The thesis is focused on social work with people with mental illness with emphasis on the ethical component. The aim was to ascertain how the social workers work with the given target group and how they´re influenced by ethics at their work. With help of expert sources, the meritorious part is theoretically focused on issues of mental illness with respect to the psychiatric care system in the Czech Republic, submits principles of social work with the corresponding target group and presents the ethical point of view including the most influential ethical trends. It also pays attention to a significant change - reform of psychiatric care that has been currently taking place. Its task is to update the psychiatric care and enhance the quality of life of people with mental illness. The discussion part confronts the theory with practice based on conversation with social workers. The conclusion confirms the conformity resulting from the discussion. The statements of social workers correspond to problems that are described in professional publications. One can assume from the thesis, life with mental illness is not easy. However, people suffering from mental illness have their dignity and should be an integral part of society. They shouldn´t be discriminated nor perceived only as a diagnosis.

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Introdução: o estigma com relação aos transtornos mentais atinge pessoas de todas as idades, culturas e condições socioeconômicas, funciona como barreira de acesso aos serviços de saúde, pode afetar seriamente as chances de recuperação e reforçar atitudes e comportamentos negativos com relação às pessoas com transtorno mental. Os profissionais de saúde não são menos suscetíveis do que o público em geral quanto às crenças e comportamentos estigmatizantes com relação às pessoas com transtorno mental, pois são expostos a processos de socialização que podem levar à internalização de atitudes estigmatizantes e discriminatórias. A \"Opening Minds Scale for health care providers (OMS-HC)\" busca medir o estigma de profissionais de saúde com relação às pessoas com transtorno mental. Objetivo: adaptar culturalmente a OMS-HC para uso no Brasil em uma amostra de profissionais de saúde de Atenção Primária. Método: estudo metodológico aprovado pela Secretaria Municipal da Saúde de Ribeirão Preto e pelo Comitê de Ética da Escola de Enfermagem de Ribeirão Preto. O processo de adaptação cultural ocorreu por meio de tradução da escala original, avaliação e síntese da tradução pelo comitê de juízes, retrotradução e pré-teste. O pré-teste foi realizado no período de julho a agosto de 2018, em sete Unidades de Saúde de Ribeirão Preto. Participaram do estudo 40 profissionais de saúde (enfermeiros, auxiliares e técnicos de enfermagem, médicos, dentistas, auxiliares e técnicos bucal, farmacêuticos e auxiliares de farmácia). A OMS-HC é uma escala de auto-relato e consiste de uma série de itens, cada um com uma sequência equilibrada de resposta de valor: concordo totalmente, concordo, nem concordo nem discordo, discordo, discordo totalmente; sendo que para cada item é atribuída pontuação de 1 a 5. A OMS-HC mede cinco dimensões relacionadas ao estigma: Recuperação; Responsabilidade Social; Distância Social; Outros conceitos (periculosidade, obscurecimento de diagnóstico); e Divulgação. Resultados: o processo de adaptação cultural ocorreu sem intercorrências significativas, as alterações decorrentes das traduções e avaliações foram, de forma geral, pontuais e relacionaram-se à substituição de algumas palavras por outros sinônimos para melhor adaptação. Os participantes, no pré-teste, eram 80% do sexo feminino e 20% do sexo masculino, com média de idade de 43,6 anos. A média do tempo de formação foi de 16,5 anos e, em relação à especialidade, dos 40 profissionais de saúde, 52,5% tinham alguma especialidade e 47,5% não tinham. A média do tempo de atuação profissional foi de 18,2 anos. Houve prevalência (65%) de profissionais da Enfermagem (enfermeiros, auxiliares e técnicos em enfermagem). A prevalência da ocupação dos profissionais das Unidades foi de auxiliares e técnicos de enfermagem (37.5%), seguidos de enfermeiros (15%). A média do tempo de atuação na Unidade de Saúde foi de 5,2 anos. O tempo de aplicação