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This study was designed to assess the community identification of discharged mental patients in community boarding homes-specifically, those patients discharged from the Riverview Mental Hospital and placed directly into Vancouver City boarding homes as part of a cooperative programme between the Social Service Department of the Riverview Hospital and the Medical Section of the City Social Service Department. Community identification was defined in terms of three factors: physical presence in a geographic area; quality and quantity of social participation; and, relative opportunity for decision-making and independent functioning. Quantitative measurement of the latter two factors was attained through administering the Chapin Leisure Participation and Enjoyment Scale and the Vine-land Social Maturity Scale respectively. A qualitative measurement was attained by administering two questionnaires designed by the researchers--one to the boarding home operators, the other to the patients in the boarding homes The design of the study was initially that of a retrospective nature, comparing current data to data of previous performance obtained from hospital files. As this latter source proved inadequate, a longitudinal design was proposed, and a pretest of the research instruments was implemented with a boarding home sample and a comparative hospital sample. The findings of the study thus pertain to the qualitative responses of the former patients in community boarding homes, and to qualitative comparisons of the responses of the community and hospital samples. The qualitative responses were generally of a positive nature indicating a satisfaction with community placement and an enjoyment of community life. The quantitative responses indicated a decrease of social participation, occupational activity and socialization skills following placement into the community boarding homes, but an increase in the skill of self-direction and competency of locomotion. A comparison of the interviewers' ratings and the patients' ratings of significant impediments to social functioning indicated that the latter perceived this in financial terms while the former perceived it in psychological terms. Conclusions of this study, necessarily limited because of its preliminary nature, relate primarily to the concept of community identification and to the difficulty of defining this concept in concrete terms. As the findings indicated that autonomy and independent decision-making were most closely related to subjective feelings of community identity, and that this increase in autonomy was related to increased feelings of dignity and self-worth, it was suggested that greater autonomy was the principal factor in the community identification of this population, and that this indicated a positive evaluation of the boarding home placement programme in that it led to the enhancement of the patients' feelings of dignity and self-worth. Recommendations for improvement of the programme include psychiatrically trained staff to supervise the patients, new regulations concerning finances, and provision of more activities and facilities designed to enhance the patients' feelings of self-worth. / Arts, Faculty of / Social Work, School of / Graduate

Home care has been the fastest growing sector in the U.S. healthcare system for over three decades. In 2012, there were over 4.7 million home care patients in the United States. Most of these patients were elders (4 million); and this number is expected to increase as the U.S. population continues to age. One major health concern in this elderly home care population is mental health disorders (MHDs), which have been noted with increasing rates and substantial consequences in local data. However, much of our knowledge on this topic was generated from local studies that had a number of methodological limitations. These include over reliance on local and outdated data, a lack of theoretical foundation, and a lack of statistical justification, which may well account for the high variability across findings. To date, no national investigation has been conducted on this topic, supporting the need for a large-scale study which employs recent data to better understand the prevalence, risk factors and impact of MHDs among home care elders in the U.S. This dissertation study addressed these gaps by using the de-identified national home care dataset, Outcome and Assessment Information Set (OASIS), to: 1) examine the national prevalence of MHDs and MHD-caused medical events in the U.S. elderly home care population, and 2) identify factors associated with MHDs and MHD-caused medical events in this population. The 5% random sample used in this study was consisted of 28,475 elderly home care patients: their average age was 79.41; patients were mostly female, white, Medicare beneficiaries, referred from short-stay acute hospitals, and living with others at home. Approximately 38% of this sample had MHDs, mostly depression (28.0%) and anxiety (18.9%). Compared with other patients, those with MHDs were younger, more likely to be female, smokers, frail, living alone, referred from psychiatric hospitals, cognitively or sensually impaired, in poorer general health, had a recent history of falls or multiple hospitalizations, and evidenced insufficient social support. Among patients identified with MHDs, less than one third (31.8%) received mental health services, including psychiatric nursing services (n=317) and depression interventions (n=4,459). During the 60-day home care episode, 16.95% of the sample had subsequent hospitalizations and 12.72% had subsequent emergent care events; 0.45% of these medical events were directly caused by MHDs. In addition, depression intervention was the strongest risk factor for these subsequent medical events, associated with an approximate two-fold risk for all-cause hospitalizations (HR: 1.943) and emergent care events (HR: 1.974). However, 61.61% (n=2,747) of these high-risk depression intervention recipients did not screen positive for depression at admission. Findings in this dissertation study revealed the high national prevalence of MHDs in the elderly U.S. home care population, and the strong association between these disorders and subsequent all-cause medical events. However, these MHDs were largely under-detected and under-managed in this population, highlighting the need for closer monitoring and targeted intervention through enhanced psychiatric training among front-line home care nurses. Recommendations for further work are made, including the development of an electronic algorithm of identified MHD correlates and risk factors as useful in the development of a nationwide monitoring system for geriatric MHDs in the home care setting.

