which were discussed further in chapter three. The last theme was that professional nurses have positive experiences when caring for psychiatric patients in rural communities. This theme has got two sub-themes as well discussed further in chapter three.

Indiana University-Purdue University Indianapolis (IUPUI) / The primary purpose of the current study was to determine the relationship between employment and the nonvocational functioning of people with severe mental illness in a prospective 24 month study, as a partial replication of another study. An employment typology was utilized that was comprised of participants at four employment levels: no work (those who did not work the entire study period), minimal work (those who worked 24 weeks or less in competitive and/or noncompetitive, paid employment), paid work (those who worked 24 or more weeks, the majority of which was spent in noncompetitive, paid employment), and competitive work (those who worked 24 or more weeks, the majority of which was spent in competitive employment). Both objective and subjective outcomes were addressed, including quality of life, symptoms, psychiatric hospitalizations, social networks, and residential status. Participants consisted of persons with severe mental illness (most with a schizophrenia-spectrum disorder) who were receiving employment services at a large, urban psychiatric rehabilitation center. Mixed effects regression modeling and logistic regression were used to analyze the date. Results indicate that the competitive work group experienced an accelerated improvement in negative symptoms across time and was less likely to have psychiatric hospitalization days as compared with the no work group. The paid work group showed an accelerated improvement in social network scores across time as compared with the no work, minimal work, and competitive work groups. The full sample demonstrated improvements across the study period regardless of employment typology status in the areas of overall quality of life, financial quality of life, cognitive symptoms, and social networks. In conclusion, this study adds to the growing body of evidence indicating that work, particularly periods of extended competitive work may lead to important benefits in clinical and social domains, although threats to internal validity that could not be ruled out preclude a causal link from being established. Future research is needed to further investigate this relationship, particularly in regards to those outcomes that are not well understood, such as residential status.