This study is about the exploration of the concept of community, using the Mamelodi Counselling Clinic as the context for the exploration. The members who got involved in different phases in the running of the clinic, went through the process of defining and redefining the concept. This process was based on their experiences and their coevolved reality of what the concept means. These experiences will be discussed and in the end, a punctuated end product of the coevolved meanings will given. Furthermore, an account will be given as to how the running of the clinic evolved with the changes in meaning. The author's perception of the division between clinical and community psychology was altered as a result of the findings in the study and this will also be discussed. / Psychology / M.A. (Clinical Psychology)

Thesis (M Social Work)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Mental health is a fundamental aspect of social functioning which affects a significant portion of the population. The movement toward deinstitutionalization became the core focus of mental health policies such as the White Paper (1997) and the Mental Health Care Act (17 of 2002) post-apartheid. However, this process was implemented at a rapid rate, with poor corresponding development of necessary outpatient and community-based facilities and services. Social, cultural, and economic conditions have significant and measurable effects on both individual health status and the delivery of health care. As a result, there is a growing recognition of the need for social work services within the mental health outpatient and community-based care context. Research regarding the role of the social worker within mental health care, particularly within a South African context is poor and therefore a research gap with regard to examining the views of social workers on their role in mental health outpatient and community-based services exists. The overall objective of the study was to, in light of the above, examine the views of social workers on their role in mental health outpatient and community-based care. A combination of both qualitative and quantitative research approaches was employed for the study, with a stronger emphasis on the use of qualitative data. A combination of exploratory and descriptive research designs was utilized as the framework for the implementation of the research approach. This was appropriate for the utilization of both quantitative and qualitative design elements. A purposive sample of twenty social workers was compiled, and data was collected through the means of semi-structured interviews; a pilot study was implemented to test the measurement instrument with two social work participants. Two literature chapters are presented, focusing on the topic of mental health and its related policy, as well as expanding on mental health care and service rendering according to an ecological perspective. These chapters served to achieve established objectives of the study. Chapter four is a presentation of the empirical study. Data which was collected was both relayed and analyzed, in accordance also with the literature study. Data was analyzed, through both quantitative and qualitative analysis and was presented according to identified themes, sub-themes and categories. Relevant tables, figures and participant narratives were used to further substantiate the analysis of data. Chapter five gives an overview of relevant conclusions and recommendations, in terms specifically of the role of the social worker in mental health outpatient and community-based care, in light of the empirical study and data analysis. Five specific roles were identified as being significant for the social worker in mental health care, with regard to their role in therapeutic intervention, working with clients and families in a one-on-one, counseling capacity; supportive services, through linking of clients to necessary resources; advocacy, through fighting for, and protecting