The history of the care of the mentally ill in Britain, which has been broadly reflected in Western Australia since 1826, can be conveniently, if simplistically divided into a number of epochs. Each epoch is characterised by a particular focus or paradigm of clinical management, which prevails over a period of time but is then followed by a comparatively short period of rapid change to a new paradigm. Such changes are shaped by a number of forces, but three categories can be readily identified. These are: concepts of mental illness; reactions of administrative systems and the attitudes of medical practitioners. As the concept of the nature of mental illness has changed, succeeding epochs have evolved to a more humane and enlightened approach to the mentally ill. Nevertheless, each management paradigm has failed to deliver the expected 'cures' and the consequent reduction in the burden of illness. Each has been replaced by a new and radically different paradigm, often at enormous cost, but there has been no progressive evolution towards a system that incorporates measures that have proven value. In recent years 'Community Care', has failed in such a manner that there have been strong arguments that it should be abandoned. At the same time there is evidence that a new paradigm 'Primary Care Psychiatry' is emerging as government policy. The challenge is to preserve the best elements of community care and integrate Primary Care Psychiatry into the broader framework. The best chance of achieving this is to develop a gradual, evolutionary process, built on consensus between psychiatrists, general practitioners and administrators. / The purposes of the present research are threefold: to develop a conceptual model for an optimal community based mental health service. Then by examining the views of general practitioners, psychiatrists and administrators, determine the degree of congruence of these views. This is achieved by a qualitative study comprising extended interviews with 24 GPs, 15 psychiatrists and 11 administrators. This approach is chosen over a more broadly based, structured questionnaire approach for two reasons. Firstly, the views expressed in informal face to face interviews are more likely to be true expressions of opinion, especially when these are critical. Secondly, by using a comparatively unstructured approach, the stakeholders are able to express views on issues that they consider important. Finally, the areas of consensus and disagreement are analysed and recommendations made on strategies to develop a plan for a practical, viable service in a local area.

Private community-based mental health agencies fill a vital role in Virginia's health system in that they increase access to care and provide a wide range of services. In order to operate and receive state funding, these private agencies are responsible for abiding by regulations set forth by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS). Supervision, as defined by DBHDS and DMAS, features a more administrative approach, requiring supervisors to review policies and ensure procedural compliance. In contrast, supervision as defined by counselor educators leans more towards a clinical approach whereby a more experienced member of the profession will guide the supervisee in professional development through the enhancement of skills and techniques. The issue of interest herein is that little is known about how supervisors in private community-based mental health agencies are navigating these multiple areas of supervisory emphasis. This quantitative inquiry focused on understanding clinicians' perceptions of supervision emphasis and its influence on the supervisory relationship in private mental health agencies in Virginia. Three research questions were developed to determine (a) the influence of clinicians' perceptions of supervision emphasis on the supervision working alliance, (b) the relationship between a supervisor's licensure status (Licensed Professional Counselor versus other designations) and the influence on the supervisory working alliance, and (c) the influence of supervisor responsibilities of hiring/terminating staff and/or conducting performance evaluations on the working alliance. Instruments used in this study included a demographic questionnaire, the Supervisor Emphasis Rating Form-Revised (SERF-R), and the Working Alliance Inventory-Revised (WAI-R). Analysis methods utilized in this study included multiple regression, T-tests, and analysis of variance. Three key findings emerged from this investigation. The first finding is that multiple regression results showed that the professional behaviors mean score in the SERF-R could explain 13% of variance in the WAI-R. The second key finding is that supervisors with the credential of Licensed Professional Counselor had a higher mean working alliance score than those with other professional licensures. The final key finding is that there was no significant difference in the working alliance between clinicians whose supervisors were responsible for certain administrative tasks and those clinicians whose supervisors had no such responsibilities. The implications of this study, its limitations, and suggestions for future research are detailed herein. / Ph. D.

Social workers have no clear professional guidelines about the application of culturally competent mental health service delivery. Without culturally competent mental health service delivery, clients from diverse cultures do not access needed mental health services and they experience less effective therapy treatment outcomes and overall disparity of service delivery throughout the therapeutic process. The purpose of this descriptive case study was to better understand how community-based social workers are delivering culturally competent services to clients. The theoretical framework for the study was multiculturalism and the primary research questions addressed how associate clinical social workers who provide in-home mental health services in Los Angeles deliver culturally competent services to their clients. Through 8 interviews with associate clinical social workers, this descriptive case study revealed that without clear direction on what culturally competent services are, or how to deliver them, social workers are using a combination of personal experience and personal culture, educational and practice knowledge, and in some cases no attention to culture, to meet the mental health needs of their clients. This study emphasized the need for an industry wide understanding of the term cultural competency, so it could serve as the frame of reference by which practice professional skill level could be assessed, practice protocols measured, and could lead to social change through greater access to counseling services for clients.

