The intention of this thesis is to explore and discuss the experiences of consumers and carers with psychiatric disability support services. In particular their participation in service development and delivery and the degree to which their relationship with services and providers has influenced this participation, is explored and discussed. These relationships are particularly relevant in the context of the dynamics that determine power and the strategies that consumers have adopted so that they become more empowered and have control over their own lives. / Consumers and their carers are placing greater demands on the mental health service system within Victoria. Reforms to mental health and psychiatric disability support service delivery and practice have resulted in deinstitutionalisation, recognition of fundamental human rights and changes to mental health legislation. Participation by consumers and carers in service development and delivery has been viewed by governments as necessary and important in contributing to care, treatment and support systems. / The National Mental Health Policy developed by the Australian Health Ministers paid substantial attention to the need to include consumers and carers in decisions that shape mental health services. These are underpinned by the World Health Organisation’s doctrine that people have the right and duty to participate individually and collectively in the planning and implementation of their health care. (WHO 1990, p. 14). In Victoria, the National Mental Health Policy lead to the development of a framework for mental health services that reinforced consumer and carer participation in service development and delivery. / A qualitative methodology was used for this investigation. In-depth interviews were conducted with consumers and carers to gain a thorough understanding of their experiences and perceptions of the current mental health system. A review of available literature on the developing mental health consumer movement and on the concepts and practices of empowering strategies was undertaken. The opportunities for participation in the design, development and delivery of services in the context of actual experiences, are discussed with consumers and carers with particular emphasis on consumers’ perceptions of power and empowerment. / The transition from institution to community, known as deinstitutionalisation, has not been an easy one to accept by consumers and carers alike. The changes to service design and delivery with a greater focus on community and out reach services, and the necessary changes in attitudes by providers toward consumers as a result of these changes, have established major challenges for the mental health and psychiatric disability support services sector. Consumers and carers argue that the rhetoric inherent in the decision to implement deinstitutionalisation policies and practices that have lead to a shift to services primarily delivered outside of institutions, needs to be taken to another level. They want to ensure that they are recognised and accepted as bringing essential knowledge and experience to a service system that should be designed to support consumers and carers who face life altering circumstances as a result of a mental illness. / The information provided by consumer participants suggests that the reforms to some degree have provided them with more opportunities to take control over their own lives particularly in relation to their involvement in community based psychiatric disability support services. However, they describe the attitudes of providers as remaining the greatest barrier to advancing consumer participation. Carers on the other hand describe their experiences with psychiatric disability support services as disempowering. Their disillusionment with the mental health system is attributed to the lack of support and their perceived lack of recognition in their role as carers.

This thesis examines the implementation of mental health reforms in Britain and Italy since the 1950s from a geographical perspective. Both countries have experienced the policies of deinstitutionalisation and community care, yet the timing, methods and outcomes of implementation have varied considerably, both between the countries and within them. This situation suggests that underlying social, political, economic and cultural differences have been important influences on the implementation of the respective mental health reforms, and this is a theme that is considered throughout the thesis. The research was conducted at three levels of enquiry: firstly by comparing the implementation of mental health reforms at the national scale in Britain and Italy, looking in particular at the influence of politics and place; secondly by focusing upon the implementation of the reforms in two cities, for which Sheffield and Verona were selected; thirdly a case study approach was adopted in order to study in greater detail one community-based mental health service in each city. It was at this level of enquiry that the more intensive research was carried out, in the form of two local resident questionnaire surveys, one in each city, and semi-structured interviews with mental health professionals from the two case study services. This research illustrates that the implementation of mental health reforms in Britain and Italy has led to a geographical unevenness in the distribution of community-based services at all spatial scales. However, the social, cultural and political contexts in which the reforms have occurred in the two countries have been quite different and therefore when contemplating direct comparisons between mental health reforms in Britain and Italy, the argument that 'place matters' is highly pertinent.

No description available.

No description available.

