It is the responsibility of professions to provide evidence of the demonstrable value and quality of service delivery. Occupational therapists in mental health care settings find it difficult to produce convincing evidence of the demonstrable value and their contribution to health care. Currently no effective outcome measure for occupational therapists in mental health practices exists for the South African context . The development of an outcomes measuring system is much needed in these crucial times of cost-cutting, rendering quality of care with the minimum resources and the quest for evidence of the effect of intervention. The purpose of this study was to fill the outcome measurement gap by developing a system that is clinically tested and user-friendly for occupational therapists in mental health care settings. Such a system had to represent the outcomes in the occupational therapy programmes, meet the needs of the therapist in terms of purpose of the tool, be easily administered and be standardised. It was also important that the outcome measure was grounded in the theoretical framework that guides intervention programmes, namely Vona du Toit’s Model of Creative Ability. This theoretical framework is widely used in South African mental health care settings and was found suitable to be transformed into a rating scale for the outcome measure. A participatory approach combined with a mixed method exploratory design, specifically the instrument development model, was selected to guide the study. The development of the outcome measure happened in three phases. Domains for the outcome measure emerged after participation from occupational therapy clinicians and mental health care users in Phase 1. The operationalisation of the domains and the development of the rating scale happened during Phase 2. The third phase was the piloting of the outcome measure to identify issues to be optimised for the final implementation of the outcome measure. Eight domains with 52 representative items emerged from Phase 1. The domains were Process skills, Communication and Interaction skills, Lifeskills, Role performance, Balanced lifestyle, Motivation, Self-esteem and Affect. Clinicians were satisfied that these domains represented the service that they deliver and compared well with the mental health care users’ need for occupational therapy. The involvement of mental health care users in confirming relevant domains for the outcome measure ensured a client-centred approach in the research process. The outcome measure, named as the Activity Participation Outcome Measure (APOM), has a unique feature of generating reports and spider graphs for every mental health care user. The APOM was piloted in three mental health care settings. In spite of good intentions from clinicians to apply the measure, it was clear that measuring outcomes is neither a priority, nor a routine task in clinical settings. The preliminary investigation into the psychometric properties yielded positive results. However, the sample sizes for the validity and reliability samples were not optimal and further data collection needs to continue for confirmation. It is recommended that investigations into the psychometric properties of the instrument continue to eventually market it as a valid and reliable outcome measure for occupational therapists in mental health care settings. / Thesis (PhD)--University of Pretoria, 2010. / Occupational Therapy / unrestricted

The state´s responsibility for the health and well-being of the population was part of the development towards the welfare state. Government agencies at various levels were helpful in surveys and were also the state´s tool for enforcing social policy goals. The main purpose of the essay is to investigate in what way mental health care 1935-1939 was a tool for the growth of the welfare state. The pronounced questions are about what mental health care looked like regarding patients’ activation, mental care in families’ homes, sterilization and forensic psychiatry, and in what way mental health care can be said to have been a state administrative unit. The investigated material is documents from the administration at St. Olof's Hospital in Visby and the source material is examined on the basis of Michel Foucault's theories on discipline, control, exclusion mechanisms and biopolitics. The result of the essay is that mental health care and St. Olof's Hospital can be seen as one of the tools for the growth of the welfare state both as part of the administration, as a prerequisite for biopolitics, and as an entertainer and messenger of norms and discipline.

Managed Mental Health Care (MMHC) began blanketing the United States when cost of care rose exponentially. MMHC is one avenue many employers and insurance companies have chosen to provide employees with mental health treatment at controlled costs. However, not all employers view supplying their employees with mental health treatment beneficial, as they do not know mental health problems can significantly decrease work productivity. Brown and Jones (2005) used the Social Role Scale (SR) of the Severe Outcome Questionnaire (SOQ) to estimate work productivity in employees under the assumption that the scale measures work productivity. The purpose of this study was to move closer to an estimation of the relationship between improved mental health and improved workplace functioning by examining the relationships among a self-report measure of mental health (i.e., the SR), a self-report measure of work productivity (i.e., the Work Productivity and Activity Impairment Scale [WPAI]), and objective measures of work productivity (i.e., the quality and timeliness of institutional records, supervisor ratings, and sick hours used). It was thought that understanding the relationships among these measures might assist in estimating the cost/benefit of investing in psychotherapy. Participants in this study were employees and inpatients at the Utah State Hospital. Statistical analyses indicated the SR did predict two WPAI scales (i.e., Presenteeism and Activity Impairment) for employees. Specific relationships among measures, and suggestions for future research, are discussed.

