This study focused on youths’ experience of receiving school-based mental health services and community-based mental health services. This qualitative study utilized a sample of eight girls and boys, ages 15-17 years old, who attended school within the district of Timmins. Data was collected using individual interviews and analyzed using thematic analysis. Results of the study revealed benefits to services, limitations to services, and some recommendations for changes to services. This research helped to explain what the participants, who have had experiences with mental health services, thought about the services they have had; it also provided some recommendations the participants made for changes to the mental health services based on their experiences. The conclusion of this study involved a connection between this study and social work practice, and offered suggestions for future research in the field of children’s mental health services.

This thesis explores how concepts of "adolescence" and "adolescent psychopathology" have become salient among medical and lay communities in Pelotas, a small town in Rio Grande do Sul, Brazil's southernmost state. The concept of adolescence emerged throughout the 20th century in Western Europe and North America from various specialized fields, including evolutionary medicine, psychiatry, and developmental psychology. Within these sub-fields, adolescence came to refer to a transitional phase in the life span, and specifically, to the psychopathologies and psychological opportunities ensuing from what could potentially become a life-altering transformation. In the past two decades, this concept of adolescence has been adopted by a number of global health agencies, who depict the adolescent phase as an opportunity for addressing the underlying causes of multiple psychopathologies and accordingly, for improving the developmental "health" of nations. Concepts and practices relating to the management of adolescent psychopathology readily took hold in Pelotas in the 1990s, not only because local professional communities have been seeped in a psychoanalytic tradition dating back to the early 20th century, but also because of a recent growing community-based health care movement that prompted the expansion of publicly funded mental health services. This expansion widened definitions of "therapy" to include preventive care and social mobilization, and impacted significantly the identity, social role and political inclinations of practitioners. Due to these changes, psychiatrists and psychologists are showing greater interest in adolescent patients and their various common mental disorders, including "aggressiveness," nervos, anxiety, and learning and school achievement problems. Yet several social and class struggles ensue when practitioners, many of whom seek to maintain their psychodynamic models relatively intact, shift the focus of their work f

This research presents a consumer evaluation of the delivery and aspects of services provided at three community run mental health centres. The purpose of this research is to describe the satisfaction levels of consumers with mental health service delivery in Durban, with a view to using this information to improve the services in future for quality assurance. The current investigation takes a look at how a comprehensive community mental health centre is perceived by its consumers. The subjects totalling one hundred and eleven clients who were attending psychiatric community health clinics during the study period. Using client self report questionnaires, the study investigates clients' perceptions of several aspects of their clinical care in community mental health service. In addition to assessing the clients' level of overall satisfaction and degree of acceptability of the services to the clients, the researcher was also interested in determining the expectation of consumers and how the clients perceived the effectiveness of health care service delivery. Additional information provided was the clients' views of the quality and outcome oftherapy. As further measures of the clinic's effectiveness and client satisfaction, questions relative to other help seeking actions, future behaviour in similar situations and recommendations ofthe clinic to others were asked. In addition to asking a wide variety of satisfaction-related questions, sociodemographic detail (i.e. age, gender, race, educational level, employment status, length of visits to the clinic) were asked. Most participants were unemployed men. Analysis of findings indicated that most participants were satisfied with the health service provided. Recommendations were, however, further made for improving quality of care and towards additional studies in other settings to include appropriate proportions of all racial groups in South Africa. / Thesis (M.Cur.)-University of Natal, Durban, 2002.

This thesis investigates different spaces in the lives of a group of adults living with long-term mental illness in Montreal. In particular, it is interested in exploring the role and functions of an alternative mental health resource that they all attend, using their narratives as the basis of meaning construction. My intention is to illuminate the complex interplay of identity, social participation, and physical place itself in the 'space' of experience for individuals. The way that a description of one of these elements is often in relationship with the other two, and that these connections can be useful in understanding descriptions of experiences by individuals, which, in David Morris' terms occur in a, "realm beyond language" (1997:p29). Finally, the concept of the 'border' is proposed as a tool to reexamine culture, identity and space, and one that is particularly useful in the context of self-help groups.