The Austrian mental health care system has been characterized by reform initiatives since the 1970s. The reform strategies can be summarized under the term 'community mental health care'. The thesis focuses on an analysis of the reform (context) and the related challenges for mental health care financing with respect to its interdependencies with service provision in the process of change. In a qualitative research process, firstly, reform documents and transcripts of qualitative interviews have been analyzed via a discourse-analytical approach. Secondly, secondary data on mental health care financing in Austria and in western European countries have been collected. An analytical framework was, finally, applied to analyze the interrelations between mental health care financing and reform discourse with respect to its impact on the micro-level and on the macro-level of the mental health care system. The results show that the reform discourse reflects broader welfare state transformation processes. Yet, financing issues have hardly been addressed in reform discussions. Nevertheless, discursive elements are either explicitly or implicitly associated with financing issues or are even linked to specific financing models. A central impact from the restructuring processes on the micro-level is an increasing (financial) responsibility for people who are affected by a mental disorder and/or their relatives. On the macro-level, the processes of change are related to decreasing (financial) responsibility for the sector 'state' while responsibility for the sectors 'family' and 'voluntary/community' is rising. The international development shows similar characteristics. The thesis finishes with some recommendations for developing an alternative financing model and provides a guideline for a comprehensive discussion of alternative mental health care financing approaches. (author´s abstract)

No description available.

Title from second page of PDF document. Includes bibliographical references (p. 99-101).

A presente dissertação propõe-se a contribuir para um dos desafios atuais enfrentados pelo movimento da Reforma Psiquiátrica brasileira quanto às possibilidades de participação social e exercício de protagonismo dos usuários de saúde mental. Embora tenhamos avançado no terreno dos direitos sociais, garantindo a abertura de serviços e a mudança na concepção de tratamento à loucura, ainda resta o fantasma do usuário/alienado mental, reduzido à passividade e inércia frente ao seu tratamento. A partir disso e do contexto das conferências de saúde mental, realizadas no decorrer do ano de 2010, o objetivo desta pesquisa foi cartografar o processo micropolítico de participação associado à produção de protagonismo em saúde mental. Para tanto, o referencial da Análise Institucional e da Pesquisa-Intervenção serviu de sustentação metodológica, valendo-se da observação participante, do diário de campo, do questionário dos Incidentes Críticos e da realização de entrevistas semi-estruturadas enquanto ferramentas de pesquisa. A pesquisa de campo valeu-se de espaços instituídos de participação, mediante inserção do pesquisador em duas conferências de saúde mental, através da Associação dos Usuários, Familiares e Militantes da Saúde Mental e das reuniões das Assembleias dos Usuários em um Centro de Atenção Psicossocial (CAPS) do município de Alegrete, fronteira oeste do Estado do Rio Grande do Sul. Como resultados, foi possível identificar que a necessária institucionalização de espaços participativos em saúde mental pode acarretar no risco de uma cronificação desses mesmos espaços, reduzindo seu potencial instituinte à mera burocratização. Entretanto, quando esses espaços constituem-se enquanto terreno para a instalação de processos de singularização, construídos coletivamente, então se pôde constatar a possibilidade de exercício de protagonismo pelos usuários. Esse protagonismo entendido como um processo de subjetivação, costurado micropoliticamente a partir da convivência e organização de um coletivo de usuários. Desse modo, a pesquisa aposta no protagonismo enquanto efeito subjetivador, resultante desse espaço coletivo de participação, capaz de empoderar os usuários para o efetivo exercício de autonomia e cidadania. / This dissertation intends to contribute to the current challenges faced by the Brazilian Psychiatric Reform movement of the possibilities of social participation and exercise of self-governing of users of mental health. Although we have advanced the field of social rights, ensuring the opening of services and changing the design of treatment of madness, there remains the specter of the user / alienated user, reduced to passivity and inertia in their treatment. From this and the context of mental health conference, held during the year 2010, the objective was to map the micropolitical participation process associated with production of leadership in mental health. For this, the reference of Institutional Analysis and Research-Intervention served as a methodological support, drawing on participant observation, field diary, questionnaire of Critical Incident and conducting semi-structured interviews as research tools. The field research took advantage of spaces for participation established by insertion of the researcher in two conferences on mental health, through the Association of Users, Families and mental health militants and the meetings of the Assemblies of users in a Psychosocial Attention Center in Alegrete, western border of Rio Grande do Sul. As a result, we identified that required institutionalization of participatory spaces in mental health can result in a risk of chronicity of those spaces, reducing their potential to merely instituting bureaucratization. However, when these spaces are constituted as a ground for the installation process of being unique, collectively built, so if you could see the possibility of exercise of self-governing by users. Such leadership understood as a subjective process, tailored micropolitically from the relationship and organization of a collective users. Thus, research on the role as a bet subjectifying effect, resulting from this collective space for participation, capable of empowering users to the effective exercise of autonomy and citizenship.

