The focus of this study was to explore how Clinical Psychologists narrate their experience of relatedness within a multi-disciplinary team. Mental health services in the UK are facing increased financial pressure and a necessity for all professionals to justify their role. In this context value often appears to be placed on the cheapest way of providing individual, independent care for clients rather than on the relational value of job satisfaction, joint working and therapeutic relationships. The aim of this study was to explore the experience of Clinical Psychologists and through this contribute to thinking around collaborative and interdisciplinary working. This study was guided by eight individual semi-structured interviews which were conducted with Clinical Psychologists who work in Multi-Disciplinary working age adult Community Mental Health Teams and explored using Narrative Analysis. The participants consisted of seven females and one male who had been qualified between three and fifteen years and were working at various pay bands between 7 and 8c. Four relational narratives were found. These were connections to the self of the psychologist, connections to clients, connections with colleagues and connections with the system. The first relational aspect was how the Clinical Psychologists in this study storied their ability to remain connected to their own humanity and their personal values within the context of their Multi-Disciplinary Teams. The second level involved the stories about relationships and connections with clients, particularly thinking about the perceived impact and consequences of the other relational levels for the clients and their safety. The third relational aspect was the stories that Clinical Psychologists told about their sense of relatedness to their colleagues within their teams and the importance of having time available for this. Finally, the fourth level, which was evident within all the other relationships, was of the impact of the wider system and context. These stories emerged from the analysis process with the understanding that the interviews were co-constructed and represented multiple voices. This study confirmed that despite a history of both research and legislation highlighting the benefits and values of inter-professional working and compassion the reality remains elusive. To achieve these aims there needs to be a shift in focus from short-term planning evaluating efficiency in relation only to perceived financial value, to thinking more widely and long-term about relational value. There is a need for investment and recognition of the aspects of team working that are less easy to quantify financially. Further research could explore the experience of other professional groups within CMHTs, and other MDTs, and of clients. This would give a voice to individuals who did not have an explicit voice in this research.

Class of 2005 Abstract / Objectives: This retrospective study investigated the relationship between compliance, hospitalizations rates, and cost of care in an outpatient behavioral health facility over a 12-month period for schizophrenic patients treated with depot antipsychotic medications. Methods: Databases from COPE Behavioral Health Center in Tucson, AZ were utilized for administration of depot injections, hospitalizations, and cost of care for patients between July 1, 2003 and June 30, 2004. Results: Records were utilized for 103 patients receiving depot antipsychotics (n = 34 fluphenazine decanoate, n = 69 haloperidol decanoate). Increased number of injections received per year was associated with lower number of hospitalizations per year (p = 0.025 fluphenazine and p = 0.001 haloperidol). Also, increased number of hospitalizations was associated with increased total cost of care (p = 0.001 fluphenazine and p < 0.001 haloperidol). Implications: Patients with schizophrenia who received a greater number of depot antipsychotic injections had a lower number of hospitalizations during a 12-month period. Improved adherence with depot antipsychotics may improve clinical outcomes and reduce the total cost of care in patients with schizophrenia.