the rights of clients and related vulnerable groups within mental health; relational role, recognizing the importance of social and interpersonal aspects on the functioning of mentally ill clients; and finally their role as a holistic worker within a multidisciplinary team, incorporating key aspects of the ecological perspective into assessments and interventions. / AFRIKAANSE OPSOMMING: Geestesgesondheid is ʼn fundamentele aspek van maatskaplikefunksionering wat ʼn beduidende gedeelte van die bevolking affekteer. Die beweging na deïnstitusionalisering het die kern fokus van verwysings na geestesgesondheidsbeleide soos vervat in die Witskrif (1997) en die Wet op Geestesgesondheidsorg (17 van 2002) geword. Hierdie proses is teen ʼn vinnige tempo geïmplementeer, wat die ooreenstemmende ontwikkeling tussen dienste aan buitepasiënte en gemeenskapsgebaseerde fasiliteite en dienste benadeel het. Maatskaplike, kulturele en ekonomiese toestande het ʼn groot en meetbare uitwerking op beide individue se gesondheidstatus en die lewering van gesondheidsorg. As gevolg hiervan, is daar ʼn groeiende erkenning van die behoefte aan maatskaplike dienste in die geestesgesondheidsorg van buitepasiënte en binne ʼn gemeenskapsgebaseerde konteks. Navorsing oor die rol van die maatskaplike werker in die geestesgesondheidsorg, veral binne ʼn Suid-Afrikaanse konteks is onvoldoende. ʼn Gaping bestaan veral in navorsing oormaatskaplike werkers se rol in geestesgesondheidsorg met betrekking tot buitepasiënte en die gemeenskapsgebaseerde dienste. Die oorkoepelende doel van die studie was om, in die lig van die bogenoemde, ondersoek te doen oor die sienings van maatskaplike werkers met betrekking tot hul rol in geestesgesondheidsorg van buitepasiënte en gemeenskapsgebaseerde dienste. ʼn Kombinasie van beide kwalitatiewe en kwantitatiewe navorsingsbenaderings is gebruik vir die studie, met ʼn sterker klem op kwalitatiewe navorsing. ʼn Kombinasie van verkennende en beskrywende navorsingsontwerpe is gebruik as ʼn raamwerk vir die implementering van die navorsing benadering. 'n Doelgerigte steekproef, bestaande uit twintig maatskaplike werkers is saamgestel, en data is ingesamel deur middel van semi-gestruktureerde onderhoude met behulp van ʼn onderhoudskedule. Loodsonderhoude met twee deelnemende maatskaplike werkers is gevoer ten einde die onderhoudskedule te toets. Twee literatuurhoofstukke word aangebied, wat fokus op die onderwerp van geestesgesondheid en verwante beleide, sowel as geestesgesondheidsorg en -dienslewering volgens ʼn ekologiese perspektief. Hierdie hoofstukke dien as fondasie om die doelwitte van die studie te bereik. Hoofstuk vier dien as ʼn verslag oor die empiriese studie. Die data wat ingesamel is, is op grond van die literatuurstudie ontleed. Data is geanaliseer deur middel van beide kwantitatiewe en kwalitatiewe analise en is aangebied volgens geïdentifiseerde temas, sub-temas en kategorieë. Toepaslike tabelle, figure en narratiewe is gebruik om die analisering van data te substansieer. Hoofstuk vyf bied relevante gevolgtrekkings en aanbevelings aan in terme van spesifiek die rol van die maatskaplike werker in geestesgesondheidsorg met betrekking tot buitepasiënte en gemeenskapsgebaseerde dienste. Vyf spesifieke rolle is geïdentifiseer as belangrik vir die maatskaplike werker in geestesgesondheidsorg: maatskaplike werkers se rol in die terapeutiese intervensie met betrekking totberading van individue en gesinne; ʼn ondersteunende rol wat kliënte met die nodige hulpbronne in verbinding bring; ʼn voorspraakrol, deur te beding vir die beskerming van die regte van kliënte en verwante kwesbare groepe in geestesgesondheidsorg; ʼn verhoudingsrol in die erkenning van die belangrikheid van sosiale en interpersoonlike aspekte in die funksionering van geestesgesondheidskliënte; en die rol as ʼn holistiese werker binne ʼn multidissiplinêre span, waarin belangrike aspekte van die ekologiese perspektief in assessering en intervensie geïnkorporeer word.