da escala foi, para 82.5% dos profissionais de saúde, de 04 a 10 minutos. Com relação à aplicabilidade e compreensão dos itens, os profissionais relataram que a escala é muito \"generalizada\", pois o termo \"transtorno mental\", sem especificação, abrange experiências diversificadas na saúde mental. O alfa de Cronbach, no pré-teste, foi de 0,74 (consistência interna satisfatória). Considerações finais: a versão brasileira da OMS-HC apresentou linguagem adequada ao contexto brasileiro, de fácil aplicação, com formato adequado para uso, entendimento apropriado e consistência em relação à versão original. A versão brasileira da OMSHC encontra-se apropriada para o desenvolvimento de estudo para avaliação de suas propriedades psicométricas / Introduction: stigma towards mental illness reaches people of all ages, cultures and socioeconomic conditions, acts as a barrier of access to health services, can seriously affect the chances of recovery and reinforce attitudes and negative behaviors towards people with mental illness. Health professionals are no less susceptible than the general public to stigmatizing beliefs and behaviors toward people with mental illness, as they are exposed to socialization processes which may lead to the internalization of stigmatizing and discriminatory attitudes. The \"Opening Minds Scale for health care providers (OMS-HC)\" seeks to measure the stigma of health professionals towards people with mental illness. Objective: to culturally adapt the OMS-HC for use in Brazil in a sample of Primary health care professionals. Method: a methodological study approved by the Municipal Health Department of Ribeirão Preto and by the Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. The process of cultural adaptation occurred through translation of the original instrument, evaluation and synthesis of the translation by the Judges Committee, backtranslation and pre-test. The pre-test was performed in the period from July to August of 2018, in seven Health Centres of the city of Ribeirão Preto. 40 health professionals (nurses, nursing assistants and technicians, doctors, dentists, oral assistants and technicians, pharmacists and pharmacy assistants) participated in the study. The OMS-HC is a self-report scale and consists of a series of items, each with a balanced sequence of value responses: I totally agree, agree, neither agree nor disagree, disagree, totally disagree; and for each item scores vary from 1 to 5. OMS-HC measures five dimensions related to stigma: Recovery; Social responsability; Social Distance; Other concepts (dangerousness, diagnostic overshadowing); and Disclosure. Results: the cultural adaptation process occurred without significant intercurrences, the changes resulting from the translations and evaluations were, in general, specific and related to the changes of some words by other synonyms for better adaptation. The participants, in the pre-test, were 80% female and 20% male, with an average age of 43.6 years. The average training time was 16.5 years and, in relation to the specialty, of the 40 health professionals, 52.5% had some specialty and 47.5% did not. The average time of professional practice was 18.2 years. There was a prevalence (65%) of nursing professionals (nurses, nursing assistants and technicians). The prevalence of occupations within the Units was of nursing assistants and technicians (37.5%), followed by nurses (15%). The average practice time at the Health Unit was of 5.2 years. The time of application of the scale was, for 82.5% of health professionals, from 04 to 10 minutes. Regarding the applicability and understanding of the items, professionals reported that the instrument is very \"general\", as the term \"mental illness\", without specification, encompasses diverse experiences in mental health. Cronbach\'s alpha, in the pre-test, was 0.74 (satisfactory internal consistency). Final considerations: the Brazilian version of the OMS-HC presented adequate language to the Brazilian context, easy to apply, with adequate format for use, appropriate understanding and consistency in relation to the original version. The Brazilian version of OMS-HC is suitable for the development of a study to evaluate its psychometric properties

In my thesis I am going to focus on one of the areas of community care for people with mental illness and thus on the area of employment. The main focus of the thesis is on a description of current situation in the provision of the employment support for people with mental illness. The focus is also on the formulation of the specifics of the Employment Support Program for people with mental illness. Another part of my thesis contains empirical investigations focusing on the sustainability and the perspective of the Employment Support Program for people with mental illness. The goal of my thesis is to set up an updated oveview study on the issue of providing employment support for people with metal illness. Powered by TCPDF (www.tcpdf.org)

本研究探討心理衛生社會工作者與精神病患照顧者工作之中相互期待的角色內涵、影響角色期待之因素或歷程，以及相互期待之認知、行動如何修正與調整。本研究採質性研究深度訪談法，採立意抽樣選取研究對象，對三十九位受訪者（二十六位心理衛生社會工作者、十三位精神病患照顧者）進行半結構式訪談，主要研究發現如下： 1. 精神病患照顧者的照顧內容和與角色立場： （1）照顧內容：症狀因應、社區生活 （2）照顧態度：積極主動、合理期待、自我照顧 （3）與其他家屬互動：聚會交流、自助助人、權益倡導 2. 照顧者樣態與社會工作者對照顧者之角色期待： （1）所見樣態：積極參與、消極參與、不當期待、家庭動力不穩 （2）對照顧者之角色期待：配合服務、適度支持、個別化期待、如個案需要協助 （3）影響因素：社經認知條件、家庭文化因素、疾病照顧經驗、社區環境、社工接觸經驗 3. 社會工作者與照顧者之工作方法，與照顧者對社會工作者的角色期待： （1）工作方法：傾聽陪伴支持、協作釐清期待、衛教家屬團體、家庭動力工作、社區資源連結、權益倡導協調 （2）指導原則：聚焦正向改變、以個案為中心、重視家庭經驗、尊重照顧知識、抱持覺察開放的態度 （3）照顧者對社會工作者之角色期待：教育引導、家庭陪伴、權益倡導 （4）影響社會工作者角色因素：個人因素、專業教育、組織因素、結構因素 4. 照顧者與社會工作者關係：夥伴關係、工作關係、彈性關係 5. 照顧者與社會工作者相互角色期待調整方式： （1）照顧者對社會工作者期待調整：接受現況、調整期待、自立自強 （2）社會工作者對照顧者期待調整：接納現況、調整期待、擇善固執 （3）社會工作者挫折因應方法：經驗回饋、自我照顧、團隊支持 最後，研究者結合上述研究結果，嘗試繪製出心理衛生社會工作者與照顧者相互角色期待內涵與影響因素之概念架構圖，並提出本研究限制與建議，提供照顧者、心理衛生社會工作者和政策制定者、未來研究者參考，期冀本研究有助於減少照顧者可能產生的失望，甚至進而奠定一個基於夥伴關係的服務方式。 / The purpose of the study was to explore the content of mutual role expectation for mental health social workers and caregivers, the factors influencing role expectation, and the adjustment process of role expectation. This study used purposive sampling to select thirty-nine participants (twenty-six mental health social workers and thirteen caregivers), conducting in-depth interviews by using a semi-structured interview outline. The major results of the study include: 1. Care content and role of caregivers: (1) Care content: symptom management, community life promotion. (2) Care attitude: proactive, reasonably expected, self-care. (3) Interaction with other caregivers: family support group and gathering, help others and self-help, advocacy. 2. Caregiver pattern and role expectation of caregivers: (1) Caregiver pattern: actively participated, passively participated, improperly expected, unstable family dynamics. (2) Role expectation of caregivers： service adherence, moderate support, individual expectation, potential client. (3) Factors influencing role expectation: socioeconomic and cognitive conditions, family and cultural factors, caring experience, community environment, the experience of contacting social worker. 3. Working methods and role expectation of social workers: (1) Working methods: listening and accompanying, cooperating to clarify expectation, group psychoeducation, family systems therapy, mobilizing community resources, advocacy and negotiation. (2) Guiding principles: focus on positive changes, case-centered, attention to family experience, respect for caring knowledge, open-mindedness and self-awareness. (3) Role expectation of social workers: educator and guide, family supporter, advocate. (4) Factors influencing role expectation: personal factors, professional education, organizational factors, structural factors. 4. Professional relationship: partnership, working relationship, elastic relationship. 5. Adjustment process of role expectation for caregivers and social workers： (1) Role expectation of caregivers adjusted by social workers: accepting the status quo, adjusting expectation, self-reliance. (2) Role expectation of social workers adjusted by caregivers: accepting the status quo, adjusting expectation, persisting. (3) Frustration coping methods: experience feedback, self-care, team support. Based on above findings, researcher drew out the depiction of mutual role expectation for mental health social workers and caregivers, as well as the factors influencing role expectation, proposing the study restrictions and suggestions on policy making, partnership-based approach for mental health social workers and caregivers, and further research.

