Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2020 / The integration of mental health care (MHC) into primary health care (PHC) has been identified as a practical intervention to: increase accessibility to mental health care; reduce stigma and discrimination against people living with mental illnesses; improve the management of chronic mental illness; and, to reduce the burden of comorbidity of mental illnesses with other chronic illnesses. In the South African context, integrating MHC into PHC also seeks to respond to numerous legislative reforms, with the aim of providing comprehensive health care, particularly to previously disadvantaged populations. The aim of the present study was to explore the perceptions of facility managers in the Tshwane District (Gauteng Province) towards the integration of mental health into PHC. Fifteen participants from the Tshwane district facilities participated in the study. The participants were selected through a non-probability purposive sampling method. Data was collected through in-depth interviews using a semi-structured questionnaire, and analysed using the thematic coding approach. Significant findings suggested that the major hindrances to the realisation of the policy objectives may be due to: the lack of rehabilitation and psychotherapeutic services; insufficient skill and knowledge of mental health on the part of staff; insufficient or unsuitable practice space in the facilities; and, poor cooperation between South African Police Services, Emergency Medical Services and Primary Health Care. Inter-facility communication, district implementation support and policy knowledge has notably increased over the years and were deemed to be amongst the biggest enablers.

CONTEXTE : Les critères de jugement prenant en compte le ressenti des patients, tels que la qualité de vie, deviennent des éléments déterminants pour l’évaluation des prises en charge et l’aide à la décision. Bien que les troubles mentaux représentent un fardeau considérable tant en termes de prévalence que de conséquences économiques, les connaissances sur la qualité de vie des patients pris en charge par les services de psychiatrie sont limitées, ce qui complexifie la prise de décisions éclairées dans le champ de la santé mentale.OBJECTIFS : Nos objectifs étaient d’évaluer la qualité de vie, mesurée par des scores d’utilité, des patients souffrant de troubles mentaux en France, de mesurer la perte de qualité de vie attribuable à ces troubles et d’identifier les facteurs qui y sont associés.MATERIEL ET METHODES : Après une revue de la littérature décrivant les instruments de mesure de la qualité de vie utilisés en santé mentale, nous avons évalué la qualité de vie des patients pris en charge par le secteur de psychiatrie générale en mobilisant deux instruments permettant le calcul de scores d’utilité : le SF-36, permettant le calcul de scores d’utilité via le SF-6D, et l’EQ-5D. Nous avons comparé leurs performances et avons évalué leur concordance. Nous avons confronté la qualité de vie des patients souffrant de troubles mentaux à celle de la population générale en mobilisant les données du volet « ménages » de l’enquête Handicap-Santé. Enfin, nous avons recouru à des outils de modélisation adaptés aux spécificités des distributions des scores d’utilité pour étudier les caractéristiques sociodémographiques, cliniques et les prises en charge psychiatriques des patients qui y sont associées.RESULTATS : Notre enquête a inclus 212 patients. Leurs scores d’utilité moyens s’élevaient à 0,684 dans le cas d’une mesure par le SF-6D et à 0,624 dans le cas de l’EQ-5D et étaient inférieurs de 11% à ceux de la population générale. Le fait d’être une femme et le fait d’être sévèrement malade étaient associés à des scores d’utilité plus faibles. Les patients ayant été librement hospitalisés à temps plein, par rapport à ceux ne l’ayant pas été, avaient tendance à avoir des scores SF-6D plus faibles tandis que les patients pris en charge à temps partiel présentaient des scores SF-6D plus élevés. Les scores d’utilité SF-6D et EQ-5D n’étaient pas concordants. Si les deux instruments étaient comparables en termes d’acceptabilité et de validité discriminante et convergente, l’EQ-5D était moins sensible, présentant un effet plafond, et les modèles mis en œuvre pour identifier les facteurs associés à ce score présentaient des performances modestes.CONCLUSION : Nos travaux ont permis d’objectiver l’impact négatif des troubles mentaux sur la qualité de vie des personnes atteintes. Les différences importantes identifiées entre les scores d’utilité SF-6D et EQ-5D font du choix de l’instrument le plus adapté un enjeu majeur. Le manque de sensibilité du score d’utilité EQ-5D et les difficultés rencontrées pour trouver un modèle statistique adapté aux spécificités de ce score suggèrent une meilleure adéquation du SF-6D au champ de la santé mentale. Cependant, des travaux menés sur des échantillons de taille plus conséquente seront mis en œuvre pour préciser nos résultats. / BACKGROUND: Assessment criteria which take patients’ perceptions into account, such as quality of