published_or_final_version / Social Work / Master / Master of Social Work

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.

Aim: Antipsychotic medication is the predominant intervention used for psychosis in the UK. However, there are risks associated, it is not always effective and service-users express ambivalence towards taking it. The research aims to explore community mental health professionals’ perspectives on working with people with psychosis who express antipsychotic ‘medication refusal’. Method: A mixed-methodology was utilised. A survey of community mental health professionals was undertaken (N=74) to enquire about frequency of medication refusal and actions taken by professionals. Four uni-professional focus-groups were held to discuss the topic. The resulting data was subjected to a discursive analysis. Findings: Antipsychotic medication refusal was presented as a common experience by participants, with service-users often stopping against advice. A substantial proportion of survey participants reported experience of supporting service-users without using antipsychotics or to come off, with good rates of success. ‘Risk talk’ was a prevalent feature of the focus-groups: a range of ‘risk’ repertoires were drawn on by participants to warrant particular actions. Implications: Government initiatives relating to service-user choice, empowerment and recovery in mental health are in opposition to more pervasive ‘risk’ discourses. The notion of ‘risk’ in relation to antipsychotics needs further consideration, with professionals made more aware of its social construction and alternative conceptualisations of psychosis and antipsychotics.

No description available.

This participatory action research project enabled service users to influence the modernisation of local mental health day services. The modernisation programme was based on principles of social inclusion, and there were limited understandings of how it could be applied locally. Interpretations of policy gave priority to the relocation of services and facilitating individual recovery. An occupational perspective informed the design, implementation and analysis, emphasising what people chose to do. Critical ethnography informed the role of the researcher. Service user involvement was understood as a democratic process, drawing on direct experience for service development. A forum, established for four years, worked on and supported three research strands, focused on social networking. Service users captured their use of a social lounge using photography in Strand A. In Strand B a checklist was used to investigate social activities. Userled social groups were explored in Strand C through individual interviews. All the findings were systematically analysed and service users were involved in this for Strands A and B. The findings of this research emphasised the importance of social networking within the day services. Strand A indicated the benefits of a safe space, before getting involved and moving on. The final report from this strand led to ongoing funding being allocated for a safe space. For Strand B many social and recreational activities were identified by service users. Stigma was recognised as an ongoing barrier to sustained inclusion. A poster was designed and displayed locally to share the findings. Themes from Strand C demonstrated that user-led groups required active collaboration with mental health services to survive and thrive. A final stage of analysis aimed to uncover the details of taking an occupational perspective. The findings indicated that varied occupational forms involved different service users in different ways, enabling more people to participate. Making the functions of the different events explicit was important for negotiating participation. Meanings were expressed in shared and individual reflection as the research unfolded. Understanding and attending to these aspects facilitated meaningful service user involvement in this research, enabling many people to influence the development of the services they received.

Thesis advisor: Rocío Calvo / Hispanics are less likely than non-Hispanic whites to use mental health service, even after controlling for various social, environmental, and health factors. Mental health services disparities between Hispanics and non-Hispanic whites have been well-documented and consistent over time. However, very little is known about the impact mental health care organizations have on Hispanics’ access to mental health care, especially since the implementation of the Patient Protection and Affordable Care Act (ACA). The three papers in this dissertation utilize the 2010, 2014, and 2016 waves of the National Mental Services Survey (N-MHSS) to assess the impact of the ACA on Hispanics’ access to mental health care and mental health care organizations’ provision of integrated services. The N-MHSS is a national repository of data on the mental health organizations in the United States. This dataset was created to report the characteristics and client enrollment at mental health care organizations. Paper 1 uses the 2014 N-MHSS to describe the structural characteristics of mental health care organizations according to the proportion of Hispanics they serve and the organizations’ structural characteristics in Medicaid expansion and non-expansion states. Paper 2 uses the 2010, 2014, and 2016 N-MHSS waves to examines the impact of the ACA and the health safety net on Hispanic admissions at mental health care organizations. These three waves were merged together using a repeated cross-sectional design to assess whether Hispanic admissions increased after the implementation of the ACA. The final paper uses the 2014 and 2016 N-MHSS waves to assesses whether integrated care has increased at Hispanic-serving organizations compared with mainstream organizations two years after the implementation of the ACA. This paper also assessed whether the increased funding for integrated services under the ACA has disproportionately affected mainstream organizations compared with Hispanic-serving organizations. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Thesis advisor: Thanh V. Tran / ABSTRACT This dissertation has the following specific aim: to measure outcomes of social work emergency certificates produced by a Mobile Crisis Team to determine the effectiveness of these certificates at linking clients to services. Linkage to services is a programmatic goal and is achieved by ensuring clients receive adequate crisis and follow up services as a result of Emergency Certificates. In doing so, risks of homicide, suicide and grave disability are mitigated. Under its administrative umbrella, Mobile Crisis Team operates a police-social work collaboration known as Crisis Intervention Team, and both are administered by the State of Connecticut Department of Mental Health and Addiction Services in southeastern Connecticut. The data comes from 233 consecutive cases that involved Emergency Certificate's to transport clients to the local emergency department for psychiatric evaluation and treatment. Data was gathered post-hoc by reviewing copies of each specific certificate and cross-referencing those certificates with an agency risk management report and an electronic data base that stores demographic data on all clients. Descriptive, bivariate and multivariable analysis, such as cross tabulations and binary logistic regression, were used to analyze the data in this study. Additionally, the chi-square automatic interaction detector (CHAID) was used to construct outcome trees to describe subgroups of interest. This research is a continuation of previously published research on the various permutations and outcomes of mobile crisis programs, and contributes two unique programmatic features: the use by social workers of a legally proscribed coercive tool to send people to the emergency department for assessment, and the effectiveness of police-social work collaborations compared to social work only referrals. Overall, linkage occurs in over 80% of cases, with significant predictors of linkage identified as substance abuse, Hispanic ethnicity, criminal justice involvement, suicide, affective disorders, and insurance status. Implications for program evaluation, future research and limitations of the study are also discussed / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Typescript (photocopy). / Digitized by Kansas Correctional Industries / Department: Regional and Community Planning.