This research project began from an interest in 'what happened' at a residential psychiatric disability support service (therapeutic community) where I had previously worked as a social worker, or, as it was termed in the program, support worker. Residents used the program in various ways, to get back on track with their lives, and workers aimed to support them in that process. My approach to data collection was, as for many social work researchers, qualitative. As my work on the project developed over time, I was consistently informed and re-informed not only by ideas arising from my engagement with participants and relevant literature, but also by new concepts and areas of interest that opened up as a result of my teaching in a progressive Bachelor of Social Work course. Gradually, as my understanding of critical and reflective postmodern social work theory evolved, new interpretations crept into my writing. Some of the tensions that arose as a result of th is overlaying of new conceptual frameworks are evident in the thesis. While I have tried to create internal cohesion, the layers of different approaches that informed me are sometimes evident, like the sides of a canyon that display evidence of its historical and ongoing formation. This may not be dissimilar to social work itself in the new millennium, as new ideas variously challenge, consolidate, destabilise and/or reshape theory and practice. While this thesis began as an exploration of the experiences of individuals in a therapeutic community and the role of support workers in that process, it became, additionally, an exploration of ways in which the role and practice of social work is constructed. However, the stories of participants remain a central feature. Chapters include: the professional gaze and the construction of subjects; problematising worker power and professionalism; boundaries, vulnerability and authority; therapeutic community; sensemaking, meaning ascription and the creation of cul ture; change and turning points; and problematising and exploring outcomes in mental health.

No description available.

Thesis (DPhil (Psychology))—University of Stellenbosch, 2009. / ABSTRACT: This study, within the fields of occupational therapy and occupational science, describes the occupations of isiXhosa-speaking individuals with longstanding histories of mental illness living in chronic poverty. Occupation refers to the daily tasks and purposeful activities which, in occupying people’s time, establish the patterns of their lives and give expression to their roles, identity, interests and abilities. The aim of this study was to describe how poor households and persons with psychiatric disability living in those households coped with their circumstances and how they viewed, orchestrated, drew meaning from and attributed purpose to the everyday things they did, in particular the self-identified, primary income generating occupation of the disabled person. The research questions elicited information about the genesis, characteristics, meanings and functions of occupation, in particular those occupations performed by the disabled member that contributed to the survival of the household. Using case study methodology, the research involved prolonged engagement with five households living in a peri-urban, informal settlement on the outskirts of Cape Town, South Africa. Qualitative data about occupation was derived through demographic screening, multiple interviews with key informants in each household, participant observation and focus group discussion. In addition, discussions were held with mental health professionals familiar with the context and the Xhosa culture. Four forms of data analysis and interpretation (Kavale, 1996; Stake,1995) were applied to develop substantive case studies: condensation (identification of major organising ideas); categorisation (thematic categorical aggregation); patterning (narrative structuring) and generalisation (naturalistic interpretation). In addition, discussions were held with mental health professionals familiar with the context and the Xhosa culture. Four forms of data analysis and interpretation (Kavale, 1996; Stake, 1995) were applied were applied to develop substantive case studies: condensation (identification of major organising ideas); categorisation (thematic categorical aggregation); patterning (narrative structuring) and generalisation (naturalistic interpretation). Thematic descriptions of the basics of occupation are used to illustrate the various ways participants negotiated the challenges of life at the margins of society through the ordinary things they did everyday. Cross case analysis provided insights into the financial and social costs of mental illness as well as the strategies, embedded in occupation, adopted by participants in dealing with their circumstances. The central thesis of this dissertation is that psychiatrically disabled people, as economic actors functioning in complex structural, social and occupational matrices, contribute in paradoxical ways to the survival of their households. While