This study examined the use of language in the development and implementation of mental health policy. It focused on the current discourse of mental health reform in Ontario as it related to individuals with a mental illness and who are in conflict with the law. Using a qualitative design, informed by critical inquiry and a postmodern perspective, the researcher explored administrative perceptions of the accomplishments and challenges faced at different levels of the mental health and criminal justices systems in Ontario. The participants' understandings of the provincial mental health reform policy, Making it Happen, and the extent they felt that their organizations and related policies were able to create positive change in the lives of service users were also examined. While the language of mental health policy encompasses an empowerment, community integration approach to providing services, findings indicated that a biomedical-model, public safety discourse appear to inform both policy and practice. A number of questions and apparent inconsistencies in the manner in which the mental health and criminal justice systems deal with the needs of this population were also identified. This thesis concludes with recommendations for future research.

Over the past decade, concerns with the accessibility and quality of health services have led several individuals to bring tort claims against provincial governments. Unlike other types of health sector legal claims, which have been the subject of much commentary, this thesis provides the first treatment of the tort cases against governmental defendants. To date, Canadian courts have not been receptive to these claims, striking nearly all of them on pre-trial motions, on the basis that government defendants did not owe the plaintiffs a duty of care. In order to situate the health sector tort claims within the judiciary’s broader approach to governmental liability, I compiled a dataset of all tort cases against Canadian governmental defendants from the past decade. My dataset indicates that judges have dismissed more health sector tort claims than those arising from nearly all other sectors of government activity, even accounting for other explanatory variables. I also develop a framework to categorize the judicial approaches to the test for establishing a duty of care. Canadian judges now generally conduct a comprehensive analysis of the closeness and directness of the parties’ relationship and the policy implications of tort liability in determining whether a defendant owes a plaintiff a duty of care. However, judges adjudicating health sector claims fail to appreciate the government’s modern role in the health sector and are almost singularly concerned with the policy implications of their decisions. I conclude with two policy recommendations. First, I argue that judges should more frequently permit these claims to proceed beyond the pre-trial dismissal stage to a full trial, in order to evaluate the policy concerns both for and against governmental liability with the benefit of a full evidentiary record. Second, I argue that judges should more frequently permit health sector tort claims to proceed beyond the duty of care stage of the negligence analysis to an assessment of whether the government met the standard of care. While this approach would allow judges to scrutinize the reasonableness of the government’s decisions, improving transparency and potentially motivating an improved decision-making process, it would not necessarily lead to widespread liability.

Over the past decade, concerns with the accessibility and quality of health services have led several individuals to bring tort claims against provincial governments. Unlike other types of health sector legal claims, which have been the subject of much commentary, this thesis provides the first treatment of the tort cases against governmental defendants. To date, Canadian courts have not been receptive to these claims, striking nearly all of them on pre-trial motions, on the basis that government defendants did not owe the plaintiffs a duty of care. In order to situate the health sector tort claims within the judiciary’s broader approach to governmental liability, I compiled a dataset of all tort cases against Canadian governmental defendants from the past decade. My dataset indicates that judges have dismissed more health sector tort claims than those arising from nearly all other sectors of government activity, even accounting for other explanatory variables. I also develop a framework to categorize the judicial approaches to the test for establishing a duty of care. Canadian judges now generally conduct a comprehensive analysis of the closeness and directness of the parties’ relationship and the policy implications of tort liability in determining whether a defendant owes a plaintiff a duty of care. However, judges adjudicating health sector claims fail to appreciate the government’s modern role in the health sector and are almost singularly concerned with the policy implications of their decisions. I conclude with two policy recommendations. First, I argue that judges should more frequently permit these claims to proceed beyond the pre-trial dismissal stage to a full trial, in order to evaluate the policy concerns both for and against governmental liability with the benefit of a full evidentiary record. Second, I argue that judges should more frequently permit health sector tort claims to proceed beyond the duty of care stage of the negligence analysis to an assessment of whether the government met the standard of care. While this approach would allow judges to scrutinize the reasonableness of the government’s decisions, improving transparency and potentially motivating an improved decision-making process, it would not necessarily lead to widespread liability.

In this dissertation we present mathematical models that help answer health policy questions relating to HIV and Hepatitis C (HCV), and analyze bias in Markov models of disease progression. We begin by developing a Markov decision process model that examines the timing of testing and treatment for diseases with asymptomatic periods such as HCV. We explicitly consider secondary infections, false positives and negatives, and behavioral modification from information from test results. We derive sufficient conditions for testing and/or treating in a dynamic environment, i.e., when unscheduled patients arrive. We also develop a detailed simulation model for general testing and/or treating for HCV. A key finding is that the current policy recommendations on testing for HCV may be too restrictive, and that it is cost-effective to test the overall population if done at the appropriate times. The Markov models used in the study of HCV motivated the next topic where we examine bias in Markov models of diseases. We examine models in which the progression of the disease varies with severity and find sufficient conditions for bias to exist in models that do not allow for transition probabilities to change with disease severity. We apply the results to HCV and find that the bias is significant depending on the method used to aggregate the disease data. We close with a discussion on a specific question in HIV policy where we develop a Bernoulli process transmission model in which, for a given individual, each risky person-to-person contact is treated as an independent Bernoulli trial. Using the model and data from the Urban Men's Health Study, we estimate the affect that interventions at venues, namely bathhouses, in which high-risk behavior takes place would have on HIV transmission.

Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions.The findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 88-109).

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Thesis (Ph.D.)--University of Wollongong, 2002. / Typescript. Includes bibliographical references.

Thesis (M.Sc.(Hons.))--University of Wollongong, 2004. / Typescript. Includes bibliographical references: leaf 135-138.

Thesis (Ph.D.)--University of Wollongong, 2005. / Typescript. Includes bibliographical references: leaf 356-399.