This study focused on the quantitative and qualitative aspects of suicidal behaviour of 90 people who had come to the attention of the Accident and Emergency Department of Westmead Hospital, Sydney, N.S.W., after an attempt to harm themselves. The risk factors identified in the study were combined with the circumstances and motive of attempt. Participants were regrouped according to whether the problems the respondent described were chronic (longstanding) or acute (pivotal). The participants were further classified according to the persistence of thoughts of self-harm ( impulsive or non-impulsive/deliberate) and the presence or absence of these feelings at the time of the interview (the resolution of the attempt) and the types of problems/situations and triggering events the person described as wanting to escape. By developing strategies and treatments for the problems as they were identified in this study and by raising the awareness that there is help available for these different issues, we may be able to reduce the pain which results in an attempt to self harm. / Doctor of Philosophy (PhD)

Under-utilisation of mental health services is widespread globally and within Australia, especially among culturally and linguistically diverse (CALD) communities. Improving service access is a priority, as is the need to deliver culturally competent services to the CALD communities. Having migrated to Australia in waves for approximately 150 years from China and South East Asia for various social, political and economic reasons, the Chinese population in Sydney is now the fastest growing non-English speaking ethnic group. There is a need to better understand the impact of culture on the emotional experiences of these Chinese in Australia. How do Chinese make sense of their depressive episodes? To address this question, this study explored the ways participants reach out for medical and/or non-medical help. Lay concepts of illness underpin these decisions and were thus unveiled. Mixed-method research design provided the opportunity to bring together multiple vantage points of investigation: population mental health, transcultural psychiatry and medical anthropology. A study combining quantitative survey and qualitative focus groups was undertaken in metropolitan Sydney. Narratives on symptoms, explanatory models and help-seeking strategies were articulated by focus group informants. Surveys covered demographics, symptom-recognition, previous depressive experiences and professional help sought. Depression measurement tools were cross-culturally validated. Self-ratings of ethnic identities and the Suinn-Lew Self-Identity Acculturation Scale were used to quantify Chinese participants' acculturation level. This allowed comparisons between 'low-acculturated' Chinese', highly-acculturated' Chinese and Australians. Survey results showed comparable levels of symptom-recognition in all subgroups. Focus group discussions provided rich data on informants' help-seeking strategies. Highly acculturated Chinese closely resembled the Australians in many study variables, yet qualitative data suggested cultural gaps beyond language barriers in influencing service use. Participants believed that trustful relationships could work as the bridge to link services with those in need. The implications for Australia's mental health policy include recognising the importance of rapport-building and the existence of cultural gaps. The study indicated professionals can benefit from acquiring information about the mental health beliefs both of individual clients and the wider ethnic communities in which they belong, and respecting the cultural differences between helper and helped as the first step towards cultural competency.

Under-utilisation of mental health services is widespread globally and within Australia, especially among culturally and linguistically diverse (CALD) communities. Improving service access is a priority, as is the need to deliver culturally competent services to the CALD communities. Having migrated to Australia in waves for approximately 150 years from China and South East Asia for various social, political and economic reasons, the Chinese population in Sydney is now the fastest growing non-English speaking ethnic group. There is a need to better understand the impact of culture on the emotional experiences of these Chinese in Australia. How do Chinese make sense of their depressive episodes? To address this question, this study explored the ways participants reach out for medical and/or non-medical help. Lay concepts of illness underpin these decisions and were thus unveiled. Mixed-method research design provided the opportunity to bring together multiple vantage points of investigation: population mental health, transcultural psychiatry and medical anthropology. A study combining quantitative survey and qualitative focus groups was undertaken in metropolitan Sydney. Narratives on symptoms, explanatory models and help-seeking strategies were articulated by focus group informants. Surveys covered demographics, symptom-recognition, previous depressive experiences and professional help sought. Depression measurement tools were cross-culturally validated. Self-ratings of ethnic identities and the Suinn-Lew Self-Identity Acculturation Scale were used to quantify Chinese participants' acculturation level. This allowed comparisons between 'low-acculturated' Chinese', highly-acculturated' Chinese and Australians. Survey results showed comparable levels of symptom-recognition in all subgroups. Focus group discussions provided rich data on informants' help-seeking strategies. Highly acculturated Chinese closely resembled the Australians in many study variables, yet qualitative data suggested cultural gaps beyond language barriers in influencing service use. Participants believed that trustful relationships could work as the bridge to link services with those in need. The implications for Australia's mental health policy include recognising the importance of rapport-building and the existence of cultural gaps. The study indicated professionals can benefit from acquiring information about the mental health beliefs both of individual clients and the wider ethnic communities in which they belong, and respecting the cultural differences between helper and helped as the first step towards cultural competency.

Health Studies / M. P. H.

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses. / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008