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.

Objective: This research explores the critical need for individualized care planning to ensure maximum cost savings by providing a balance between individuals’ care needs and care wishes. The primary objective of this research is to identify common goals of care (GoC) expressed by long-term care residents (using the interRAI LTCF) and clients receiving community supportive services (using the interRAI CHA) or community mental health services (using the interRAI CMH). Methods: Three interRAI datasets were used to perform data analyses. The responses to the open-ended GoC item were quantified and grouped into common goal categories, which were then examined against the interRAI outcome measures and Clinical Assessment Protocols (CAPs). Demographic and clinical characterisitics were compared across the sample populations using the chi-square test. Logistic regression models were created to reveal variables that are predictive of not having a GoC recorded within each care setting. Results: Twenty-five GoC categories were created. Although the GoC responses were very diverse, many persons had no goal recorded. Nearly 70% of long-term care (LTC) residents and community support service (CSS) clients were unable to state a GoC. Different populations in different service settings had distinct GoC but had some commonalities as well such as goals that focused on general physical or mental health issues. GoC varied with the CAPs- the triggering of a CAP did not necessarily mean a corresponding GoC was noted. Each care sector had different predictor variables that were strongly associated with not having a GoC. Conclusions: There is not a “one size fits all” solution to care planning. The same goals and outcome measures are not appropriate or realistic for all persons. It is critical to incorporate self-reported goals into the development of effective and individualized care plans to ultimately improve one’s quality of life, satisfaction with care, and success in achieving desired outcomes of care.

The present study examined the subjective experiences of individuals living in the community with a severe or persistent mental illness receiving services from the Sunnybrook Program of Assertive Community Treatment (SunPACT). The researcher employed McCracken’s (1998) Long Interview Method to interview a sample of 8 clients from SunPACT. The aim of this research was to explore client perspectives on their experiences of SunPACT and their perception of its impact on their quality of life. The findings from this study overlapped with the literature, as well providing new and vital information in the implementation and monitoring of quality of care of an ACT model. This research demonstrated that clients experience the effects of their treatment differently, and therefore, understanding client feedback is imperative to understanding how to maximize treatment benefits and provide effective services. Specific details about their experiences are outlined. Implications for social work practice are discussed.

Thesis (M.A.)--University of Hawaii at Manoa, 2007. / Includes bibliographical references (leaves 126-132). / ix, 132 leaves, bound 29 cm

Self neglect among older people refers to situations in which older individuals fail to adequately maintain their environment and to perform essential self care tasks. This concept has been variably addressed in the fields of biomedicine, adult protection, and suicide prevention, yet minimal research has been conducted on this topic in Australia. While the existing literature acknowledges that these situations can pose considerable challenges for professionals, no research has explored the actual experience of these dilemmas in professional practice. This thesis aims to address these gaps by critically exploring how self neglect among older people is understood in the Australian context, investigating the content of ethical dilemmas that arise in these situations, and examining how professionals resolve these ethical dilemmas. A two-part, qualitative methodology was used to address the research aims. In Part One, a five-month period of participant observation was conducted at a community-based organisation that had obtained funding to provide case management to people living in squalor. In Part Two, 18 semi-structured interviews were conducted with professionals who worked with situations of squalor and self neglect in the community. The results from both parts of the research were analysed using NVivo, a software program specifically designed to assist in the analysis of qualitative data. This research uncovered that, unlike the definition of self neglect used in the wider literature on this topic, participants clearly differentiated between personal neglect (self neglect) and environmental neglect (squalor and hoarding). Ethical dilemmas were common in these situations and fully understanding how professionals resolved these dilemmas required that both objective and relational approaches to ethics be used to analyse participant responses. In this way, a pluralistic approach to ethics emerged as the theory best suited to fully explore ethical decision-making in situations where older people were self neglecting or living in squalor. Decisions that resulted in good outcomes were found to be increasingly constrained by changes to services driven by neoliberalism and managerialism. Individual reflection and peer support emerged as important elements that helped professionals to cope with the ethical dilemmas and the practical constraints that were encountered in these situations.

Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers