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Background: As the paradigm underlying mental health care slowly shifts from an approach primarily institutional and medical in its orientation toward one more community-based and recovery-oriented, housing needs have come to the forefront. Many people with persistent mental illness accept group home living situations that do not necessarily meet their needs, and do not align with the recovery vision. Research focused on recovery for residents of group homes is all but absent in the literature. Purpose: The purpose of this study was to identify the challenges and opportunities for enabling group homes to increase their capacity to serve as an environment that integrates the recovery vision. Method: Using ethnographic methods, this case study examined the cultural milieu of a group home, how recovery is understood within the setting, and the impact of policies and practices on enacting the recovery vision. By converging multiple strategies for data collection (participant observation, key informant interviews, and document analysis), a multi-level perspective was achieved. The use of the social-ecological model, with its attention to multiple levels of influence, emerged as a highly relevant perspective, without which the recovery vision cannot be realized. Findings: The culture within the home revealed a comfortable atmosphere, basic needs being met, access to planned and unplanned activity, and caring relationships with staff, which contribute to a place attachment that could be difficult to loosen. There is a lack of awareness of recovery-enabling practice at multiple levels, which emerged as a key challenge to its implementation. Although some policies at the government level support self-sufficiency as an important objective, others make progress towards this ideal difficult, if not impossible, such as those related to funding. The focus on enhancing well-being in the day-to-day setting subsumes the growth goals associated with recovery. Conclusion: Integrating the recovery vision within group home could benefit from confronting well-established approaches, embracing advocacy roles, and addressing mechanisms for change at multiple levels. Only then will people with mental illness living in group homes reap the benefits of social justice, social inclusion and full citizenship that come with recovery. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2013-02-27 23:27:44.925

According to Mechanic (1967), the layman has usually assumed that the psychiatric professional is the unbiased expert on who is, or is not, mentally ill. In addition, the psychiatric professional has also usually assumed that his labeling decisions are based upon an unbiased scientific examination of the available information. However, Mechanic, and other sociological observers of the mental illness labeling process, have recently questioned whether these assumptions are legitimate. In fact, these observers have found that the professional’s labeling decisions are apparently heavily biased in favor of mental illness. Mechanic (1967), recounting his experience at two state institutions, reported that once a person is presented for institutionalization, seldom if ever does the psychiatrist dis- agree, although the psychiatrist’s “reasons” for hospitalization may be based on different premises than the public’s. Scheff (1964a, 1964b) found that when psychiatrists work within a court commitment setting, they tended to presume the existence of mental disorder. In a detailed examination of actual court procedures and psychiatrists’ pre- commitment patient interviews, his evidence indicated that the psychiatrists’ investigations appeared biased and presumed the existence of disorder. The psychiatrists frequently chose arbitrary evidence upon which to base their decisions- -evidence that involved elaborate psychiatric straining and interpretation. Often they decided to commit the person in question even where no evidence could be found. Their offhand remarks suggested pre- judgment of the case, and the interviews were conducted with such marked haste and carelessness that they only lasted on the average about ten minutes. As one of the psychiatrist’s states: The petition cases are pretty automatic. If the patient’s own family wants to get rid of him you know there is something wrong (Scheff, 1964a, p. 410). Coffman (1961) has noted that psychiatrists usually seek only that information that is consistent with their opinions through a process he has called “discrediting”. Within the mental hospital with which he was associated, the patient’s records and history were carefully searched to provide justification for the patient’s label, while any evidence of health was usually ignored. On the other hand, Gove (1970) has disputed the veracity of these observations. He has presented evidence that psychiatric professionals do not routinely label people as mentally ill, and do not commit every person they examine to a mental institution. Gove has also questioned the scientific adequacy of the methods employed by Mechanic and Scheff. Unfortunately, Gove’s rebuttal was based upon a review of the literature, and most, if not all, of the studies in his review were not originally directed toward the question of possible professional bias. In the writer’s opinion, an adequate test of the legitimacy, or illegitimacy, of Mechanic’ (1967), Scheff’s (1964a, 1964b), or Goffman’s (1961) observations has not yet been made. If professional bias does exist in the mental illness labeling process, then two primary factors might account for Mechanic’s, Scheff’s, and Goffman’s observations. First, an individual’s work setting may be associated with various situational expectancies that might influence one’s diagnostic judgment. For example, the situational expectancies of the psychiatric professional, operating within his typical work setting, might be biased in favor of the probable appearance of a mentally ill person. If one expects to interview a mentally ill person, then one’s diagnostic judgment of that person’s mental status might be affected. Second, the psychiatric professional’s training and experience might foster an increased inclination to view people as mentally ill--a greater inclination than the non-professional. If the professional is less inclined to tolerate deviance than the non-professional, then the professional’s diagnostic judgments should be more likely to lead to the mental illness label. The primary goal of this dissertation will be to examine these two factors--situational expectancies and tolerance of deviance--and their role in the mental illness labeling process. Bias in the application of the mental illness label may be traceable to the effects of these two factors. / This thesis was digitized as part of a project begun in 2014 to increase the number of Duke psychology theses available online. The digitization project was spearheaded by Ciara Healy.