published_or_final_version / Social Work / Master / Master of Social Sciences

This qualitative study explores the experiences of adult mental health service users as well as their families upon discharge of service users, to their families in the Durban area, from Ekuhlengeni Care Centre (ECC) during May 1999 to December 2001. In so doing, the aim was to ascertain the nature of mental health service users' adjustment to living in the community, their impact on the home environment, to identify gaps in community care and to provide suggestions on resolving these gaps. The study was guided by a qualitative research paradigm and utilized an exploratory descriptive research design. Availability sampling was used. Unstructured face-to-face, in-depth interviews were conducted with four mental health service users (MHSUs) and six family members. The results of the study reveal the many dilemmas that both MHSUs and their relatives experience because of the lack of support and services available in the community. There is overwhelming evidence to suggest that the environment is ill suited at all levels to meeting the needs of MHSUs and their relatives. This study examines the challenges experienced by MHSUs and their relatives and makes recommendations for practice and policy that can contribute to improved service delivery. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

In the context of recent shifts in South African national health policies that integrate mental health care into primary health care, the family rather than the institution has become the primary site of ongoing care for psychiatric clients. The purpose of this qualitative phenomenological study was to describe how caring is rendered at home for the mentally ill person by family caregivers, living in Northdale, Pietermaritzburg. Purposeful sampling was used to recruit six family caregiver participants from the psychiatric clinic waiting room. These were caregivers who had accompanied their family member with mental illness for treatment on that particular day. Data generated from in-depth interviews with these participants provided personal experiences of their caregiving practices, behaviours, and problems. Data analysis was based on descriptive phenomenology and Colaizzi’s method of data analysis and data representation. Significant statements were extracted and grouped to form larger units or clusters. The clusters were then organised into nine themes, with associated significant statements made by the caregivers: Theme 1: Family as support system. These aspects related to daily maintenance of nutrition, hygiene and grooming for the family member with mental illness. The participants indicated that the maintenance of these activities f daily living were very important in the care of the SMI individual at home. Theme 2: Commitment to care. Evident throughout the interviews were issues of how caregivers perceived and sustained the ongoing responsibilities of home care for the mentally ill. There was a willingness and complete commitment to caring for the SMI family member with all its responsibilities. Theme 3: Disruption to family life. Details emerged from the interviews about how families adjusted to the constant needs of care provision, supervision, and vigilance demanded by home care giving. The participants accepted that problem behaviours were part of caring. Theme 4: Value in contributing to care. The interviews revealed various aspects of how caregivers drew reassurance and a sense of positive accomplishment from successes in teaching, supervising and managing a mentally ill relative at home. There were positive aspects to caring in that the SMI individuals could be of help to the caregivers. Simple tasks such as empting of bins, shopping and dish washing were part of the daily routine which proved beneficial to the caregiver and the family member with mental illness. Theme 5: Maintaining hope. Various implications emerged in the study such as being hopeful, and having a positive outlook as caregiver, despite the behaviour problems and chronic nature of the client’s mental illness. Participants indicated that despite the fact that they have a responsibility to care they are hopeful that one day the family member would be as normal as any other person. Theme 6: Support and Guidance: Ongoing assistance. Several issues emerged in relation to the involvement of the community psychiatric clinic professional staff in giving support and guidance to the individual caregivers, such as provision of information about side effects of medication, especially drowsiness, impaired communication and inactivity, guidance on how to cope with taking of substances by the client, and assistance with preparing for lifelong care of the family member with mental illness. Theme 7: Concern for Continuity of care. There was the need to look at what would be the outcome if the parents were not there to care for the SMI individual. Even though this is something to think about and had been broached at one time with the psychiatrist the family and care giver are hopeful that another family member will step into the caring role should they not be there. Theme 8: Fears and difficulties experienced in caring. Problem behaviours and danger to self and others is always upper most in the minds of the care givers, this resulted in even limiting friends because the SMI individual could be influenced into taking drugs. Care giving involved taking steps to ensure the family member does not hurt himself or herself. Theme 9: Misuse of Social Grant. Financial burdens were experienced by the family of the mentally ill individual. Social grants were being used to maintain the whole family for food, lights and rent. Sometimes the caregivers are forced to hand over the social grant to the MHCU just to ensure that there will be no problems at home if they were refused. Money is used to purchase cigarettes and drugs. Fear that the grant would be stopped results in the family not willing to report the abuse to the clinic staff. Implications for psychiatric nursing practice that the study highlighted included need for intervention by the community psychiatric nurses in regard to side-effects of medication, management of problem behaviours, and education for caregivers concerning the illness and especially its progressive signs and symptoms. Further research might explore current supportive programmes available in the community to keep pace with societal changes, with particular focus on whether. caregivers are included in the visits to the clinic with the mentally ill family member and what attention is given to their needs and problems so that they feel appreciated and valued. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