A presente dissertação propõe-se a contribuir para um dos desafios atuais enfrentados pelo movimento da Reforma Psiquiátrica brasileira quanto às possibilidades de participação social e exercício de protagonismo dos usuários de saúde mental. Embora tenhamos avançado no terreno dos direitos sociais, garantindo a abertura de serviços e a mudança na concepção de tratamento à loucura, ainda resta o fantasma do usuário/alienado mental, reduzido à passividade e inércia frente ao seu tratamento. A partir disso e do contexto das conferências de saúde mental, realizadas no decorrer do ano de 2010, o objetivo desta pesquisa foi cartografar o processo micropolítico de participação associado à produção de protagonismo em saúde mental. Para tanto, o referencial da Análise Institucional e da Pesquisa-Intervenção serviu de sustentação metodológica, valendo-se da observação participante, do diário de campo, do questionário dos Incidentes Críticos e da realização de entrevistas semi-estruturadas enquanto ferramentas de pesquisa. A pesquisa de campo valeu-se de espaços instituídos de participação, mediante inserção do pesquisador em duas conferências de saúde mental, através da Associação dos Usuários, Familiares e Militantes da Saúde Mental e das reuniões das Assembleias dos Usuários em um Centro de Atenção Psicossocial (CAPS) do município de Alegrete, fronteira oeste do Estado do Rio Grande do Sul. Como resultados, foi possível identificar que a necessária institucionalização de espaços participativos em saúde mental pode acarretar no risco de uma cronificação desses mesmos espaços, reduzindo seu potencial instituinte à mera burocratização. Entretanto, quando esses espaços constituem-se enquanto terreno para a instalação de processos de singularização, construídos coletivamente, então se pôde constatar a possibilidade de exercício de protagonismo pelos usuários. Esse protagonismo entendido como um processo de subjetivação, costurado micropoliticamente a partir da convivência e organização de um coletivo de usuários. Desse modo, a pesquisa aposta no protagonismo enquanto efeito subjetivador, resultante desse espaço coletivo de participação, capaz de empoderar os usuários para o efetivo exercício de autonomia e cidadania. / This dissertation intends to contribute to the current challenges faced by the Brazilian Psychiatric Reform movement of the possibilities of social participation and exercise of self-governing of users of mental health. Although we have advanced the field of social rights, ensuring the opening of services and changing the design of treatment of madness, there remains the specter of the user / alienated user, reduced to passivity and inertia in their treatment. From this and the context of mental health conference, held during the year 2010, the objective was to map the micropolitical participation process associated with production of leadership in mental health. For this, the reference of Institutional Analysis and Research-Intervention served as a methodological support, drawing on participant observation, field diary, questionnaire of Critical Incident and conducting semi-structured interviews as research tools. The field research took advantage of spaces for participation established by insertion of the researcher in two conferences on mental health, through the Association of Users, Families and mental health militants and the meetings of the Assemblies of users in a Psychosocial Attention Center in Alegrete, western border of Rio Grande do Sul. As a result, we identified that required institutionalization of participatory spaces in mental health can result in a risk of chronicity of those spaces, reducing their potential to merely instituting bureaucratization. However, when these spaces are constituted as a ground for the installation process of being unique, collectively built, so if you could see the possibility of exercise of self-governing by users. Such leadership understood as a subjective process, tailored micropolitically from the relationship and organization of a collective users. Thus, research on the role as a bet subjectifying effect, resulting from this collective space for participation, capable of empowering users to the effective exercise of autonomy and citizenship.