life, are becoming increasingly important in health services assessment and policy and clinical decision-making. Despite the fact that mental disorders represent a significant burden in terms of prevalence and economic consequences, there is a lack of knowledge regarding quality of life of patients cared for by mental health care services which impedes informed decision-making in the field of psychiatry.OBJECTIVES: Our objectives were to measure quality of life using utility scores of people cared for by mental health care services in France; to assess the loss of quality of life attributable to mental disorders; and to identify factors associated with quality of life.MATERIAL AND METHODS: After a literature review describing quality of life tools used in the field of mental health, we undertook a survey to measure the quality of life of people suffering from mental disorders who were treated in the general psychiatric sector using two tools and the corresponding utility scores: the SF-36, allowing calculation of utility scores by the SF-6D, and the EQ-5D. We compared them in terms of performance, and we assessed their consistency. We evaluated the quality of life loss attributable to mental disorders considering data from the French general population-based survey on health and disabilities as a reference. Finally, we used several models adapted to the specificities of the utility score distributions to identify socio-demographic, clinical and mental health care utilization characteristics associated with quality of life.RESULTS: 212 patients were included. The mean utility score was 0.684 when assessed by the SF-6D, and 0.624 when assessed by the EQ-5D. Utility scores of patients suffering from mental disorders were 11% lower than those of the general population. Being a woman and being severely ill were factors associated with lower utility scores using both tools. In comparison with no hospitalization, voluntary hospitalization within the past 12 months was associated with lower SF-6D utility scores, whereas part-time hospitalization was linked with higher SF-6D utility scores. SF-6D and EQ-5D utility scores showed poor agreement in measuring quality of life. These instruments were similar in terms of acceptability as well as discriminant and convergent validity; however, the EQ-5D showed lower sensitivity, illustrated by a ceiling effect, and the models used to study factors associated with this score showed poor performances.CONCLUSION: We objectivized the negative impact of mental disorders on quality of life. Considering the significant differences identified between the SF-6D and EQ-5D utility scores, the choice of the most adapted instrument constitutes a major issue. The lack of sensitivity of the EQ-5D and the difficulties experienced in finding a model adapted to the specificities of this score would suggest that the SF-6D is better suited to the field of mental health. However, our results must be confirmed by analysis on larger samples.

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Abstrakt Trots att det i Sverige finns lagar som säger att patienten så långt det är möjligt ska vara delaktig i sin egen vård, så verkar inte det vara fallet. Inom den psykiatriska tvångsvården är det ofta en obalans mellan personalen och patientens makt, därav vikten av att arbeta mot patientens delaktighet. Syftet med den integrerade litteraturöversikten var att sammanställa kunskap om patientdelaktighet vid sluten psykiatrisk tvångsvård. Följande frågor besvarades: Vilka förutsättningar för delaktighet finns i den slutna psykiatriska tvångsvården? Vilka hinder för delaktighet finns i den psykiatriska tvångsvården? Metod Integrerad litteraturstudie. Sökningar gjordes i tre databaser utifrån tre sökblock. Det resulterade i sexton artiklar som svarade mot syftet, två kvantitativa, en mixad metod och tretton kvalitativa. Inklusions kriterier: peer-review, engelska och inte äldre än tio år. Detta resulterade i sexton artiklar. Artiklar lästes igenom både enskilt och tillsammans, därefter vidtog dataextraktion där enheter togs ut som svarade mot syftet. Resultat: Analysen resulterade i elva kategorier, varav attityd, engagemang, relation och tvångsvård var mest framträdande. Det som kom fram är att för att det ska kunna jobbas utifrån patient delaktighet krävs det att personalen har en öppen, engagerad och ärlig attityd. Detta gör det möjligt att bygga en god relation mellan patient och personal, vilket i sin tur kan leda till patientdelaktighet. Slutsats Vad behövs för patientdelaktighet beror på vilken attityd man har. Är man som personal öppen, engagerad och ärlig då kan man bygga en relation till patienten och lägga grunden för patientdelaktighet

