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Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.P.H.)--University of Michigan, 1946.

The goal of mental health delivery system is to allow the individual with severe and persistent mental illness to live and function effectively in the community and to ensure that the consumers and their families have access to accurate information that promotes learning, self-monitoring and accountability (Stuart & Laraia, 2005:710). In community-based health care, the persons living with severe and persistent mental illness (SPMI) are in their natural environment in the context of the family and the community. The goals of care are focused around maximizing the person living with SPMI’s quality of life (Hunt, 2001:15-16). In South Africa, an integrated package of essential Primary Health Care (PHC) services has been made available to the entire population in order to provide the solid foundation of a single unified health care service (Department of Health, 2000:4). The assessment of health care needs of persons living with SPMI is a dynamic on-going process that is used to collect information, recognise changes, analyse needs and plan health care to provide baseline information to help evaluate the physiological and psychological normality and functional capacity of persons with SPMI (Hunt, 2001:100). There is insufficient information from the Department of Health to either satisfy the enquiry of whether the health care needs of persons living with SPMI are being met comprehensively or whether the practitioners rendering community-based health care are knowledgeable and comply with PHC norms and standards developed by this Department. The researcher is interested in understanding how the persons living with SPMI and their families experience the community-based health care provided by PHC nurses. The purpose of this research study is to develop strategies that would assist the PHC nurses in the selected rural areas of the Eastern Cape to facilitate community-based health care and to render a health care service relevant to the health care needs of the persons living with SPMI and their families. To achieve the objective of the study, the research design was based on a qualitative, exploratory, descriptive, contextual research approach. Phase one includes describing and selecting the research population and the sampling process prior to conducting the field work which comprises individual interviews with persons living with SPMI and their families as well as PHC nurses. According to Dickoff, James and Weidenbach (1968:422) and Chinn and Kramer (1995:78), this strategy involves identifying concepts from fieldwork and creating conceptual meaning to provide a foundation for developing strategies to facilitate community-based care for persons living with mental illness. Phase two of the research design will focus on development of conceptual framework in order to allow better understanding of the phenomenon of interest, as the major concepts will be simplified by connecting all related concepts together by means of statements. This was done by making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008:237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, applicable and relevant to the nursing practice have been developed for use by Department of Health and Primary Health Care to facilitate the multifaceted role of the PHC nurses.

The dissertation discusses the provision and organization of mental health services through the operation of Community Mental Health Centres outside the Greater Vancouver area in the Province of B.C.. A derived organizational structure of a CMHC is presented permitting a generalizable discussion of inter- and intra-organizational features and their relationship to administration peculiar to this organization. A number of propositions are generated regarding CMHC organizational structure and process; these propositions are based on the dimensions identified in the areas of organizational technology, environment and goals. The propositions are applied to a model of management permitting an examination of general areas of management concern. Methods of optimizing these areas are discussed operationally with the intent of facilitating organizational effectiveness in a CMHC. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The chronically mentally disabled need to be defined as a special needs group in order to receive the social and health services they require for community survival. Their needs can be identified by reviewing the relationships between chronic mental disability and schizophrenia, poor social margin, long term use of treatment facilities, and poor social and vocational functioning. Before the 1950's, services to the chronic patient were provided mainly within the asylum system. Although some innovations in psychiatric services were developed earlier, these were directed to patient groups other than the chronically mentally disabled. This tradition of attention to other patient groups has influenced the community mental health movement of the last 25 years. This movement was expected to provide for the needs of the chronically disabled in the community as the mental hospitals were reduced in population. Recognizing that community centered care of the former asylum populations is a technically feasible goal, the National Institute of Mental Health (N.I.M.H.) has proposed a model community system of services for this patient group. This model addresses their special needs, but its application requires a concerted and coordinated effort by several separate agencies. Recent changes in Canadian health care financing allows a realistic look at the American model. This paper uses Vancouver Island, British Columbia, as a planning area for services to the chronically mentally disabled. The population of the area is 441,000. The mental health services available to these patients are reviewed in order to determine the extent of this availability. Criticisms of community services in other jurisdictions were found to be relevant in the planning region. Recommendations are made based on the model service system developed by N.I.M.H. A comparison of the costs of the existing services to chronic patients and the ideal system shows that the required improvements could be made with little extra cost. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