M.A. / NISAA was established in 1994. It is one of the first organisations dealing with women abuse in Lenasia and the surrounding areas. The organisation has great potential in becoming a recognised institution in South Africa. Women who are in distress, have no where to go and are left abandoned have a shelter with NISAA. In the short period of its existence NISAA has strived hard to uplift and assist women. Counselling and treatment is offered on a daily basis by professionals and trained personnel. However, many needs still have to be met and research has shown us that not nearly enough is being done for those who are being abused, be it wife abuse or child abuse. The processs of research is presented in five stages and covers, the problem statement, the literature survey, research methodology, analysis, conclusions and recommendation. The survey of the literature is very important in this study. South Africa has become epitomised by a rapidly changing social order, swiftly unfolding political development and an unprecedented fluidity in the thinking of future opinions. The attitudes and perceptions of domestic violence and violence in general needs to be changed. The chapter on research methodology stresses the importance of feminist organisations. Feminist organisations' role is vital in any study on woman abuse, as research on woman abuse began with these organisations. Methodology in this study also focuses on the qualitative nature of battering, research and the relevant themes surrounding battering. These themes include woman abuse, intervention. treatment and shelters. Other important aspects discussed is coding of data, research design, sampling and interviewing procedures. The analysis and results shows that NISAA has made a significant contribution to battering of women. From the results of this study, NISAA has become an important structure and service in the South African society. The services NISAA should expand on include, a safe and positive crisis help, as well as promoting the rights of all victims. Important to the growth of NISAA is alleviating the funding problem. Other relevant findings discussed are attitudes and perceptions of women abuse and services that encourage and discourage the use of NISAA. These findings compliments. Gishen's (1993) study on the Power Organisation. Recommendations made to NISAA are based on the findings of this research. This research hopefully will expose abuse, help women to achieve recognition in its fight against abuse and in its quest for the empowerment of women. The research was also intended as an educative process. This study entails the physical and psychological abuse of women which has become a global problem. The problem needs to be addressed, understood, analysed and treated. An effective solution must be found.

<div><div><div><p>Objectives: Previous research suggests an association between working alliance, the collaborative and affective bond between patient and therapist, and improved therapeutic treatment outcomes within treatment of severe mental illness (SMI). However, little is known about the mechanisms through which working alliance improves outcomes in this population. Through investigating key elements of recovery within SMI, two possible mediators—patient activation and hope—appear particularly relevant to the relationship between working alliance and improved treatment outcomes. The current study aimed to examine patient activation and hope as potential mediators in the relationship between working alliance and improved depression in individuals with SMI. Additionally, the current study investigated whether or not the patient’s evaluation of which provider is most important to their recovery significantly moderated the relationship between working alliance and patient activation/hope.</p><p>Methods: The current study was a secondary analysis of longitudinal (baseline, 6-month, and 12-month) data comparing two interventions aimed at reducing treatment provider burnout in community mental health settings primarily serving individuals with SMI. Participants (maximum N for analyses = 346) completed measures of working alliance with a linked provider on their treatment team, patient activation, hope, and depression at baseline, 6 months, and 12 months. Using moderated mediation analysis, 6-month patient activation and 6-month hope were examined as mediators in the relationship between baseline working alliance and 12-month improved depression (change score between 12-month and baseline depression). Additionally, whether or not the patient deemed their linked provider as most important to their recovery was tested as a moderator in the relationship between baseline working alliance and 6-month patient activation/hope.</p><p>Results: Overall, the current study’s hypothesized model was not supported. Baseline working alliance did not significantly predict improved depression 12 months later. Further, both patient activation and hope measured at month 6 in the study did not significantly mediate the relationship between working alliance quality at baseline and improved depression at month 12. Additionally, whether or not the patient believed their linked provider was most important to their recovery did not significantly moderate the relationship between baseline working alliance and 6-month patient activation or 6-month hope. However, results indicate that better quality working alliance at baseline did significantly predict higher patient activation at 6 months. Lastly, the current study found a significant positive correlation between importance of provider and baseline working alliance.</p></div></div></div><div><div><div><p>Discussion: Results suggest that improvement in depression may not be a key SMI treatment outcome that relates to working alliance, patient activation, and hope. Further, fostering a positive working alliance (e.g., collaboratively developing goals/tasks in-session) may increase patient’s ability, willingness, and confidence in managing their own mental health care. Additionally, a positive working alliance may also contribute to how important the patient believes the provider is to their recovery. However, those that have seen their provider for longer (e.g., more chronically ill) may be less active in managing their own mental health care. Limitations and possible future directions are discussed.</p></div></div></div>

