M.Cur. (Psychiatric Nursing) / The purpose of this study was to explore the experiential world of the chronic psychiatric patient In a rehabilitation centro and to sot guidelines for the psychiatric nurso to utilize the principles of restoration of merital health. Various stumbling blocks In the recovery process of chronic psychiatric patients were noticed in a rehabilitation centre. The centre Is highly structured and democratic decision making does not always transpire. The external environment Is In a residential area characterised by violence. The question arising, was to what degree the chronic psychiatric patient's experience of his/herworld In the rehabilitation centre, can contribute towards the mobilization of resources In order to facilitate the restoration of mental health of the chronic psychiatric patient and reintegration Into society. The approach followed, was that of the Nursing Whole Person Theory. With this theory as basis, the chronic psychiatric patient Is viewed as a whole In Interaction with his/her Internaland external environment In his/her questfor mental health as Integral part of wholeness. An exploratory and descriptive qualitative study, contextual of nature, was used as research design. The method for research was phenomenological, semi· structured interviews with chronic psychiatric patients In a rehabilitation centre. The participants In this study were selected In a purposive and non-selective manner. Botes' Model for Nursing Research was used to structure the research of this study. Measures used for reliability and validity, were that of Woods and Catanzaro. The central question "How do you experience living In this rehabilitation centre?" was asked. Similar studies were Investigated In order to ascertain similarities and unique aspects of this study. Categories of experience within the unit of assessment and diagnosis from the Nursing for the Whole Person Theory, Indicated both stumbling blocks and facilitating elements. Stumbling blocks In chronic psychiatric patients' (In a rehabilitation centre) quest for wholeness were experiences of avoidance, frustration, anxiety, lack of motivation, Inability to maintain longstanding relationships and dispute.

D.Litt. et Phil. / Please refer to full text to view abstract

The individualization and medicalization of the emotional distress of those given psychiatric diagnoses deny the social, political, and economic context in which the presenting behaviours arose and leads away from making changes to society. Some people who are psychiatrically labelled join in groups for solidarity in the face of being stigmatized. In these groups the members can resist the disempowerment and helplessness learned in the psychiatric system. With co-researchers from a self-help group this study gives expression to the usually silenced voices of psychiatrized people. Feminist and standpoint theories, co-cultural and living systems theories form a framework for this narrative study. A structural narrative method is used to analyze the stories, found in the transcripts of six individual interviews, told by the co-researchers about their experiences in psychiatric services and in the recovery process. The stories reveal how the ideology and practices of psychiatry use stigma, oppression and the creation of the identity of psychiatric patient for control and management. The stories also reveal the reality of hope for recovery through the support of peers and from the role models of those who have significantly recovered their mental health. Two focus group interviews were conducted with members of the self-help group where suggestions for programs were developed to address issues raised within the groups and in the individual interviews. The findings of the research will be reported to the self-help group who will use the study to back proposals for the funding of recovery-oriented programs. When social workers and other mental health professsionals recognize the importance of supporting the process of recovery, consumer/survivor-run programs will be acknowledged as effective and integral parts of any mental health system / Arts, Faculty of / Social Work, School of / Graduate

D.Litt. et Phil. / The mentally ill population is one of the most neglected subpopulations of the Western World and this is most certainly the case in Southern Africa. With the restructuring of the mental health system, the process of discharging properly rehabilitated individuals from long term hospital stays into a strong community mental health support structure has become a priority. In order to embark on a process driven by an ethos of primary health care, the present inpatients in custodial settings need to be discharged into the open community. This process is termed deinstitutionalisation, and involves the discharge of all able patients from chronic or long-term custodial care institutions, into the open community as functional members, with all of the rights and freedom which this may imply. Deinstitutionalisation as a concept embraces the essence of human rights, as the person takes control of his/ her life circumstances with all of the accompanying responsibilities. Present deinstitutionalisation practice in traditional South African long-term care facilities has no rehabilitation/ recovery focus with which to drive the discharge process of patients. Barriers to the success of the process are the lack of rehabilitation services, poor discharge planning and process, and lack of follow-up and integration of community services. These would seem to be the biggest stumbling blocks to the success of a deinstitutionalisation initiative. The initial process of design and implementation of a viable programme, and one that addresses uniquely South African issues was challenging. This was because of the lack of information, and reliable reporting systems with which to identify availability and need of service, client subpopulations, and service provision agencies. A preexisting NGO system was described and assessed for service provision and success rates, and the same system was used to measure the availability and applicability of psychosocial rehabilitation service in South Africa. The process comprised describing a the necessary components required by a recovery-driven, psychosocial rehabilitation system, using international literature as well as the early findings and results of the changed system. Suggestions have been made in terms of necessary facilities and services required, as well as staff competencies and methods of addressing historic issues of anti trust which have developed because of apartheid mental health practice.

Magister Curationis - MCur / Aggressive and violent behaviour in inpatient mental health facilities is found worldwide and is a frequent and serious clinical and nursing care problem. Despite the importance of international research findings and recommendations, it appears that patients perceptions of the possible contributing factors toward aggressive and violent behaviour in mental health facilities is an area of enquiry that has not been widely explored in South Africa in general, or in the Western Cape, in particular. It is against this background that this study endeavoured to investigate the external and situational contributing to patients aggressive and violent behaviour in mental health facilities in Cape Town, as seen from patients perspectives. / South Africa

Both popular clinical folklore and the findings of empirical research have suggested a relationship between cognitive rigidity and suicidal behavior. Specifically, it has been hypothesized that individuals deficient in the capacity for flexible thought become increasingly hopelessness and suicidal in the face of high levels of environmental stress. That is, these persons are thought to be cognitively unprepared to deal with negative life events. The present study sought to evaluate this model with hospitalized psychiatric patients placed on suicidal precautions status by hospital staff. Suicidal and non-suicidal control subjects completed measures of life stress, depression, cognitive rigidity, hopelessness, and suicidal intent. In addition, these subject also completed two measures of interpersonal problem-solving. Suicidal subjects were found to report higher levels of negative life stress in the previous year than members of the control group. Suicidal subjects were also significantly more cognitively rigid and the rigidity appears to have been reflected in their performance on the interpersonal problem-solving measures. Overall, suicidal subjects were observed to be poorer problem-solvers than the non-suicidal control group members on both measures of interpersonal problem-solving skills. More specific analyses showed that these subjects were not able to generate as many potential solutions to interpersonal problems from their own lives and when asked to evaluate these solutions, the suicidal subjects tended to rate them more negatively than did the control subjects. Suicidal subjects were also less likely than control subjects to employ these alternatives when subsequently attempting to solve the presented problem. Additionally, the suicidal subjects tended more often to implement irrelevant solutions. Although the suicidal subjects were significantly more hopeless than the non-suicidal subjects, it appears that this variable contributed independently to the level of suicide intent, rather than resulting from cognitive rigidity and interpersonal problem-solving deficits. Results are interpreted as supporting Beck's (1979) viewpoint that both deficits in problem-solving skills and hopelessness need to be addressed in the treatment of suicidal patients. / Ph. D.

Psychosocial differences between weight loss maintainers and weight loss non-maintainers were compared at least one year after reaching a medically approved weight goal through a medically supervised weight loss program. Research questions addressed differences between groups on the dimensions of somatization, obsessive/compulsive issues, interpersonal sensitivity, depression, anxiety, hostility, ability to resolve past emotional issues, social interpersonal relationships, and tolerance of ambiguity. The all-female sample consisted of maintainers of weight loss (N=30), non-maintainers (N=33), psychotherapy maintainers (N=14), and psychotherapy non-maintainers (N=ll). Research instruments administered were the Symptom Checklist-90-Revised, Fundamental Interpersonal Relations Orientation-Behavior, Personal Orientation Inventory, and Budner Scale for Tolerance/Intolerance of Ambiguity. To determine differences between groups, a t test was performed on data relating to the maintaining and non-maintaining groups. An analysis of variance was performed on data related to the maintaining, non-maintaining, psychotherapy maintaining, and psychotherapy non-maintaining groups. An intercorrelation matrix was completed for all variables. Non-maintainers of weight loss had significantly more difficulty with somatic problems as indicated in the results of both the t test and the analysis of variance (p < .009, p < .02, respectively). Non-maintainers expressed more complaints which focused on cardio-vascular, gastrointestinal, respiratory, and somatic equivalents of anxiety (headaches, pain, discomfort of the gross musculature). An analysis of variance showed non-maintainers (p < .05) to be significantly less effective in resolving past emotional issues than maintainers, psychotherapy maintainers, and psychotherapy non-maintainers. Non-maintainers were more burdened by guilt, regrets, and resentments from the past. Results of the analysis of variance indicated that psychotherapy maintainers (p < .03) were more socially adjusted than maintainers, non-maintainers, and psychotherapy non-maintainers. Inclusion and control subscales characterized psychotherapy maintainers to be more socially adaptable and flexible. They assumed responsibility without support of others and were less burdened with fears of helplessness and incompetence.

Thesis (doctoral)--Universität, Bonn, 2003. / Includes bibliographical references (p. 249-268).

published_or_final_version / Social Work / Master / Master of Social Sciences

Thesis (M.S.)--University of Michigan, 1985.