Cette recherche porte sur les pratiques d’intervention des agents de réponse en intervention de crise (RIC), de leur partenaire fixe et des agents en attente de la formation du Service de police de la Ville de Montréal (SPVM) auprès des personnes en crise ou atteintes de troubles mentaux. Les agents RIC sont des patrouilleurs de première ligne qui ont reçu une formation complète sur les principes d’intervention en contexte de crise ou de santé mentale. Ce modèle de réponse spécialisée est une solution proactive qui a pour but d’améliorer l’action policière en situation de crise et de veiller à une meilleure prise en charge de ces personnes par les ressources institutionnelles. La désinstitutionnalisation des soins et des services psychiatriques a eu pour effet une augmentation du nombre de personnes atteintes de troubles mentaux dans la communauté. Par conséquent, cet accroissement a engendré des rapports plus fréquents entre les services policiers et cette clientèle. Les interventions en contexte de crise ou de santé mentale sont particulières et complexes, de même qu’elles requièrent un niveau supérieur de compréhension des crises humaines. Les autorités policières ont admis que ces interventions représentent une part significative de leur travail et que la formation policière traditionnelle ne les prépare pas suffisamment pour intervenir adéquatement auprès de cette population. En réponse à ces considérations et dans l’objectif d’améliorer leur capacité d’agir, les forces policières se sont dotées de modèles de réponse policière spécialisée en intervention de crise. L’approche la plus répandue est l’équipe d’intervention de crise (« crisis intervention team » ou « CIT »), aussi appelée le modèle de Memphis. Il existe plusieurs variantes de ce modèle, mais les composantes principales, c’est-à-dire la formation avancée et la consolidation d’un partenariat avec le système de santé demeurent dans l’ensemble de ces structures. L’objectif de cette recherche consiste à sonder les perceptions des agents RIC, de leur partenaire fixe et des agents en attente de la formation afin de comprendre et de contraster leurs visions et leurs pratiques d’intervention en contexte de crise ou de santé mentale. Chaque groupe a apporté des précisions intéressantes. Nous avons conduit 12 entrevues qualitatives avec des policiers du SPVM. De façon générale, les participants rapportent que leurs pratiques d’intervention auprès des personnes en crise ou atteintes de troubles mentaux sont davantage ancrées dans une perspective de relation d’aide. Ils mentionnent également que la communication, l’écoute et la confiance doivent être privilégiées avant tout autre stratégie dans les situations qui les permettent et que la force doit être employée seulement lorsqu’elle est nécessaire, c’est-à-dire lorsque leur sécurité ou celle d’autrui est en péril ou lorsque la communication n’est pas possible. Puis, ils admettent que le recours à l’expertise des intervenants en santé mentale permet une analyse plus approfondie de la situation et de l’état mental de la personne visée par l’intervention. D’autre part, en ce qui concerne les limites de la formation policière traditionnelle, les candidats ont soulevé qu’il y a un manque de connaissances en matière de santé mentale ainsi qu’une difficulté associée à l’évaluation de l’état de la personne et du besoin de transport ont été soulevés. Sur le plan des apprentissages, les agents RIC disent avoir une compréhension plus globale de la problématique de santé mentale, de meilleures habiletés communicationnelles, une analyse plus approfondie de la situation, de plus grandes connaissances juridiques, une compréhension du fonctionnement des services hospitaliers ainsi qu’une appréciation particulière pour le partage de savoirs et les principes d’endiguement. Ils font part également de l’importance des rapports pour documenter l’évolution de l’état mental d’une personne et ils ajoutent que la dimension temporelle joue un rôle clé dans la résolution définitive de la problématique. Au sujet des partenaires, ils évoquent des retombées similaires. Toutefois, à la suite de la formation, ils reconnaissent davantage l’importance de leur rôle dans la sécurité de leur partenaire et ils y accordent dorénavant une attention marquée lors de ces interventions. Enfin, les agents non formés formulent des attentes relatives au développement d’outils et de compétences, ce qui leur sera rendu dans la formation RIC. Globalement, les agents RIC et les partenaires interviewés ont modifié leurs pratiques pour les arrimer avec la philosophie des interventions en contexte de crise ou de santé mentale. Ils ont également davantage confiance en leurs capacités et habiletés d’intervention auprès des personnes en crise ou atteintes de troubles mentaux grâce aux connaissances acquises dans la formation. / This research focuses on police responses provided by the RIC officers of the Service de police de la Ville de Montréal (SPVM) with people in crisis or suffering from a mental disorder. The RIC agents are frontline patrol officers who have received complete training on the principles of intervention in times of crisis. This specialized response model is a proactive alternative that aims to improve police action in crisis situations and to ensure a better management of this population by the institutional resources. Deinstitutionalization of care and psychiatric services has led to an increased number of people with mental disorders in the community. Therefore, this increase has resulted in more frequent interactions between the police and this type of clientele. Interventions in times of crisis are unique and complex and require a higher level of understanding of human crises. The police have admitted that these interventions represent a significant part of their work and that traditional police training did not prepare them sufficiently to respond appropriately. In response to these considerations and in order to improve their abilities, the police forces equipped themselves with police response models specialized in crisis intervention. The most common approach is the crisis intervention team (CIT), also called the Memphis model. There are several variations of this model, but the main components are advanced training and consolidation of a partnership with the health system which both remain in all of these structures. The objective of this research is to explore the perceptions of the RIC officers, their partner and the officers waiting for training in order to better understand and contrast their visions and practices in a crisis or mental health context. We conducted 12 qualitative interviews with officers from SPVM. Overall, participants report that their interventions with people in crisis or with mental disorders are more rooted in a perspective of counselling. They also mention that communication, listening and trust must be privileged above all other techniques in situations that allow them. Furthermore, force should be used only when needed, that is, when their safety or the safety of others is at risk. They also admit that the participation of mental health workers enables a deeper analysis of the situation or the mental state of the person targeted by the intervention. Secondly, in regards to the limits of traditional police training, the candidates have raised that there is a lack of knowledge in the field of mental health and a difficulty in assessing the mental state of the person as well as the needs for transportation. Thirdly, the RIC officers say that they have a better understanding of mental health issues, enhanced communication skills, a deeper analysis of the situation, a greater legal knowledge, an understanding of the operation of hospital services and a particular appreciation for the sharing of knowledge and the principle of containment. They also expressed the importance of the reports to document the evolution of the mental state of a person and they add that the time dimension plays a key role in the final resolution of the issue. As for the partners, they discuss similar benefits. However, after training, they recognize even more the importance of their role in the security of their partner and therefore, they pay more attention during these interventions. Finally, non-trained agents formulate expectations concerning the development of tools and skills, which will be addressed in their training. Overall, the RIC agents and their partners changed their practices to align them with the philosophy of crisis intervention. They also have more confidence in their abilities and skills to intervene with people in crisis or suffering from mental disorders from the knowledge acquired in training.

This diploma thesis describes the current state of social field work in the Fokus organization and their experience with the involvement of a peer worker. Another aim was to define key concepts, to formulate possible recommendations. The empirical part of this work focuses on the specific experience of Fokus with the involvement of the peer worker through structured interviews, case studies, proceedings and practical experience gained through work at Fokus.

Community mental health teams common in many countries with developed community mental health care have been slowly advancing in recent years. It is expected that this trend will continue to grow with the reform of psychiatric care. The diploma thesis focuses on community mental health teams for the target group of people with severe mental illness, which are one of the basic pillars of mental health care abroad. The theoretical part describes the activities of these teams in the context of community mental health care and also presents these teams mainly in terms of their composition and way of work. The research part analyzes the current situation of four specific teams in terms of multidisciplinary composition and team cooperation, describes and interprets some of the specific difficulties that these services face in the beginning of multidisciplinary teamwork and captures some specific moments of their functioning. Utilizing a qualitative approach through in-depth interviews with team leaders and their founding organizations has enabled them to convey the specific context of these teams and at least partially capture the dynamics of their current state and development. The practical part points to some factors that may complicate the teamwork, such as insufficient involvement of medical staff...

The ongoing process of mental health reform in the Czech Republic brings transformation of services provided for people with mental illness. Considering the Convention on the Rights of Persons with Disabilities, the involvement of care users in decision-making in both policy and service delivery is also becoming the point of interest. One form of participation of users with their own experience of mental illness in ongoing changes is to employ them as peer workers. The thesis deals with the view of peer workers employed in mental health field on the profits and difficulties associated with their profession and how peers perceive the impact of their employment on their path of recovery. The theoretical part describes the concept of recovery, explains the development and basic principles of peer support and peer jobs in the Czech Republic. Subsequently, the development of services for people with mental illness is described from institutional care to community services. Then the development of psychiatric services in the Czech Republic is explained. In the practical part, the opinion of peer workers on the advantages and disadvantages associated with their profession is examined using the qualitative research. A qualitative analysis of data obtained from semi-structured interviews with ten peer...

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