This research was undertaken to determine whether the growth of computer-supported information systems in community mental health centers can be characterized by distinct stages of development. Data collection and analysis were designed to answer the following two questions: (1) Can distinct stages of information system growth be characterized by common profiles of computer-supported applications? (2) Are there characteristic groups of enabling factors (i.e., organization of data processing activities, management planning and control techniques, and user involvement) consistent among community mental health centers at any given stage of growth? This study draws upon earlier work by Nolan who identified distinct stages which characterize the pattern of information system growth in business organizations. A model reflecting the unique characteristics of community mental health centers was formulated to describe the aspects of information system growth addressed by this study. The components of the model were used to develop three scenarios describing the hypothesized characteristics of mental health information systems at three different stages of growth. Data for this study were obtained through a two-phase survey. The preliminary survey identified which community mental health centers are using computer-supported applications. The second survey collected detailed data about each model component using a stratified random sample of centers using computer-supported information systems. Responses to the preliminary survey showed that seventy-nine percent of the centers are using computer-supported information systems. In addition, the majority of centers with manual systems have plans to automate within one year. By contrast, a 1974 survey reported that only one-fourth of the centers were using computerized information systems. The number of centers using computers has therefore increased dramatically during the last five years. The analysis of computer-supported applications showed that a refinement of the hypothesized applications profile for each stage would be more representative of the state of the art of computerized applications in community mental health centers. The original model depicting three stages of applications development was extended to four stages. The predominant types of applications being developed are those supporting administrative and clinical recordkeeping functions. These findings indicate that the development of computer-supported applications in centers parallels applications development in other mental health programs. The analysis of characteristics of enabling factors revealed distinct differences among centers in each stage of development. The study results clearly showed that centers which are developing the most comprehensive sets of computerized applications are implementing formal planning and control techniques and user involvement strategies. These centers also reported the most favorable staff attitudes toward the usefulness of the information system and the most interest in developing new applications. While distinct characteristics of data processing organization variables were identified, these characteristics did not reflect a progression toward increased formalization of the data processing function.

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2004. / Vita. Includes bibliographical references (leaves 55-68).

Typescript (photocopy). / Digitized by Kansas State University Libraries

Studies have found a relationship between psychopathology and sleep disturbances, as well as between psychopathology and personality traits. What has not received attention to date, however, is the interplay amongst all three factors: psychopathology, sleep disturbances, and personality characteristics. This study explores the interaction amongst the three areas, as well as examines specific relationships between psychopathology and sleep disturbances and personality and sleep disturbances. Forty clients were recruited from a community mental health center. Participants were receiving outpatient psychological services, were over 18, and did not have a diagnosis of active psychosis or mental retardation. Participants completed 9 questionnaires covering items about demographic information, psychological concerns, sleep, personality style, and social desirability. They received a $10 gift card upon completion of the study. Participants had a mean age of 47.6 (70% female, 77% Caucasian). Results indicated that individuals with more severe psychopathology had poorer sleep quality and greater insomnia severity; however, participants with longer histories of psychopathology did not have more dysfunctional beliefs and attitudes about sleep. Participants with more extraverted personality styles did not sleep less than individuals who were less extraverted, and those who were more neurotic did not exhibit poorer sleep quality or greater insomnia severity. Lastly, when examining the relationship amongst all three factors, it was found that psychopathology may be a better predictor of sleep disturbances than personality is (depending on how sleep was assessed), and personality and sleep disturbances are both significant predictors of psychopathology. The results reinforce the interplay amongst psychopathology, personality, and sleep disturbances. Mental health professionals may want to place greater importance on the role of sleep in the treatment of psychological and personality disorders. Future research could replicate the study with a larger sample, utilize a different personality measure, or follow participants longitudinally from the start of their mental health treatment.