Informed by constructivist and social constructionist theory, a qualitative research study was conducted applying Andersen’s (1991) reflecting team model to explore use of self themes in the supervision process. A male and female Supervisor were paired with a male and female therapist to form two person supervision and reflecting teams. Four RTS sessions were conducted. Each RTS session involved three phases: 1) supervision of a case with the reflecting team observing, 2) reflecting team discussion of their observations with the supervision team observing, and 3) supervision follow-up by the supervision team with the reflecting team observing. The three phases of the RTS process led to three derivations of the original therapist story. The RTS process was discussed after each session in the post-session discussion. Utilizing the reflections of the reflecting team from Phase 2, a difference that makes a difference was introduced into the supervision story. In Phase 3, the supervision follow-up, the supervisor helped the therapist explore previously non-conscious use of self themes in the supervision narrative and construct a different narrative about him/herself and the case brought for supervision. The nature of the points of connection established in the socially constructed conversation between the therapist and client(s) was pertinent to the establishment of a "relational distance" between the client and the therapist that was too close or too distant. The supervisor not only helped the therapist become aware of the points of connection but also helped introduce a difference that allowed the therapist to be more maneuverable. All three phases of RTS are important to a supervision process. The role of the reflecting team in uncovering the "unsaid," and the supervisor in creating a difference possibly become less critical as supervisors develop reflexivity and incorporate these two phases into their typical supervision process. / Ph. D.

A combined, multiple-methods action research strategy is constructed and used to assess teams of personnel working in and around group homes for mentally retarded adults and young offenders in the Canadian Province of Newfoundland and Labrador between August, 1983 and January, 1987. Grounded in the practise experiences and previous research of the author, the question "what works?" is developed both as a contextual framework for the examination of teamwork as a component of professional practise and as a contextual feature of group care. The question is used to guide categorization and organization of differences amongst 51 sample teams in order to isolate valid and reliable measures of team work functioning. Drawing from four distinct theoretical traditions comprising core knowledge of human behaviour in the social environment, multiple methodologies for differentiating within and amongst teams are combined to triangulate data around the central research question. A methodology for the collection and analysis of data which are thought to represent the "lived experiences" of sample subjects is developed and used to illuminate the phenomenological alignments of team members. Qualitative themes in the reports of on- and off-the-job satisfactions and frustrations for sample subjects are examined for teams and for occupational groupings. Separate measures of Level of Organizational Change and Prevalence of Stressful working Conditions are developed and used to examine the interplay between these variables and other preselected variables. The assessment procedures and the typology of team functioning developed by Fulcher (1983) are replicated. Specific flaws and limitations in Fulcher's methodology and design are overcome through the use of a different theoretical orientation, extensions and refinements of the methodology, changes in instrumentation and by replicating his findings with a more homogeneous sample. Four of the team styles of adaptation are empirically validated and their descriptions refined. Both linear and non-linear statistical analytic methods are used to test for correlation and association between and among preselected variables. The Heimler/Fulcher Work Orientation Schedule, which serves as the basis for Fulcher's interpretative categorization of teams, is subjected to tests of reliability and validity and found to meet predetermined expectations. Through the use of an international, comparative data base, norms for team satisfaction and ratio of frustration to satisfaction for this instrument are empirically validated. Further research using Fulcher's typology along with the Work Orientation Schedule is indicated. Field observation recordings, sample subjects' personal narratives, the social policy and corporate contexts in which the study takes place, and a mythical, yet ultimately necessary, experiment which takes place in the future are all used to illuminate and ground the findings in the action research process.