A presente dissertação propõe-se a contribuir para um dos desafios atuais enfrentados pelo movimento da Reforma Psiquiátrica brasileira quanto às possibilidades de participação social e exercício de protagonismo dos usuários de saúde mental. Embora tenhamos avançado no terreno dos direitos sociais, garantindo a abertura de serviços e a mudança na concepção de tratamento à loucura, ainda resta o fantasma do usuário/alienado mental, reduzido à passividade e inércia frente ao seu tratamento. A partir disso e do contexto das conferências de saúde mental, realizadas no decorrer do ano de 2010, o objetivo desta pesquisa foi cartografar o processo micropolítico de participação associado à produção de protagonismo em saúde mental. Para tanto, o referencial da Análise Institucional e da Pesquisa-Intervenção serviu de sustentação metodológica, valendo-se da observação participante, do diário de campo, do questionário dos Incidentes Críticos e da realização de entrevistas semi-estruturadas enquanto ferramentas de pesquisa. A pesquisa de campo valeu-se de espaços instituídos de participação, mediante inserção do pesquisador em duas conferências de saúde mental, através da Associação dos Usuários, Familiares e Militantes da Saúde Mental e das reuniões das Assembleias dos Usuários em um Centro de Atenção Psicossocial (CAPS) do município de Alegrete, fronteira oeste do Estado do Rio Grande do Sul. Como resultados, foi possível identificar que a necessária institucionalização de espaços participativos em saúde mental pode acarretar no risco de uma cronificação desses mesmos espaços, reduzindo seu potencial instituinte à mera burocratização. Entretanto, quando esses espaços constituem-se enquanto terreno para a instalação de processos de singularização, construídos coletivamente, então se pôde constatar a possibilidade de exercício de protagonismo pelos usuários. Esse protagonismo entendido como um processo de subjetivação, costurado micropoliticamente a partir da convivência e organização de um coletivo de usuários. Desse modo, a pesquisa aposta no protagonismo enquanto efeito subjetivador, resultante desse espaço coletivo de participação, capaz de empoderar os usuários para o efetivo exercício de autonomia e cidadania. / This dissertation intends to contribute to the current challenges faced by the Brazilian Psychiatric Reform movement of the possibilities of social participation and exercise of self-governing of users of mental health. Although we have advanced the field of social rights, ensuring the opening of services and changing the design of treatment of madness, there remains the specter of the user / alienated user, reduced to passivity and inertia in their treatment. From this and the context of mental health conference, held during the year 2010, the objective was to map the micropolitical participation process associated with production of leadership in mental health. For this, the reference of Institutional Analysis and Research-Intervention served as a methodological support, drawing on participant observation, field diary, questionnaire of Critical Incident and conducting semi-structured interviews as research tools. The field research took advantage of spaces for participation established by insertion of the researcher in two conferences on mental health, through the Association of Users, Families and mental health militants and the meetings of the Assemblies of users in a Psychosocial Attention Center in Alegrete, western border of Rio Grande do Sul. As a result, we identified that required institutionalization of participatory spaces in mental health can result in a risk of chronicity of those spaces, reducing their potential to merely instituting bureaucratization. However, when these spaces are constituted as a ground for the installation process of being unique, collectively built, so if you could see the possibility of exercise of self-governing by users. Such leadership understood as a subjective process, tailored micropolitically from the relationship and organization of a collective users. Thus, research on the role as a bet subjectifying effect, resulting from this collective space for participation, capable of empowering users to the effective exercise of autonomy and citizenship.