Thesis (M.S.)--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. / 2031-01-01

Many clients with severe mental health problem, live in the community with their relatives. Research in the area has indicated that exacerbation of psychotic symptoms in clients is strongly associated with the emotional atmosphere in the family. The presence of high expressed emotion has been linked with relapse. However, recent research suggests that it is the causal attributions which relatives make to explain the illness symptomatology, which is most predictive of relapse. Relatives viewing clients' symptoms as being controllable by the client has been associated with hostility in relatives. Little has been said in the literature about the subjective experiences of clients. The present study investigated the causal attributions which clients and relatives made to explain the manifestation of the illness. Causal attributions made to explain positive symptoms, negative symptoms and behavioural problems were examined and compared. Clients! perception of their relationship with a key relative and their affective state was measured. Participants knowledge about schizophrenia, and relatives levels of distress were also examined. The clients in the present study were men under fifty with a diagnosis of schizophrenia. Key relatives also participated. A cross sectional correlational and comparative methodology was employed. A mixture of quantitative data and qualitative information was generated. A key finding was that the nature of attributions made was determined by symptom category. Positive Symptoms were deemed to be the least controllable symptom and Behavioural Problems were considered the most controllable. Relationships existed between the attributions made by clients and relatives. Depression in clients was related to them attributing their illness to personal factors, and a reporting negative feelings about there relationship with a key relative. Findings are discussed in relation to literature, research and clinical practice.

This study investigated the relationship between intensity of grief and coping patterns of parents of individuals affected by psychotic disorders. The study investigated the intensity of grief in a sample of parents of individuals with psychotic disorders in Western Australia to determine if the results replicate international studies. It further examined if the characteristics of the psychotic disorders of children, had an impact on the grief reactions of parents and if the disorder had a measurable impact on the nature of the relationship between parents and children. The study also identified specific coping strategies that parents consider as being most helpful to them in dealing with their grief, the relationship between intensity of grief and coping patterns of respondents and gender differences in grieving and coping strategies. The research findings suggest that there is measurable grief in a cross section of parents of individuals with psychotic disorders in Western Australia with many similarities to studies done internationally. The findings also suggest that this grief increases in intensity from the time of first diagnosis and peaks at 1-2 years after diagnosis and again 20 years after diagnosis. There was a strong association between past behaviours related to grief reactions and present feelings related to grief. To the best of my knowledge, these findings have not been reported before. IV Certain characteristics of the disorder of children had an impact on the grief reactions of the parents. Higher levels of grief were reported in parents whose children needed frequent assistance with personal care and children with a late onset of the disorder. / There was a positive correlation in parents who had a close relationship with the child before the onset of the disorder and following onset of the disorder suggesting that the disorder did not affect the relationship. To the best of my knowledge, these findings have not been reported before. While this research has replicated other studies, it has also researched coping strategies that have not been identified before. Although cognitive coping strategies were most frequently used by parents and subjectively found to be more helpful, parents using predominantly behavioural methods of coping showed less intensity in their grief. Parents oscillated between approaching the feelings of grief and distracting themselves from them, which highlighted the idiosyncratic nature of coping. Although there were no gender differences in the intensity of grief, there were distinct differences in coping strategies used by fathers and mothers. These findings have important implications for social work practice and policy development within the mental health settings of Western Australia.

Doctor of Philosophy(PhD) / Policy makers, service agencies and people with mental illness themselves view employment for people with mental illness as a major concern. This is due to the low rate of employment of people with mental illness, the difficulties many experience in finding and keeping satisfactory jobs, and the perception of paid employment as highly desirable for people with mental illness. The most extensive research on employment for people with mental illness has focused on establishing statistical relationships between various hypothesised predictors of employment success and vocational outcomes. While some attention has been paid to how individuals with mental illness view being employed, this has primarily focused on specific areas such as the benefits of employment, difficulties encountered and coping techniques used. My aim in this research was to develop a theoretical formulation which explains the processes that people with mental illness engage in with regard to employment. Data was gathered by way of in-depth interviews with users of psychiatric services. Some of these participants were employed, others were seeking employment, while others were not engaged in employment-related activities. At the centre of the theoretical formulation is a process I have called negotiating an appropriate vocational place. Using this process, people with mental illness make decisions about actions to take in relation to employment and these may or may not include trying to get and keep a job. Decisions are made by weighing up the benefits and drawbacks of employment and the advantages and risks of different vocational strategies. In doing so, people with mental illness are influenced by the Australian societal context, their individual social networks, their individual characteristics and circumstances (including their mental illness), and their employment options. This process of negotiating an appropriate vocational place is cyclical, ongoing and dynamic, as individuals' views and circumstances change. Knowing that people with mental illness strive toward an appropriate vocational place rather than taking for granted that they are working towards getting a job presents a challenge to policy and practice in which a successful outcome is defined as obtaining and maintaining a paid position in the workforce. Detailing and elaborating the process by which people with mental illness go about negotiating an appropriate vocational place provides a framework for practitioners, policy makers and researchers to understand the decisions made by people with mental illness and their actions in relation to employment. The understanding provided by the findings from this study will assist those working with people with mental illness and those responsible for employment policies to tailor their work more closely to individuals' desired goals. Immediate and longer term research opportunities are identified to apply the theoretical formulation derived from this study to vocational service practice with people with mental illness.