Background: To care for someone with a mental illness can be strenuous both mentally, socially and economically. Those close to the patient are often there as support before mental health care can intervene, and they are often there when the patient is discharged from the hospital. A good relationship between mental health care personnel and those close to the patient is of most importance for creating a feeling of participation in the care of the patient. This requires that the mental health care personnel are aware of the needs of those close and have knowledge of how to meet these. Aim: To describe how those close to someone - usually a relative or loved one - with a mental illness experience the treatment from mental health personnel Method: Literature review based on 17 articles with a qualitative perspective. Analyzed using a descriptive data analysis technique. Results: Results show that those close to someone with a mental illness often feel excluded in the care of their loved ones, and mental health personnel fail to satisfy the relative or loved one’s basic needs - especially in the area of providing them with information and showing them respect. This exclusion can be felt when the care provider shows the loved one / family member an authoritarian attitude rather than appreciating or acknowledging the importance of the knowledge that these loved one possess regarding the patient’s mental illness. The results show that in cases when mental health personnel have been accommodating to the needs of the next of kin by making them feel respected, heard and taken seriously the loved one have feelings of inclusion and participation in the caring process. Discussions: The foundation of the relationship between mental health personnel and those close to the patient is often established within the first meeting. It is therefore of utterly importance that the mental health professionals are aware of how their demeanor and attitude are affecting the next of kins perception of participation. The needs of those close to the patient can, in most cases, be satisfied with relatively small means. Keywords: Relative, relatives of the mentally ill, treatment by mental health care professionals, participation, professional-family relations / Bakgrund: Att vara anhörig till en närstående med psykisk ohälsa kan vara påfrestande såväl ekonomiskt som psykiskt och socialt. Anhöriga är oftast de som är där och stöttar och hjälper till både innan och efter sjukhusvistelsen. Ett gott bemötande från vårdpersonalen är ytterst viktigt för att känna delaktighet i vårdandet, detta förutsätter att personalen är väl medveten om anhörigas behov och kan tillgodose dessa. Syfte: Att beskriva anhörigas erfarenheter av bemötandet från psykiatrisk vårdpersonal Metod: Kvalitativ litteraturstudie inkluderat 17 artiklar med kvalitativt perspektiv. Data har analyserats med tolkande dataanalys. Resultat: Resultatet visar på att anhöriga till stor del känner sig exkluderade i vårdandet av deras närstående, vårdpersonalen misslyckas ofta med att tillgodose anhörigas behov, genom att visa upp en auktoritär attityd, inte erbjuda adekvat information och uppmärksamma anhöriga som den tillgång de faktiskt är. Resultatet visar även på tillfällen då vårdpersonalens agerande får anhöriga att känna sig inkluderade och respekterade genom att skapa en känsla av delaktighet i vårdandet. Diskussion: Mötet mellan vårdpersonal och anhöriga tenderar att fallera redan på ett tidigt stadium, då innerbörden av ett gott bemötande samt vikten av att etablera en fungerade kontakt många gånger glöms bort eller inte uppmärksammas. Delaktighet i vårdandet förutsätter att vårdpersonalen är uppmärksam på anhörigas behov, genom relativt enkla medel kan dessa i de flesta fall tillgodoses.

Bakgrund: Det framkommer centrala aspekter vid omvårdnaden av patienter som skadar sig själva som i sin tur ställer krav på vårdpersonalens förmåga att förhålla sig till mötet med dessa patienter. Syfte: Syftet med litteraturstudien var att belysa psykiatrisk vårdpersonals upplevelser i mötet med patienter som skadar sig själva. Metod: En systematisk litteraturstudie baserad på Evans analysmetod och resultatet grundar sig på 22 artiklar av kvalitativ ansats. Resultat: Vårdpersonalens möten med patienter som skadar sig själva redovisas sex teman; Att utmanas av negativa känslor, Att stänga av sin empatiska förmåga, Att vara osäker på vad som komma skall, En svår balansgång, Ett gynnsamt möte och Professionell utveckling. Slutsats: Resultatet visade på att vårdpersonal i psykiatrisk vård har att hantera flera negativa känslor i sina möten med patienter som skadar sig själva. Kontinuerlig fortbildning och handledning framstår som nödvändiga förutsättningar för att möjliggöra gynnsamma möten med patientgruppen. / Background: It appears to be central aspects regarding the care of patients who self-harm and these aspects set requirements on psychiatric health care personnel's ability to relate to the meeting with the patients. Aim: To illustrate psychiatric health care personnel's experiences of meeting with patients who self-harm. Method: A systematic literature review based on a method described by Evans with a result based on 22 articles of qualitative design. Result: To meet patients who self-harm can be seen out of the six themes described in the result of the present study; To be challenged by negative emotions, To disconnect from your empathic ability, To be unsure of what´s to come, A difficult balancing act, A favorably meeting and Professional development. Conclusion: The result of the present study shows that the negative emotions were prominent. Continuous further training and tutorial appears necessary conditions to enable favorable meetings with the patient group.