Community treatment orders (CTOs), which allow for involuntary psychiatric treatment of individuals who meet particular legal criteria while they are living in the community, have been in effect in Ontario since 2001. Some similar form of mandated community-based psychiatric treatment exists in every Canadian province and in many other jurisdictions around the world. In the wake of deinstitutionalization, CTOs filled a gap in mental health care, allowing for the treatment of people with serious and persistent mental illness (SPMI) who were otherwise unable or unwilling to access care; however, CTOs brought their own host of legal, ethical and practice dilemmas, as well as mixed results in research about their effectiveness. This doctoral research examines the way CTO policy is situated within a larger historical, social, legal and discursive system; the way it is deployed, operationalized and negotiated in day-to-day practice; and the layered effects that this has on the multiple actors involved. This study gives voice to a small and vulnerable subset of the population who, in addition to experiencing mental illness, have layered experiences of stigmatization and low socio-economic status. The purpose of this study was to explore the cultural context, beliefs and values underlying the CTO and perpetuated by the CTO, as it was used in community mental health care in Ontario, through an examination of its impact on identity of people living with SPMI. The study was guided by a theoretical framework that brought together the work of Michel Foucault on governmentality and Elizabeth Grosz on body image in order to critically examine the issue of identity from both the outside in (how identity is constructed) and the inside out (how that constructed identity is experienced). It used a critical ethnographic methodology. Data collection included in-depth interviews with persons with SPMI (N=7), family members (N=5) and clinicians (N=10), observations of health care practices for people with CTOs, and analysis of documents used during the CTO process. Data was analyzed using critical discourse analysis. This study revealed insights in the into social context of CTOs, that is, the complex social landscape in which CTOs operate; the social practice of CTOs, that is, the many steps and many actors involved in the CTO process; and the social impact of CTOs, that is the effect of CTO processes on both the constructed and the experienced identity of the patient, family member and clinician. The constructed identity of the patient included perceptions of the patient as risky, defective, and in need of surveillance; the experience of this identity was characterized by feelings of being criminalized, disconnected, muted, traumatized and gaslit. The constructed identity of the family members included an idealization of families as responsible and available, and instrumentalization of the family role. This identity experience was characterized as a dissonance between roles, a witnessing of the absurd, and as putting a strain on other elements of life/identity. The constructed identity of the clinician in relation to CTOs included the role of enforcer, fall-guy, paternalistic provider, and the patient’s adversary. The experience of this identity was characterized by frustration, powerlessness, distress, and an acceptance of dissonance. CTOs, while facilitating access to some treatments and services, also act to construct identities for patients that further limit their full integration into communities as valued members. An examination of the constituent parts of the CTO highlights areas in which CTO processes could be changed; research participants conveyed areas in which they thought the CTO could be improved, including changes to methods of police intervention, better collection and use of administrative data, systemic change, the use of specific approaches to care, changes to the timings of renewals, and changes to the Consent and Capacity Board hearings. The discussion highlights ways in which a re-examination of the context in which CTOs are used can lead to the consideration of political and therapeutic means to reduce both the circumstances that lead to mental and emotional distress and to improve our responses to mental and emotional distress when these are experienced by members of our communities.

People with mental illness and histories of homelessness represent a vulnerable and marginalized population for whom a wide range of health, social, and community services have been developed. Despite the array of services, their role in the lives of currently and formerly homeless people with mental illness is not fully understood. Three studies were conducted that addressed two research questions: [1] How do patterns of service use differ during transitions from homelessness to housing compared to those from housing to homelessness among people with mental illness? and [2] What is role of services in enhancing the lives of housed and homeless people with mental illness? The first research question was addressed in Study 1, which involved secondary data analysis from a multisite randomized controlled trial of Housing First in Canada known as the At Home/Chez Soi demonstration project. The study explored how service use patterns over 24 months differed among people who achieved housing stability compared to those who remained unstably housed or re-experienced housing instability during the second year of the study. Findings showed that, as homeless people with mental illness transition into stable housing, their service use patterns change, with less time being spent in psychiatric hospitals, prison, and emergency shelters. Housing First minimally affected the changes in service use patterns, indicating that housing stability is the key factor in producing the changes as people transition out of homelessness. Study 2 also used data from the At Home/Chez Soi demonstration project to examine predictors of recovery among homeless people with mental illness at baseline and 24 months. Findings showed that health and community factors most strongly predicted mental health recovery at baseline. The housing and service use block of predictors was also significantly associated with most components of recovery, though the effect sizes were small. At 24 months, the model, which included receipt of Housing First, did not significantly predict residual changes in recovery from baseline. Study 3 of this dissertation qualitatively explored how currently and formerly homeless people with mental illness view services in their lives using two theoretical frameworks: recovery (Part 1) and the capabilities approach (Part 2). In-depth interviews were conducted with 52 participants living in Ottawa, Ontario. Participants perceived services to have a range of positive and negative impacts of their recovery and capabilities. However, the limits of service helpfulness in helping people to move forward with their lives was also highlighted. Overall, the findings of this dissertation indicate that the health, social, and community services used by homeless people with mental illness change as people become stably housed yet are limited in their impacts on recovery and capabilities. Implications for transformative change, service delivery, and future research are discussed.