This qualitative study examines the challenges that community health workers or Promotores face when implementing their programs to produce better outcomes in the Latino community. Data collection was derived from five local promotores with an adequate knowledge base of expertise in promotores programs. Study themes focused on how promotores implement their programs, the challenges they face and providing professional and personal insight on working with the Latino community. Present day research emphasizes that promotores or the community health worker model approaches have been promoted as a strategy to address health disparities experienced by Latino communities in the U.S. These programs have been implemented in an effort to improve the health of Latino families and bring awareness to public health issues. However, not much is known about the challenges that they face when implementing these interventions. Study results indicated five emerging themes pertaining to the challenges that promotores face when implementing their programs and include: mental health stigma, recruitment, funding barriers, and lack of evaluation. Finally, suggestions for further research on promotores and the Latino community are discussed.

Orientador: Erotildes Maria Leal / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T21:58:06Z (GMT). No. of bitstreams: 1 Lopes_TatianaScala_M.pdf: 1298407 bytes, checksum: fb765ae0ccc68e0ce930955b0c2f2541 (MD5) Previous issue date: 2011 / Resumo: Esta investigação de mestrado é um estudo qualitativo multicêntrico, marcado pelo referencial da fenomenologia e da hermenêutica e tem como objetivo compreender como psiquiatras trabalhadores da rede de serviços públicos de saúde mental lidam com a dimensão da experiência particular de pessoas diagnosticadas como portadoras de esquizofrenia no desenho do cuidado. Temos como pressuposto que para promover o restabelecimento de pessoas com transtornos mentais graves e reduzir o estigma é necessário desenvolver modos de cuidar em que a própria experiência da doença não seja negada. Por isso este trabalho foi apoiado na noção de recovery, que no cenário internacional tem contribuído para valorizar a dimensão da experiência do usuário. Para cumprir nosso objetivo, além de realizar uma revisão sobre o conceito de recovery, a fim de melhor compreende-lo, realizamos grupos focais com psiquiatras dos municípios de Campinas e Rio de Janeiro, e através desses grupos pretendemos acessar a experiência dos psiquiatras na formulação do diagnóstico de esquizofrenia e proposição do tratamento. Através do material produzido neste estudo pudemos perceber que a formulação do diagnóstico de esquizofrenia exerce grande impacto sobre a experiência de cuidar do usuário. E a concepção de esquizofrenia como doença grave e crônica parece influenciar amplamente o tipo de assistência que estes profissionais irão ofertar, assim como as expectativas que terão em relação à vida futura do usuário. A idéia de tratamento dos psiquiatras parece permeada não pela idéia de recovery, mas pelos princípios e objetivos da reabilitação psicossocial em seu sentido mais ortopédico e normalizante, que tem grande compatibilidade com o modelo biomédico, e oferece poucas ferramentas de acesso ao mundo e à experiência do usuário / Abstract: This master research is a qualitative multiside study, marked by the reference of phenomenology and hermeneutics, and aims to understand how psychiatrists of community-based mental health services deal with the dimension of the particular experience of people diagnosed as suffering from schizophrenia in the caring process. We have assumed that to facilitate the recovery of people with severe mental disorders and to reduce stigma is necessary to develop ways of caring in which the very experience of illness is not ignored. Therefore this work was supported by the notion of "recovery", which in the international arena has contributed to enhance the meaning of the user experience. To accomplish our goal, besides doing a review on the concept of recovery in order to better understand it, we conducted focus groups with psychiatrists from Campinas and Rio de Janeiro. In these groups we intended to access to the experience of psychiatrists in formulating diagnosis of schizophrenia and treatment proposition. Based on the material produced in this study, we realized that the formulation of schizophrenia diagnostic has a major impact on the experience of caring user. And the concept of schizophrenia as a chronic and severe illness seems to largely influence the type of care these professionals will offer, as well as the expectations they have regarding the future life of the user. The psychiatrists? idea of treating seems to be permeated not by the idea of recovery, but by the principles and goals of psychosocial rehabilitation in its most orthopedic and normalizing sense, which has great compatibility with the biomedical model, and provides few tools to access the world and experience of the user / Mestrado / Política, Planejamento e Gestão em Saúde / Mestre em Saude Coletiva

This research study is aimed at evaluating the artwork created by a woman who has experienced the trauma of domestic violence. A qualitative research approach was used to capture the phenomenological outcomes in the art created during art therapy sessions using the theoretical lens of narrative therapy to analyze the art. For this study the subject was a young woman from Central America who had come into therapy per court mandate to address the issues of domestic violence at a community-based mental health center where the researcher was conducting her second- year practicum. The data (art) was gathered after each art therapy session. Five sessions in total were conducted where the subject was given various art making directives. The subject created six total pieces of artwork during the five sessions. The researcher then analyzed the artwork created by the subject using a phenomenological approach while looking for common themes found in the artwork using a narrative therapy lens with which to view the artwork. Many themes uncovered in the artwork were parallel to narrative therapy theory such as resilience and empowerment and held the possibility of assisting the subject who experienced domestic violence in finding new outcomes.

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs. / Health Science / M.A.(Nursing Science)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs. / Health Science / M.A.(Nursing Science)