Personality disorder has been and continues to be a contested diagnosis. Those who attract this form of diagnosis have been particularly vulnerable to the effects of stigma and have tended to be excluded from service provision. This thesis provides an examination of how recent developments in law, policy and practice have impacted upon the status of personality disorder as a diagnosis of exclusion in Scotland. The theoretical framework that provides this thesis with its structure is derived from the post-empiricist approach proposed by Derek Layder. This approach seeks to contextualise emergent inductive findings within a broader historical and contemporary analysis. In the case of this research the broader context consists of the interplay between mental health law, policy and practice in the field of mental health and the diagnosis of personality disorder more specifically. The empirical enquiry at the core of this thesis is based upon an analysis of the views, beliefs and expectations of front-line staff (psychiatrists and social workers qualified as mental health officers) involved in the process of assessment and service provision. In addition to front-line staff (n = 27) a range of key informants who were in a position to shed light on the strategic imperatives underpinning recent developments in law and policy were also interviewed. This analysis is contextualised within a review of key developments in law and policy that have particular significance for anyone who may attract a diagnosis of personality disorder. Despite the ostensibly inclusive approach towards those who may attract a diagnosis of personality disorder evident within the Mental Health (Care and Treatment) (Scotland) Act 2003, the reality is a highly selective and very limited inclusion of those who attract this form of diagnosis. The effective inclusion of those who may attract a diagnosis of personality disorder has been obstructed by several key impediments: 1: an insufficiently robust policy framework to drive forward the process of inclusion; 2: residual ambivalence towards the legitimacy of the diagnosis of personality disorder itself and the legitimacy of the claims made upon services by those who may attract a diagnosis of personality disorder; 3: insufficient and inadequately focused resources; 4: service structures that have not been redesigned sufficiently to engage successfully with service users who may attract a diagnosis of personality disorder. As a consequence of these impediments to inclusion, the majority of those who may attract a diagnosis of personality disorder in Scotland are likely to continue to face high levels of marginalisation and exclusion.

SOCIALINIO DIALOGO IR SOCIALINĖS PARTNERYSTĖS VAIDMUO PSICHIKOS SVEIKATOS PRIEŽIŪROS SISTEMOJE. Santrauka. Informacijos visuomenėje, keičiantis visuomeniniams, technologiniams procesams, socialinio dialogo ir socialinės partnerystės vaidmuo didėja visose srityse. Tai ypač aktualu psichikos sveikatos priežiūros srityje, nes visa sistema praranda autonomiškumą ir yra veikiama įvairaus lygio sąveikų, integruojami daugialypiai socialiniai santykiai. Socialinis dialogas ir socialinė partnerystė apima bendradarbiavimą, koordinavimą, konsultavimą, tarpininkavimą, apsikeitimą informacija, teikiant psichikos sveikatos priežiūros paslaugas. Socialinio dialogo ir socialinės partnerystės svarba išryškėjo prasidėjus struktūriniams pokyčiams psichikos sveikatos srityje, nes reformos apima daugiasektorinę politiką, į kurią įtraukiamas platus partnerių ir suinteresuotųjų ratas. Prastas bendradarbiavimas ir koordinavimas tarp teikiamų paslaugų ar skirtingų sektorių finansavimas veda prie prastos ir neefektyvios priežiūros. Tyrimo tezė. Socialinis dialogas ir socialinė partnerystė tampa sudėtine šiuolainės visuomenės dalimi, keičiasi psichikos sveikatos priežiūros problemų sprendimo būdai, įtraukiami nauji metodai ir naujos pagalbos teikimo fomos, tokios kaip socialinių partnerių tinklai, tarpdisciplininis komandinis darbas, stiprinama nevyriausybinių organizacijų ir pačių paslaugų vartotojų bei jų šeimų organizacijų įtaka. Raktažodžiai: socialinis dialogas, socialinė partnerystė, socialinių... [toliau žr. visą tekstą] / THE ROLE OF SOCIAL DIALOGUE AND SOCIAL PARTNERSHIP IN MENTAL HEALTH CARE SYSTEM. Summary. With changes in societal and technical processes, the role of Social dialogue and social partnership in the Information society, have increased in all areas. This issue is crucial while talking about mental health care system. System is loosing its autonomy and is determined by interactions of different levels. Multiple social relations are integrated. Social dialogue in mental health care services include all types of negotiation, coordination, mediation and consultation, starting with the exchange of information. Social dialogue has proved particularly important in situations of structural change and reform in the health sector. Such situations are particularly complex, however, and take a long time to evolve. They involve a wide variety of social partners and stakeholders who have to deal with a long agenda of issues. Insufficient or bad cooperation and coordination between services; single-sector approaches and specific organizational objectives, budgets and activities, leads to ineffective and low quality care services. Thesis. Social dialogue and social partnership becomes a component of modern society. The problems of the mental health care system are solving by using new methods and forms, such as networks of social partners, interdisciplinary team work, capacity-building of NGO and representatives of services users and their families. Keywords. Social dialogue, social... [to full text]

Thesis (Ph.D.)--University of Wollongong, 2008. / Typescript. Computer optical disc inserted in pocket on p. 195 entitled: Medication alliance core skills demonstration. Includes bibliographical references: p. 147-179.