The area of mental health distress is one that crosses many disciplines including; psychiatry, critical psychiatry, psychology, critical psychology, history, politics, economics, philosophy, sociology, culture and human geographies (Thrift, 2006). Consequently, there are a complex set of issues to consider when discussing the experiences of being a mental health service user. Notwithstanding this diversity, such representations of mental health have a tendency to position service users as a fairly homogenous and static group of bodies – in other words, they are the stable ‘other’ (Conradson, 2005; Parr, 2000). As a way of exploring the complexity, this thesis sets out to explore the multiplex constituents and heterogeneous ways in which daily service user life is played out within everyday mental health spatial contexts. These spaces incorporate the psychiatric institution, the mental health day centre and the home. Using interviews, ethnography, poetry and visual ethnographies, service users’ experiences are analysed by exploring the relational aspects of the discursive and the non-discursive, such as receiving a diagnostic label and subsequent treatments and the ways in which these practices permeate the embodied and spatial experiences of every day service user life. This corpus of research data suggests that rather than the experiences of mental health distress operating as a stratified set of factors awaiting analysis, there were divergent accounts incorporating positivity, negativity and ambivalence in the ways which service users made meanings of their daily lives (Brown & Tucker, 2010). Consequently, this thesis is framed around the ontological realms of creativity, potentiality and of becoming within and through space (Deleuze & Guattari, 2004; Massumi, 2002). Finally, some implications of the current political changes and how these may impact upon daily service user life are discussed to highlight that mental health service users’ are always on the move.

<p> The proposed support group was designed for older Cambodian refugees who suffer from any mental health conditions primarily from the Khmer Rouge regime. Although the genocide occurred three decades ago, many refugees still suffer from posttraumatic stress disorder (PTSD), depression, anxiety, and other mental illnesses, especially among the older generation. The support group will consist of older Cambodian refugees who had lived through the Cambodian genocide (1975-1979), are 55 year of age or older, are currently residing in the Long Beach community and suffer from any mental health condition diagnosed for more than 1 year. The goal of the proposed group is to strengthen the support and connection among the Cambodian refugee elders. The actual submission and/or funding of the grant were not a requirement for the successful completion of this project.</p>

This thesis looks at how older people integrate computers and the Internet into their everyday lives and make these technologies their own as part of their broader experience of ageing. The thesis starts by considering the limits of current ‘deficit-driven' models of accessible design used in relation to older people and highlights a need to develop new approaches which can accommodate the adaptive and ‘positive' capacities that emerge with advanced age. The approach subsequently developed provides a consideration of older people's situated and subjective experiences in relation to computer and Internet engagement as part of their adaptations to ageing. Qualitative and ethnographic data in the form of participant observations, contextual interviews and video-based observations are all used to examine the ways in which older users identify computers and the Internet as relevant and construct meaningful uses for them over time. Four case studies are used to explore the contextual and subjective determinants of these emerging psycho-socio-technical relationships over time and in different contexts. Through grounded analysis patterns are established in the data which outline persistent qualities of these emerging relationships in relation to ageing. A psycho-socio-technical process known as ‘appropriation' is used to frame these adaptive relationships as they develop over time. In contrast to existing models of accessibility this analysis shows computer and Internet appropriation to be driven primarily by positive adaptations to ageing rather than its deficits. Six ‘core themes of relevance' are identified across the studies (social contact; acquiring knowledge; supporting independence; intergenerational connection; reminiscence and life review and creativity) which represent age-relevant motivations that can be used as the basis for accessible designs promoting appropriation. In addition appropriation is outlined as a cumulative developmental process with distinct phases over time. This provides a structure for supporting older people's appropriation of computers and the Internet whilst maintaining an emphasis on well-being. Finally this thesis contributes to understandings of contemporary ageing, offering insights into the potential for computers and the Internet to change the ageing experience in developed societies.

