The study developed a model for projecting potential economies from manpower substitution among the four core mental health professions and applied the model to a proposed substitution situation which would substitute psychologists for psychiatrists in the delivery of a proportion of present private practice (fee-for-service) psychiatry services in British Columbia. The model identifies three controlling variables: treatment substitutability (TS), practice privilege constraints (PPC), and relative payment rates (RR). In the model, TS and PPC are conceptualized as determining the estimated substitutable share of costs (SSC%); RR, in combination with the values derived for SSC%, is then used to estimate potential cost savings (CS%). Two conditions were defined for each of the three controlling variables in order to provide a range of possible values for SSC% and CS%. For reasons of data availability, data were obtained from the Manitoba Health Services Commission for private practice psychiatry services for FY 1984 and estimates of SSC% calculated. These estimates were then applied to B.C. Medical Services Commission data for FY 1984, and projected values of CS% calculated. Calculations were made both for all services and for the subset of psychotherapy services, which accounted for 80 percent of the larger set of services. The results of the study indicated considerable possibilities for manpower substitution, ranging from 35 to 70 percent for all services and 40 to 75 percent for psychotherapy services. However, the study also found that while salaried psychologists offered the possibility of substantial cost savings, a fee-for-service arrangement suggested virtually no potential savings. Projected values of CS% for the salaried alternative were 20 to 40 percent for all services and 15 to 30 percent for psychotherapy services but in the fee-for-service alternative, only 4 to 8 percent for all services and 4 to 7 percent for psychotherapy services. Licensure and market rigidities which might pose barriers to implementation were evaluated and a review of professional training standards (TS), licensure standards (PPC), and funding alternatives (RR) indicated that the projected economies could be achieved with no necessity for modifications in existing arrangements. PPC appear to present almost no barriers to economies from the proposed manpower substitution and those barriers which are presented by TS and RR limitations still allow considerable potential for economies. Thus, the greatest opportunities for intervention in achieving and enhancing the projected, economies appear to be in the exploration of relative payment rates and relative effectiveness of treatment methods (e.g., psychotherapy vs. pharmacotherapy). The study concludes with a discussion of factors lying outside the boundaries of the model but which impinge, nonetheless, upon the feasibility of the proposed substitution and fall, necessarily, to policy makers to address. The existing network of B.C. community mental health centres was suggested as a possible mechanism for the delivery of the substitutable share of private practice psychiatry services. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The American Psychiatric Association criteria for differential psychiatric diagnoses (DSM III-R) do not exhaust the list of socially problematic behaviors displayed by the mentally ill. The extent to which such behaviors influence a person's "career" as a deinstitutionalized patient is the major topic of this study. Fiscal crises and changing public commitments have reduced support to those with severe mental illness who are deinstitutionalized, increasing the importance of understanding how degrees of competence at activities of daily living and the extent of socially problematic behaviors affect their participation in the community. The concept Interactive Competence was developed on the basis of the writer's clinical experience and a review of the literature on community adjustment of persons with severe mental illness. The concept characterizes the social functioning of persons diagnosed as mentally ill, and includes demonstration of self-care (ADL) skills and self-management skills (trouble in relationships). Secondary analysis was performed on data from a 1984 probability sample of clients in Community Support Programs for seriously mentally ill adults. Factor analysis reduced items in the original instrument, The Uniform Client Data Instrument, to scales measuring Interactive Competence. Only persons with the diagnosis of Schizophrenia or Affective Disorders were studied (n=824 of 1053), excluding diagnoses which were diverse in nature and infrequent in occurrence. Bivariate correlation and regression techniques were used to test the major hypotheses: 1) Schizophrenics demonstrate less Interactive Competence than those with the diagnosis of Affective Disorder; 2) the greater the chronicity (length of time in the social role as a patient from point of first diagnosis) the less Interactive Competence; 3) lower level of Interactive Competence is associated with a lower level of mental health service utilization. Monitoring Interactive Competence self-care (ADL) skills and selfmanagement skills (trouble in relationships) provides new insights about the service utilization of the severely mentally ill and their families. Schizophrenics had less the Interactive Competence than those with Affective Disorders; those with lower scores on Interactive Competence used more services; family involvement influenced clients' use of crisis assistance services and urgent care services. / 2031-01-01