Bakgrund: Ätstörningar anses vara ett allvarligt psykiatriskt tillstånd som kan vara potentiellt livshotande och åsamka omfattande samt mångårigt lidande. Anorexia nervosa (AN) bedöms som komplext och involverar psykiska som fysiska dimensioner av personers hälsa. Tillståndet är omdiskuterat som den mest svårbehandlade psykiskiatriska sjukdomen. Flertalet studier har lyft debatten avseende behandlingsåtgärder som generellt sett tenderar att vara sprungna ur ett mer traditionsenligt angreppssätt. Begränsningar tycks således föreligga av individers subjektiva erfarenheter vid vårdkontakt. Den samtida psykiatriska vården syftar till att stärka individers förmåga till återhämtning samt meningsfullt liv, varför det kan betraktas som väsentligt att erhålla utökad förståelse inför personer med anorexia nervosas erfarenheter för att anpassa omvårdnadsåtgärder samt förhållningssätt utifrån behov, person samt situation. Syfte: Studien syftade till beskriva personer med anorexia nervosas erfarenheter av vård. Metod: En metasyntes har genomförts med stöd av Polit och Becks niostegsmodell samt Roséns principer för att erhålla en systematik. Databaserna CINAHL, APA Psychinfo samt PubMed har nyttjats. Sammantaget medförde urvalsprocessen 13 vetenskapliga artiklar. Analys: Dataunderlaget analyserades med kvalitativ innehållsanalys och genererade tolv underteman, fyra teman och ett övergripande huvudtema. Resultat: Ett huvudtema utkristalliserades: De yttre och inre elementens inverkan samt samverkan vid vårdkontakt och återhämtning utifrån ett inifrånperspektiv. Med tillhörande fyra teman *En vård som motverkar sitt syfte med förvärvning av besvär i relation till personcentrering, *Ett hotfullt och konfliktfyllt behandlingssystem i relation till trygghet samt frigörelse, *Omgivningens och vårdpersonalens inverkan, förhållningssätt samt attityder i relation till återhämtning, *Den inre dialogen och striden i relation till återhämtningsprocessen. Slutsats: Utfallet från metasyntesen konstaterade att upplevelser och erfarenheter kunde skiljas åt mellan personer med AN samt influeras av såväl inre som yttre elements samverkan liksom inverkan. För att främja erfarenheter samt det unika behovet tycktes ett mer personcentrerat- och återhämtningsinriktat resonemang vara essentiellt.

Forskning visar att psykisk ohälsa bland barn och ungdomar som grupp har ökat sedan flera årtionden. Studier visar att psykisk ohälsa ofta börjar under tidiga utvecklingsfaser i livet och särskilt under ungdomsåldern och därför motiverar det tidiga och förebyggande insatser. Det finns stora utmaningar vid vård för psykisk hälsa och ohälsa för ungdomsgruppen vad gäller tillgång till vård med god kvalitet. Mycket av forskning på vård för unga utgår från vuxnas perspektiv och det framkommer bristande evidens gällande behandlingar för ungdomsgruppen. Ungdomars perspektiv behövs för att kvalitetssäkra vården. Det finns lite forskning inom området och därför syftar denna studie att bidra till ungdomars perspektiv på vård för psykisk hälsa och ohälsa. Frågeställningarna undersökte behov, förväntningar och på vilket sätt ungdomar önskar kontakt med vård för psykisk hälsa och ohälsa. För att undersöka detta har kvalitativ intervjumetod genomförts med åtta ungdomar, mellan 16–17 år. Resultatet behandlades/bearbetades med hjälp av kvalitativ tematisk analys och där det framkom teman som visar på att ungdomar önskar mer kunskap om vård och psykisk hälsa och ohälsa. Ungdomarna påvisar behov av tillgänglig och individuellt anpassad vård med delaktighet och valmöjlighet som främjar självständighet. Ungdomarna förväntar sig god kvalitet på vård, vård i tid, vård med rätt kompetens, bra bemötande och vård på rätt vårdnivå. Det finns fortsatta utmaningar att på samhällsnivå ge ungdomar stöd, behov av samverkan med och mellan vårdinstanser samt fortsatt forskning på området. / Research shows that mental illness among children and young people as a group has been increasing for several decades. Studies show that mental illness often begins during early developmental phases of life and especially during adolescence and therefore justifies early and preventive interventions. There are major challenges in mental health care for the adolescent group in terms of access to good quality care. Much of the research on care for young people is based on the perspective of adults and there is a lack of evidence regarding treatments for the adolescent group. Young people's perspectives are needed to ensure the quality of care. There is little research in the field and therefore this study aims to contribute to young people's perspectives on mental health care. The questions examined needs, expectations and in what way adolescents want contact with care for mental health. To investigate this, a qualitative interview method has been conducted with eight young people, between 16-17 years old. The results were processed with the help of qualitative thematic analysis and there were themes that show that young people want more knowledge about health care and mental health. The adolescents demonstrate a need for accessible and personalized care with participation and choice that promotes independence. Young people expect good quality care, care in time, care with the required competencies, good treatment and care at the right level. There are continued challenges in providing support to young people at the societal level, the need for collaboration with and connections between healthcare institutions and continued research in the area.