<p> This study examined sociocultural predictors of mental health treatment utilization among a combined clinical and community sample of Black older adults experiencing depression, anxiety and/ or traumatic events. A secondary analysis of a cross-sectional study that investigated the prevalence of depression and the factors associated with it among African Americans, and Caribbean Blacks over the age of 55 living in New York City using binominal logistic regression analyses. The current study investigated how the sociocultural factors of ethnicity, mental health beliefs, ethnic identity, spirituality, and religiosity predicted utilization of formal and informal mental health treatment services. The findings highlight the significance of ethnicity, depression, mental health beliefs and spirituality as predictors of utilization of mental health services. Caribbean Black older adults underutilized mental health treatment services of any type. The current study suggests that attitudes and beliefs about mental illness and health practices is a factor that should been taken into account by clinicians when assessing, diagnosing, treating and trying to maintain adherence to services of older Black adults. </p>

Occupational identity in later life represents a lifetime of occupational choices which encapsulate multiple meanings derived from the past and interpreted as a source of being in the present. Engaging in meaningful occupations has the potential to promote successful ageing, but health and declining capacities can influence that choice. The aim of this study was to explore the occupations that older people have engaged in during their lives, in particular, to discover how this influences occupational choice in later life. Ninety six people, aged 55 and over were recruited using local groups, organisations and communities of, or for older people. A survey questionnaire ascertained demographic and occupational data from this sample, which, largely concurred with national data. From those in the sample who had agreed to be interviewed, five women and three men aged between 64 and 92 were selected to reflect its diversity. A biographical approach was adopted and two to three in-depth interviews explored occupational life stories and the growth of occupational identity. Life chronologies provided a framework for narrative analysis of each biography which was followed by horizontal analysis to identify emerging themes. The findings demonstrate the considerable social changes that have occurred during the participants lives. Values, customs and occupational meaning gained early In life contributed to evolving occupational identity. Various factors such as family, class, gender and education for a young person in the 30's, 40's and 50's had a strong influence on opportunities and attainment in life. The gender imbalance In the years up to retirement, with men afforded greater opportunities than most of the women, was redressed after retirement with women having equal or greater occupational opportunity and choice than the men. Meaningful connection was the predominant form of meaning in both key occupations and daily routine, either through connection with the past self or 'being with' others in the present. A loss of occupational meaning, a state of 'being without' was identified following a major bereavement and new meaning was sought through occupations involving 'being with' others in an endeavour to accommodate a changed occupational identity. Finally the current conceptualisation of occupational identity reflects a western, but non-European, perspective, which this study demonstrated only pertained to the male participants, while the women demonstrated connectedness and interdependence. It is therefore important that the theoretical concept of occupational identity should in future include a notion of gender difference within it. A further study could explore a European perspective to ascertain if a gender difference exists in occupational identity for a younger cohort. Meanwhile, the findings from this study suggest that there is necessity for occupational therapists to promote occupation as part of the current drive for healthy ageing.

Care in the community increasingly means care by the community, i.e. the family. The present focus on informal carers by policy makers reflects their importance to the success of community care legislation (NHS and Community Care Act, 1990; Carers (Recognition and Services) Act, 1995). Much of the published information on the impact of caring has neglected the circumstances of carers from minority ethnic groups. Hence, this research explores the caring situations and experiences of informal carers of older people from Gujarati, Punjabi and white indigenous communities. Semi-structured interview schedules were used to elicit both quantitative and qualitative information from each of the three groups. Overall, the data confirmed some universal features of caring in that it is the family, and in particular women, who care for older people. However, the motivation for caring dffered between the three cultural groups. Findings also showed that many of the socio-demo graphic characteristics in the Gujarati and Punjabi groups were similar in that they tended to be co-resident, were younger and cared for a younger age group than white indigenous carers. However, a closer look at the data on the psychosocial aspects of caring revealed some distinct differences between the two South Asian groups. Gujarati and white indigenous carers reported higher levels of morale, significantly lower levels of stress and significantly higher perceived coping abilities than the Punjabi group of carers. This latter group reported using a proportionately lower number of active coping strategies and more avoidance coping techniques than Gujarati and white indigenous carers. Punjabi carers were also significantly less satisfied with any help received from formal and informal sources than the other two groups. In light of these findings, which emphasize some distinct dfferences in caring circumstances, a number of recommendations are made for both policy makers and future research

The thesis has a theoretical characteristic, it focuses and desribes the current age issue from the demographic, biologic, psychological and social prospective. It addresses the relationship of the society and senior citizens and describes the demonstration of age, the needs of senior citizens, their adaptability to different types of changes and also to health conditions of older people. It also focuses on the end of life, dying and etical principles.