Global studies investigating scaling-up of mental health services have highlighted mental health policy development and implementation as a priority area, especially in low- and middle-income countries. This research aimed to investigate Malaysia's National Mental Health Policy (NMHP) development and implementation and explore the barriers and facilitators to mental health care from multi-stakeholder point of view. This study, consisting of two main parts, adopted the situation analysis model from the Global Mental Health Lancet 2011 Series. Part One details the current mental health plans and development of the NMHP with data obtained via semi-structured interview, consultation observation, and government documents analysis. Part Two investigates key stakeholder perceptions and/or experiences gained through semi-structured interviews with 54 participants across five main stakeholder groups: policymakers, service providers, NGOs, service users, and caregivers. These were analysed using content analysis and the Framework Method respectively. Six categories of types of mental health plans emerged: (1) 'action plans', (2) 'education and training', (3) 'operational', (4) 'community psychiatry', (5) 'promotion', and (6) 'NGO'. Further, stakeholders identified seven key areas in relation to mental health care: (1) 'barriers to mental health care', (2) 'suggestions for improvement', (3) 'awareness and knowledge on mental health', (4) 'facilitators to mental health care', (5) 'impact of mental illness', (6) 'duty of care', and (7) 'cultural spiritual or ethnic influence'. Findings indicate the extent to which the NMHP objectives and goals were achieved between 2009 and 2016. Issues around attitude, resources, and awareness are most pressing to address. Facilitating factors, as well as suggestions for improvements, were uncovered too. Further important considerations in providing care in Malaysia revolve around raising awareness and knowledge, cultural appropriateness, and the roles of family, friends and even NGOs. This study concludes with proposed needs- and asset-based recommendations for future national mental health policy development.

This research describes the design and evaluation of an internet-based universal program for use in schools with adolescent students to prevent common mental disorders and promote mental health. The research began in response to investigations that showed that rates of mental illness in Australian children, teenagers and adults were high, that these illnesses caused significant burden to individuals and society, and that there were insufficient services to treat. When current interventions are unable to alleviate disease burden it is important to focus on prevention. Mental health prevention should target youth before disorders cause disability and restriction of life choices. A review of the mental health prevention literature supported a universal cognitive behavioural approach in schools. Internet delivery was used to maintain content integrity, enable access to people living in regional and remote areas, and to appeal to young people. Internet delivery makes universal prevention cost effective and feasible. The Intervention Mapping approach was used to direct the design of the program. A feasibility study was conducted to gain opinions from students and teaching staff. Changes were made in light of results from this study and 463 students were then exposed to the program in an effectiveness trial. The effectiveness trial was a before-after design with no control group. Results from this trial provided evidence that the program was acceptable and effective for use by teachers in the intervention schools. Also student behaviour and mood changed in beneficial ways after program administration. Specifically, student reported significantly increased knowledge about stress and coping, use of help-seeking behaviours, and life satisfaction, and significantly decreased use of avoidance behaviours, total difficulties and psychological distress. The study design allows causal inferences to be surmised concerning exposure to the intervention and changes in behaviour and mood, but further evidence is needed before firm conclusions about effectiveness can be posited and generalizations made concerning different populations, settings and times. In conclusion, this thesis provides evidence that a computerised, cognitive behavioural mental health prevention program delivered to adolescent school students by teachers can potentially change student coping behaviours and mood in beneficial ways.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1997. / Source: Masters Abstracts International, Volume: 45-06, page: 2943. Abstract precedes thesis as 1 preliminary leaf. Typescript. Includes bibliographical references (leaves 66-67).

Thesis (M. Soc. Sc.)--University of Hong Kong, 1986.

De-institutionalisation of mental health in Australia led to increased community management of mental illness. A breakdown in community care or change in illness manifestation may warrant acute mental health assessment. Increasingly, this occurs in the Emergency Department (ED). Patients with mental illness presenting to the ED represent a broad clinical spectrum. (For complete abstract open document)

Thesis (Ph.D.) - University of Glasgow, 2007. / Ph.D. thesis submitted to the Faculty of Medicine, Public Health and Community-Based Sciences, 2007. Includes bibliographical references. Print version also available.

Thesis (M.S.P.H.)--University of Michigan, 1940.