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PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / iii Abstract The Mental Health Act is the law which sets out when you can be admitted, detained, and treated in hospital against your wishes. It is also known as being “sectioned”. For this to happen, certain people must agree that you have a mental disorder that requires a stay in hospital. In South Africa, the Mental Health Act of 1973 was noted to have many gaps. Due to all the shortcomings, in 2004 the Mental Health Care Act No. 17 of 2002 came into being in order to protect human rights of the mental health care users. This study sought to determine the knowledge and explore the experiences of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002. Secondly, based on the findings, to develop a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors in Vhembe District. The population of this study consisted of all medical doctors working in Vhembe District Hospitals with mental health units and at a specialized mental health hospital as well as all documents completed by medical doctors during admission, care and discharge of mental health care users were purposively sampled. The study was conducted in two phases. In phase 1, where quantitative and qualitative designs were followed to do situational analysis. In phase 2, the programme was developed using results from phase 1, the theoretical framework and approaches outlined by Dickoff, James and Wiedenbach (1968); Chinn and Krammer (1999); Walker and Avant (1995). Individual in-depth interviews and questionnaires checklist were used to collect data which was analysed through opened coding method and SPSS. The findings of this study indicate that medical doctors have knowledge and skills deficit regarding implementation of the Mental Health Care Act No. 17 of 2002 during the admission, care, and discharge of mental health care users. Based on these, a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors during admission, care and discharge of mental health care users was developed. The study concludes that this is a significant contributor in supporting the vision of the National Department of Health to ensure improved mental health for all in South Africa. The study recommends a longitudinal study, tracking the impact of a developed programme, the knowledge of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002, and its contribution to the improvement of mental health for all should be conducted over a period of 5 (five) to 10 (ten) years

Mental illness remains one of the most devastating condition affecting the social functioning of individuals and families. The affected individuals and their caregivers expressed dissatisfaction in mental health service delivery. The mental health system is medically oriented and does not involve caregivers as partners in the provision of mental health services. Although the developmental approach has been adopted to guide the provision of services recognising human rights and social justice, the medical model remains a challenge in the provision of comprehensive mental health services. This is compounded by the Mental Health Care Act (Act No. 17 of 2002) that is silent on the role of families in the mental health system. Additionally, social workers are unable to provide adequate services due to lack of resources. A qualitative study using the exploratory, descriptive and contextual designs was undertaken. Purposive sampling was used to select 28 participants from three groups, namely ten MHCUs, nine caregivers and nine social workers. The goals of the study were to understand the experiences of MHCUs, caregivers and social workers in mental health service delivery; and to proffer guidelines for social work practice to enhance partnership between the family and mental health care providers. Data was gathered through semi-structured interviews and analysed according to Tesch’s (in Creswell, 2009:186; 2014) framework. Data verification was guided by Lincoln and Guba’s (in Krefting, 1991:214-222) model to enhance trustworthiness. The findings suggest that MHCUs and caregivers received inadequate psychosocial support which is attributed to lack of involvement in service delivery. Furthermore, social workers lack adequate training to provide effective mental health care. As a result, guidelines were developed for the establishment and enhancement of partnership between families and mental health service providers to offer comprehensive and sustainable mental health services. Future exploration of the role of the family in mental health services is required. / Social Work / D. Phil. (Social Work)