Case management, a coordinating process designed to align service provision more closely to the identified needs of people requiring assistance in the context of complex care systems, is an example of those policies and practices that cross the borders of different national welfare systems, ostensibly to resolve the same or similar problems in the adopting country. Developed in the USA, case management was re-named 'care management' upon adoption in the UK as part of the community care reforms of the early 1990s, reforms which have framed my professional life in English local authority adult social care services ever since. In 2007, a temporary research fellowship (TH Marshall Fellowship, London School of Economics) enabled me to spend four months in Berlin studying a citywide case management service for older people in the context of German long-term care policy and legislation. This experience sits at the core of this thesis which addresses the extent to which the study of a specific case management service for older people in Berlin can illuminate how case management translates across differing national welfare contexts, taking into account the particular methodological challenges of cross-national research. Drawing on both cross-national social policy and translation studies literatures and adopting a multi-method case study approach, the central problems of determining similarity and difference, equivalence and translation form the core of the thesis. Informed by a realist understanding of the social world, the study took a naturalistic turn in situ that fore-grounded the more ethnographic elements in the mix of documentary research, semi-participant observation and meetings with key informants that formed my data sources and were recorded in extensive field notes. The data were analysed to trace how case management was constructed locally in relation to both state and federal level policy and legislation, and then comparatively re-examined in the context of the key methodological problems identified above in relation to understandings of care management in England as reported in the literature, in order to further explore the question of comparability of case management across different welfare contexts. The research clearly demonstrates how institutional context both shaped and constrained the adoption of case management in Berlin, and highlights a need in comparative research for close contextual examination of the apparently similar, with a focus on functionally equivalent mechanisms, to determine the extent to which case management can be said to be similar or different in different contexts, particularly where English words and expressions are directly absorbed into the local language. Relating the case study to findings from earlier studies of care management in England highlights the extent to which care management in England is itself a locally shaped and contextualised variant of case management as developed in the USA that matches poorly to the variant in Berlin. Indeed problems discovered in the research site constructing definitional boundaries for case management in practice mirror issues in the wider literature and raise questions about the specificity of the original concept itself. Nonetheless, the study shows that, despite the multiple asymmetries of equivalence and difficulties of translation, there are sufficient points of similarity for cautious potential lessons to be drawn from Berlin, particularly with regards to policy changes on the horizon in England, but also in the other direction with regards to how case management in Berlin may also be re-shaped following recent reforms to German long-term care legislation.

Through the theoretical lens of Foucault's archaeological method, this thesis undertakes a discourse analysis to examine how old age and ageing are strategically positioned as forms of governmentality in New Labour social care policy documents. It is argued that these discourses are not directed purely at the older generation, but at everyone, at all stages of life, encompassing all aspects of everyday living. Old age thus becomes a strategy of governing the population through individual everyday lives. This hints at the way ageing is prefigured, anticipated and lived in advance. An analytical method is developed by weaving together Foucault's notions of archaeology and governmentality; the latter is utilised both as an analytical perspective and to provide an understanding of how people primarily act and interact in contemporary Western societies. This analytical perspective is initially applied to an exploration of how the form and function of social policy enable ordinary practices of life to become targets of political government, making both possible and desirable the government of everyday living: governing how we ought to live in every aspect of life from work and finances to health, to personal relationships and leisure activities. The thesis progresses to explore this in more detail through a practical application of governmentality and focused discourse analysis of eight New Labour social care policy texts. The aim of the analysis is to explore what subjectivities and forms of life are possible within these discourses and therefore what these policies actually do, as distinguished from what they claim to be doing. It is argued that the discourses that emerge in these policies act to limit and subjectify, by attempting to contain and stabilise the multitude of possibilities for practices of living. By ostensibly aiming to create social inclusion the policies make possible vast areas of exclusion that become prime spaces of government. Thus many ways of living, ageing, and being old become untenable due to their inherent contradiction with the social values and rationalities upon which these discourses are based. Whilst governmentality analyses have been brought to many other policy areas, this thesis makes an original contribution by: developing a governmental analysis of social policy as a form of biopolitics; by applying this analysis to the social care field; and by using policy discourses of old age and ageing to draw out significant aspects of a governmental society. In particular it explores the dispersion of many traditional boundaries, leading to the rearrangement of relations, responsibilities and subjectivities.