The increased abscondment of Mental Health Care Users from institutions of care, treatment and rehabilitation has prompted the researcher to conduct the study because patients who are not visited do not stand a chance of getting a Leave Of Absence (LOA). Problem: The concern is the danger of assault, murder, rape and other high risk situations the mentally ill individuals and the community are exposed to, which is caused by frequent abscondment of mentally unstable individuals who roam around the community without proper treatment and care. This is caused by failure of the relatives in coming to request patients for leave of absence (LOA). Purpose: The study investigated the effects of mental illness on relationships amongst families with the mentally ill members. The number or frequency of visitations by relatives to the mental health institutions is used by the researcher, to measure the nature of relationships between families and the psychiatric patients related to them. Method: The population comprised families of the mentally ill persons admitted at Cecilia Makiwane mental health units. The sample was collected conveniently as relatives came to visit the mentally ill until the desired number was reached. The designed tool was a questionnaire which was self administered. Data were analysed manually. Tables and graphs are shown in the results. Conclusion and Recommendations: The study revealed that approximately 100% of respondents had a lack of knowledge about mental illness and the mentally ill, in terms of care, treatment and rehabilitation hence they all need assistance in dealing with the mentally ill in the community. Findings also revealed that mental illness causes breakdown in family relationships. Recommendations regarding the enhancement of relationships between families and their mentally ill members are formulated as coping skills in the dissertation. The burden of having to deal with mentally ill person whose illness is not understood can lead the family to a state of confusion and iv not knowing what to anticipate. Lack of resources compounds the problem as the family members are not able to visit the ill member due to lack of funds (Baumann, 2007:637). The families with a mentally ill member usually shoulder the greatest part of the burden of mental illness (Uys and Middleton, 2004:77); unfortunately, lack of resources pose a problem.

Qualitative, exploratory and descriptive research study was conducted using the case study approach. The purpose of this study was to explore and describe the experiences of family members caring for a long term mentally ill patient suffering from schizophrenia. Purposive sampling was used to select one family who cared for the patient for more than two years. Data was collected through the process of in-depth, unstructured individual interviews. Interviews were tape recorded and transcribed verbatim. Themes, categories and sub-categories were finally identified. The findings revealed that although the family was willing to care for the patient at home, they experienced challenges to provide basic care. Other challenges included were lack of adherence to treatment, financial constraints, substance abuse, social stigma, fear and concerns about the patient’s future. A conceptual map was designed to reflect the major concepts of the findings / Health Studies / M.A. (Health Studies)

Qualitative, exploratory and descriptive research study was conducted using the case study approach. The purpose of this study was to explore and describe the experiences of family members caring for a long term mentally ill patient suffering from schizophrenia. Purposive sampling was used to select one family who cared for the patient for more than two years. Data was collected through the process of in-depth, unstructured individual interviews. Interviews were tape recorded and transcribed verbatim. Themes, categories and sub-categories were finally identified. The findings revealed that although the family was willing to care for the patient at home, they experienced challenges to provide basic care. Other challenges included were lack of adherence to treatment, financial constraints, substance abuse, social stigma, fear and concerns about the patient’s future. A conceptual map was designed to reflect the major concepts of the findings / Health Studies / M.A. (Health Studies)