The purpose of this dissertation is to evaluate an attempt to use the facilities of a general hospital with minimal psychiatric cover to deal with acute psychiatric conditions. This is in keeping with current psychiatric opinion in South Africa as expressed by Dr. C.W. Allwood and Dr G.A.D. Hart. This dissertation will examine the needs structure, difficulties and results of the provision of a service dealing with acute psychiatric disorders in a peripheral General Hospital and make suqqestions should similar satellite facilities be established at other peripheral hospitals. Although in principle. the concept of part-time specialist cover at a peripheral general hospital is not new in medical. surgical and gynaecological departments. the previous involvement of private psychiatrists within the teaching department has been in the form of out-patient department sessions only at academic and state psychiatric hospitals as is practiced in Cape Town. This project however allowed for the evaluation of emergency cases with subsequent referral to appropriate treatment centres if needed from a peripheral hospital. A consultation-liaison service within the general wards and the opportunity to conduct seminars, lectures and in-house training for all level of professional staff were also encompassed.

Evaluative research in the field of mental health is carried out pursuant to several goals. One is to study a very particular intervention on a very particular client (or client population) in a controlled way with the aim to test a theory of intervention. This form of research requires basically an experimental research design. It also requires rigorously defined and measured intervention and a good control for factors other than intervention. The requirements for this form of research are stringent and the number of such projects reported is, therefore, rare. The present study was done as a pilot study for the Elahan Center for Mental Health and Family Living (formerly Clark County Mental Health) in Vancouver, Washington. This agency has recently undergone much change. About eighteen months ago there was a change of Directors. At about the same time, though unrelated, the agency was involved in a public scandal around the drug program. As a result of much inter-agency strife and the change in administration, few employes from the old staff remain. The new administration is dedicatedly behaviorist in therapeutic orientation, as are some of the therapists. Use of para-professionals in professional capacities is high and most of tile para-professionals follow the behavioristic bent of the administration.

Broadly speaking, the purpose of this study is to: 1. Assess the functioning of the psychiatric hospital aftercare service delivery system by examining community service utilization patterns of Dammasch Hospital releases. 2. Obtain descriptive information relating to Washington County's chronic aftercare population. 3. Provide an objective data base that can be used to further develop the Aftercare Service Delivery System in Washington County.

Today taxpayers (those who pay for services) and clients (those who receive services) wish the best use for the money that they invest. The public is not as accepting of generalities, observations or intuitive success measures of social agencies' performance. Emotional problems are costly. Often they can lead to loss of employment, inefficiency, break-up of marriages, retarding the emotional development of children and use of monies invested by other agencies, i.e., welfare, juvenile courts, etc. Social agencies, in response to the general public, are raising issues around what are appropriate measures tor evaluating treatment outcome. The instant study is one such response on the part of Delaunay Institute for Mental Health. The study. attempts to ascertain treatment outcome in the Delaunay program and at the same time test out the PARS (Personal Adjustment and Role Skill) as an evaluative instrument in making treatment assessment.