their illness behaviour may increase the vulnerability of the household from time to time, they nevertheless facilitate its functioning either as providers of a disability grant; as contributors of additional labour or as productive income generating agents. The individual, the social and the structural are co-constituted in what poor and disabled people are able to do everyday. The less resources that are available in the occupational form, the more effort is needed to perform occupations and the more reliance is placed on the informal relational economy. Relative mastery of constrained circumstances occurred by optimising the goodness of fit between occupational form and occupational performance through adaptive capacity, an under-recognised form of agency in the context of chronic poverty. Looking beyond the obscuring façade of psychiatric disability at the ordinary things people did everyday revealed their capacity to strategise practically and attitudinally in support of the household’s survival. The study heightens awareness of human experiences that have been overlooked in the occupational science and occupational therapy literature, in particular how the basics of occupation operate in resource constrained environments. This contribution to knowledge about human occupation will inform mental health occupational therapy practice and community based psychiatric services concerned with the inclusion of disabled people in promoting social development. / OPSOMMING: Hierdie studie val binne die gebied van arbeidsterapie en ‘occupational science’. Dit beskryf die ‘occupations’ van Xhosa-sprekende individue met ‘n geskiedenis van geestesongesteldheid wat in kroniese armoede in informele nedersettings aan die buitewyke van Kaapstad, Suid-Afrika woon. ‘Occupation’ verwys na die daaglikse take en doelgerigte aktiwiteite wat mense se tyd in beslag neem; die patrone en ritmes van hul lewens bevestig en wat uitdrukking gee aan hul verskeie rolle, identiteit, belangstellings en vermoëns. Die doel van die studie was om inligting te verkry oor die oorsprong, eienskappe, betekenis en funksies van ’occupation’ in die konteks van armoede en veral met betrekking tot die psigiatries gestremde lid se belewenis en bydrae tot die huishouding se oorlewing deur sy of haar self-geidentifiseerde, primêre winsgewende ‘occupation’. Verlengde verbintenis met vyf huishoudings en sleutel informante as gevalstudies het die verkryging van kwalitatiewe data oor ‘occupation’ deur onderhoude, waarneming en fokusgroepe moontlik gemaak. Onderhoude met geestesgesondheidspesialiste vertroud met die konteks en die Xhosakultuur is ook gevoer. Vier tipes data-analise en interpretasie (Kavale, 1996; Stake, 1995) is toegepas om die ontwikkeling van substantiewe gevallestudies moontlik te maak: kondensasie (identifisering en organisasie van belangrike idees); kategorisering (tematiese sorteering van eenhede van betekenis); motief (narratiewe strukturering) en veralgemening (naturalistiese interpretasie). Kruisgevalanalise is toegepas om inligting oor die finansiële en sosiale kostes van ‘n psigiatriese stoornis in die konteks van armoede te bekom asook die ‘occupational’ strategieë waarvan informante in die hantering van hul omstandighede gebruik gemaak het. Die slotsom van hierdie verhandeling is dat psigiatries gestremde persone wat in die konteks van kroniese armoede ‘n bestaan probeer voer, op paradoksale maniere ‘n bydrae tot die voortbestaan van hul huishoudings lewer. Terwyl hulle siektegedrag die kwesbaarheid van die huishouding van tyd tot tyd laat toeneem, maak hulle nieteenstaande die oorlewing van die huishouding moontlik deur ‘n kombinasie van die volgende bydraes: die verskaffing van bykomende arbeid; die beskikbaarstelling van ‘n ongeskiktheidstoelaag en die produktiewe uitvoering van winsgewende ‘occupations’ in die sogenaamde ‘tweede’ of informele ekonomie. Die individuele, die sosiale en die strukturele is aan mekaar verbonde en beinvloed sodanig wat arm en gestremde mense daagliks in staat is om te doen. Hoe minder materiele komponente en hulpbronne in die ‘occupational form’ beskikbaar is, hoe groter is die inspanning wat benodig word om ‘occupation’ uit te voer en hoe meer afhanklik word die gestremde persoon op die informele sosiale ekonomie. Die teenoorgestelde is ook waar. Die kapasiteit vir aanpasbaarheid, ‘n miskende vorm van agentskap in die konteks van kroniese armoede, maak die bemeestering van beperkte omstandighede moontlik. Die kapasiteit vir aanpasbaarheid is geleë in die vermoë om strategies, prakties en sielkundig te funksioneer. Die studie vergroot die bewustheid van menslike ervarings wat oor die hoof gesien is in die arbeidsterapie en ‘occupational science’ literatuur, veral hoe die basiese beginsels van ‘occupation’ funksioneer in omgewings wat gekenmerk word deur deprivasie en beperkte materiële besittings. Hierdie bydrae tot kennis oor ‘occupation’ sal arbeidsterapiepraktyk en gemeenskaps-gebaseerde psigiatriese dienste toelig asook die insluiting van psigiatries gestremde persone in maatskaplike ontwikkeling bevorder.

Syftet med studien var att undersöka vilka faktorer i psykiatrisk rehabiliteringsteori som var de viktigaste stödjande och hindrande faktorerna för att deltagare i arbetslivsinriktad rehabilitering skulle kunna slutföra gymnasial/eftergymnasial utbildning och få ett arbete på dagens arbetsmarknad. Deltagarna i denna studie kom från fyra verksamheter inom Supported Education (SEd) i Sverige. Faktorerna för både stödjande och hindrande faktorer ville jag få fram i prioritetsordning, eftersom jag från tidigare forskning upplevde det svårt att veta vad som först ska prioriteras i arbetet med rehabilitering genom utbildning och arbete/anställning. Detta för att skapa en djupare förståelse för vad som är viktigt för personer med psykiska funktionshinder/ohälsa för att påbörja och slutföra utbildning, men också för att se om tjänsten SEd har potential att användas inom socialt arbete i form av arbetslivsinriktad rehabilitering och återhämtningsinriktat stöd för psykisk ohälsa och psykiska funktionshinder. För att besvara detta använde jag en enkät med tio kvantitativa slutna frågor och sju kvalitativa öppna frågor.      SEd är ett stödprogram inom arbetslivsinriktad rehabilitering för att välja, påbörja och slutföra utbildning på gymnasial och eftergymnasial nivå främst för personer med psykiska funktionshinder/psykisk ohälsa. Diskussioner pågår om att andra målgrupper utan psykiska funktionshinder/psykisk ohälsa ska kunna få detta stöd för att slutföra utbildningar.      Från resultatet av studien fick jag fram ett antal teman för vad som stödjer och hindrar slutförandet av utbildning. Resultatet visade att deltagarna generellt är nöjda med stödet de får från SEd. Mest framträdde personalens genuina engagemang, förmåga till empati och ett respektfullt bemötande som de avgörande faktorerna för att deltagarna skulle påbörja och slutföra utbildning. Andra faktorer som stödde deltagarna var att de fick stöd att slutföra studieuppgifter, att stödet inte var tidsbegränsat, att deltagarna hade regelbundna enskilda stödsamtal med personal, att de upplevde gemenskap och tillhörighet i SEd och att studie- och yrkesvägledning genomfördes som ledde till en individuell handlingsplan som följdes upp kontinuerligt.        Hindrande faktorer för deltagarna med SEd var att lokalerna var för små och studiecoacherna var för få. Generella hinder för deltagarna att slutföra utbildning var psykisk ohälsa (till exempel ångest, fobi, depression), svårigheter med studieekonomin, svårigheter med socialt samspel, svårigheter med koncentration, brist på studieteknik och svårigheter att slutföra uppgifter, ADHD, ADD, dyslexi, missbruk, svårigheter med att orka med ett högt studietempo och brist på stöd med att slutföra uppgifter. Detta resultat analyserade jag med hjälp av psykiatrisk rehabiliteringsteori. Jag förde sedan en diskussion där jag lyfte fram de utmaningar och möjligheter som vi kan se i framtiden för SEd. / The purpose of this study was to examine which factors in the psychiatric rehabilitation theory that were the most important supporting and hindering factors for getting participants in Vocational Rehabilitation to complete secondary/postsecondary education and get a job in todays labour market. The participants in this study came from four Supported Education (SEd-) projects in Sweden. I wanted to get forth the factors in order of priority since I found it difficult to find which factors to prioritize first in the work of rehabilitation through education and employment. I did this to get a deeper understanding of what is most important for persons with psychiatric disabilities/mental illness to be able to complete secondary/postsecondary education, but I also did it to investigate if the service of SEd has the potential of being used in social work in the shape of vocational rehabilitation and recoveryoriented support for mental illness and psychiatric disabilities. To be able to answer those questions I used a questionnaire with ten quantitative closed questions and seven qualitative open questions..      Supported Education (SEd) is a supportprogram aimed at supporting persons mainly with psychiatric disabilities/mental illness to choose, start and complete education on secondary and postsecondary level. There are ongoing discussions about whether other target groups without psychiatric disabilites/ mental illness could get this support to complete education.       From the results of the study I found a number of themes for what supported or hindered the participants in completing their education. The results showed that the participants generally were very satisfied with the support they got from the staff in SEd. Most of all it was the staffs genuine engagement, empathy and a respectful treatment that stood forth as the crucial factors that affected the participants to complete their education. Other factors that also supported the participants to complete their education is that they got support with completing their study tasks, there were no time limit for the support, the recurrent individual counseling sessions with staff, the experience of fellowship and belonging and educational and vocational guidance that supported the participants in forming an individual action plan which was followed up continuosly.       Hindering factors with SEd for the participants were that the localities were too small and that the study coaches were too few. Hindering factors in completing education in general was mental illness (e.g. anxiety, phobia and depression), difficulties with economy, difficulties in socialising with people, difficulties with concentration, lack of a technique for studying and difficulties with completing tasks, ADHD,ADD, dyslexia, addiction, problems to adjust to a high tempo in the education and lack of support with completing tasks. I analyzed these results by using the psychiatric rehabilitation theory. I then discussed the challenges and possibilities that we can see in the future with the SEd-method.

In recent years, a number of reforms have been made regarding the provision of care to people experiencing psychiatric disabilities. The aim of these reforms was to enable these people to participate in society and to ”live as others”. This political ambition, as well as research on recovery, stands to a certain extent in contrast to the message conveyed in the media, where the mentally ill/disabled to a great extent are represented as dangerous and incurable. The aim of the thesis is to analyse if, and how a group of people experiencing psychiatric disabilities create a sense of being like others, and to relate the analysis to the historical emergence of the contemporary conception of mental illness/psychiatric disability. This thesis employs the method of interviews. I highlight the informants encounter with the historically based stereotype that defines the persons as unreasonable, irrational and incapable of taking care of themselves. When the informants face the stereotype, they act to reduce the negative consequences. The informants’ actions can be interpreted in terms of approaches and in this perspective the informants appear as strong actors, who, contrary to the stereotype, are capable of take care of themselves. Three approaches are described: expertise, adaptation, and distancing. In situations where the stereotype is not present, the informants can create a feeling of being like anyone else. Their stories show that the feeling of being like others is individual. The development taking place in the field is “path-dependent”, meaning that the initial activity, the differentiation of persons with mental illness and the subsequent events is a development following a pattern which could explain the failure of the good political intentions. It has progressed from closed institutions to an institutionalized care service.

The MMPI-2 is the most commonly used self-report measure for the assessment of psychopathology in forensic and psychiatric disability assessments (Bacchiochi & Bagby, 2006; Bagby, Marshall, & Bacchiochi, 2005). The MMPI-2 includes a variety of validity scales designed to detect content responsive faking (e.g., faking good or faking bad) as well as content nonresponsivity (randomly responding). The present study was conducted to determine whether a combination of validity scales to detect malingering of a psychotic disorder in a non-compensatory model would be more or less effective than using only a select few of the validity scales in a compensatory model. The results supported the use of the specified validity scales (F, Fb, Fp, F – K, and FBS) in a non-compensatory model to identify correctly whether test takers faked their profiles. The results also supported the use of a smaller subset of the validity scales (Fp, F – K, and FBS) in a non-compensatory model to identify correctly whether test takers faked their profiles. The results, limitations of the current study, and future research considerations are then discussed.

Bakgrund: Många personer med psykisk funktionsnedsättning har en upplevelse av låg livskvalitet. De har också en sämre utgångspunkt materiellt, ekonomiskt, socialt och hälsomässigt. Att beviljas insatsen särskilt boende innebär att få stöd, service och omsorg i sin vardagstillvaro. Tidigare studier har visat att för att ett stöd ska upplevas stödjande behöver personalen ha både kunskap och vissa egenskaper, lyssnande, medkännande och lyhördhet. Syfte: Att beskriva vårdpersonals erfarenheter och tankar kring hur man utformar vardagligt stöd till livskvalitet för personer som bor i särskilt boende. Metod: Halvstrukturerade intervjuer gjordes där sammantaget tio personal deltog från fem särskilda boenden. Som analysmetod användes kvalitativ innehållsanalys med induktiv ansats. Resultat: Personalens erfarenheter av att ge stöd till livskvalitet rörde sig inom tre olika områden. Hur dessa områden, vårdrelation, organisation och miljö var beskaffade och upplevdes påverkade stödets insats och kvalitet. Det framkom att en viktig komponent i det vardagliga stödet utgjordes av ett omfattande motivationsarbete. Det fanns en bristande överensstämmelse mellan de boendes uppfattning om stöd behov och det som personalen ansåg att de behövde. Ett samband som visade sig var personalens uttryckta maktlöshet i vissa stödjande situationer och samtidig frånvaro eller bristande kontinuitet av handledning. Diskussion: Det särskilda boendet har som konstruktion stora utmaningar i att göra anspråk på att vara ett hem och inte en institution. Redan språkbruket etiketterar; man bor inte i en lägenhet utan på ett gruppboende och man är inte hyresgäst utan boende. De yttre strukturerna kan förstärka ett vi och dom tänkande där behov och svårigheter riskerar att bli beskrivna utifrån grupptillhörighet. / Background: Many people with psychiatric disabilities have a perception of low quality of life. They also have lower standard, materially, economically, socially and health-wise. To be granted supportive housing means getting daily support, service and care. Previous studies have shown that the supporting staff have to be knowledgeable and have special features, compassionate, responsive and attentive. Aim: To describe a health care professional experiences and thoughts on how to style casual support to the quality of life for people living in sheltered housing. Methods: Semi-structured interviews were conducted as with ten staff members from five supportive housing. The method of analysis was qualitative content analysis with an inductive approach. Results: The staffs’ experiences of providing support for quality of life was categorized into three different areas. How these areas, care relationship, organization and environment was constituted and perceived made impact on support effort and quality. It emerged that a key component of the everyday support consisted of a comprehensive motivational work. There was a mismatch between the residents' perception of support needs and what the staff felt that they needed. A relationship that turned out was the staff expressed powerlessness in some supportive situations and the absence or lack of continuity of supervision. Discussions: Supportive housing has as major challenges in claiming to be a home and not an institution. The language used; you do not live in your own apartment, but in a group home and you are not a tenant, but a person living there. The outer structures can reinforce an “us” and “them” thinking where the needs and difficulties might be described on the basis of group membership.

This dissertation presents a discussion of life in the community for people experiencing psychiatric disabilities in the post-deinstitutional era, with the goal of developing knowledge that can suggest a focus for planning more relevant services and supports. While evaluations of deinsitutionalization have focused on possibilities for providing community, rather than hospital-based services for these individuals, the intention was to support a participatory life in the community, a life defined by much more than just care and treatment. The Mental Health Care Reform of 1995 in Sweden paved the way for this more community-based view of needs related to psychiatric disabilities, as local social services became responsible for supports to a participatory life, “like all others”.  The general aim of this dissertation was to explore and analyze the results of a series of surveys of psychiatric disability, in order to develop knowledge of the social context of the lives which individuals experiencing these disabilities live in the community. More specifically, the aim was to; • describe contacts/interactions between these individuals and the societal organisations with which they seek services or support. • describe characteristics and needs of the individuals identified in these studies as expressed by representatives of the helping system and users who participated in the studies. • develop knowledge of the mechanisms involved in these patterns of seeking support by exploring and analyzing the empirical results within the context of theoretical (social) approaches to understanding psychiatric disability. The findings of this research are based on an analysis of the quantitative and qualitative results of three studies involving seven municipalities in northern Sweden. Of the 2385 individuals who personnel identified as meeting the criteria for a serious psychiatric disability, approximately half did not have active contact with the formal mental health system. They did however seek services, supports and opportunities that they saw as relevant to their lives and needs as community members. These included health, housing and financial assistance as well as opportunities for education and employment. Various mechanisms operating in the community, including stigmatizing attitudes, exclusionary practices and organizational systems and rules, were seen by respondents as obstacles to these individuals developing meaningful and participatory roles. Social approaches, when utilized to explore and understand issues regarding psychiatric disability in the community, support a focus on the social landscape in which ndividuals experience disability-related needs, as well as the dynamics of the disability experience. While in the deinstitutional era, needs were assessed relative to the individual’s relationship to the psychiatric care system, in the post-deinstitutional era, they should be assessed from a participation-relative perspective, where their position as community member, rather than as patient or client, describes the social location of need. Specialized support to general community resources and services in addition to psychiatrically defined supports, would likely reach many, especially younger individuals who might otherwise become seriously disabled.

No description available.

Le travail constitue un levier de rétablissement pour les personnes vivant avec des troubles psychiques ; de nombreux dispositifs existent pour favoriser leur insertion professionnelle. En France, l'accès à l'emploi pour ce public est encore faible et peu de recherches sont réalistes alors que des pratiques existantes sont intéressantes, notamment celle des ESAT de transition de l'association Messidor, qui visent une insertion en milieu ordinaire pour ces personnes. L'objectif de cette thèse était de décrire ce dispositif de transition "par et vers l'emploi" , en le comparant aux pratiques de référence au plan international, et de comprendre comment il peut contribuer à un processus de rétablissement pour les personnes accompagnées.Un volet Accompagnants (étude mixte qualitative puis quantitative) a été consacré à décrire et comparer le dispositif par rapport aux pratiques référencées, et à décrire les métiers des accompagnants, conseiller d'insertion et responsable d'unité de production, afin de voir comment ils contribuent au rétablissement des personnes accompagnées. Un volet Travailleurs (étude quantitative longitudinale, n=160) a été consacré à évaluer la perception des bénéficiaires en début de parcours et à documenter les facteurs prédictifs de leur maintien en emploi dans l'ESAT, d'une évolution positive vers l'insertion en milieu ordinaire et de leur rétablissement.Les ESAT de transition constituent un modèle hybride entre une structure protégée, une entreprise d' économie sociale et un programme d'emploi accompagné. Le binôme d'accompagnants complémentaires, grâce à une posture relationnelle subtile, favorise un changement de regard sur soi. La mise en situation de travail "réelle", avec ses difficultés productives, conjointement à l'étayage des accompagnants qui soutiennent sans assister, conduit la personne accompagnée à retrouver une estime de soi comme travailleur, un regard sur soi valorisé et un espoir en l'avenir, aspects-clés d'un processus de rétablissement. Les bénéficiaires ont une évaluation positive de leur situation en ESAT de transition et confirment le rôle-clé de leurs accompagnants et de l'estime de soi comme travailleur, pour favoriser aussi bien leur maintien en emploi dans l'ESAT, une évolution vers le milieu ordinaire que leur rétablissement. Les implications pratiques concernent le type d'accompagnement à mettre en oeuvre pour ce public ainsi que la formation et l'encadrement à développer pour les accompagnants, afin d'améliorer l'insertion professionnelle et le rétablissement des personnes vivant avec des troubles psychiques en France. / Work is a key-factor of recovery for people with severe mental illness. Various programs exist to support them to gain and maintain competitive employment. In France, the rate of employment remains low for this population and only scarce researches are developed in this field, although some French practices, such as the Ç ESAT de transition È (transitional workshops) of the MESSIDOR association, appear to be performing well. Theses transitional workshops support people with psychiatric disability to gain a competitive employment on the regular labor market while working in a sheltered activity. The goal of this research was to describe the Ç ESAT de transition È program, comparing it to international evidence-based practices, such as supported-employment programs, and to define how this program can facilitate a recovery process for people with a severe mental illness.The first part of this research is intended to describe the program with a mixed method (qualitative then quantitative) in order to compare it with international evidence-based practices and to describe the roles, tasks and competencies of the two professionals supervising people with a severe mental illness, counselors and supervisors, and to define how they contribute to a recovery process for them. A second part of the research is dedicated to clients of this program, with a longitudinal study (n=160) of clinical and psychosocial variables, at the beginning of the program, and in order to document predictive factors of their job tenure in the program, of their positive evolution to work integration on the regular labor market and of their recovery.These Ç ESAT de transition È are an hybrid form of a sheltered workshop, social enterprise and supported-employment program for people with a severe mental illness. In a workplace close to the context of regular labor market, thanks to a subtle relational posture, the two professionals supervising the workers help them to develop a new positive identity, self-esteem as a worker and hope in the future, which are key-factors of a recovery process. Clients have a positive perception of their situation in this program, on clinical and psychosocial variables, and this perception is stable on the 9 months follow-up of the study. They confirm that self-esteem as a worker, counselors and supervisors are key-factors to ensure their job tenure in the program, their positive evolution to work integration on the regular labor market and their recovery. Practical implications and recommendations from this research are the type of support that should be developed in France for people a with severe mental illness to help their work integration, as well as the type of training and supervision that should be offered to the professionals supporting them.