This study explored the perspectives on place of eight people with severe mental illness living, for one year or longer, in an urban psychiatric hospital. The research questions were: how do people with severe mental illness view the psychiatric hospital as place?; and how do they make meaning of the experience of living in hospital. The research employed a phenomenological approach, as described by Giorgi (1985). Using purposive sampling, one time, semi-structured, individual interviews were conducted. The audio recorded interviews were transcribed and thematically coded using Giorgi’s (2005) method. The meanings of the participants’ experiences are captured by the meta-theme: this is not a home; it’s a hospital. Four additional major themes emerged; and each of the major themes also had sub-themes The findings of this study challenged commonly held assumptions on how people living long term in a psychiatric hospital view the hospital as place and on institutionalization.

This study explored the perspectives on place of eight people with severe mental illness living, for one year or longer, in an urban psychiatric hospital. The research questions were: how do people with severe mental illness view the psychiatric hospital as place?; and how do they make meaning of the experience of living in hospital. The research employed a phenomenological approach, as described by Giorgi (1985). Using purposive sampling, one time, semi-structured, individual interviews were conducted. The audio recorded interviews were transcribed and thematically coded using Giorgi’s (2005) method. The meanings of the participants’ experiences are captured by the meta-theme: this is not a home; it’s a hospital. Four additional major themes emerged; and each of the major themes also had sub-themes The findings of this study challenged commonly held assumptions on how people living long term in a psychiatric hospital view the hospital as place and on institutionalization.

No description available.

Paper one is a systematic literature review of qualitative studies examining psychosis in women using a metasynthesis approach. The review involved three stages: a systematic search of qualitative studies reporting the experiences of women with psychosis, critical appraisal of these studies, and the metasynthesis. Thirteen studies met the inclusion criteria, yielding data from 220 women in total. The synthesis of the studies demonstrated three overarching themes: (a) women's beliefs about their illness, (b) perceived consequences of illness, and (c) strategies to cope with illness. Important barriers to strategy use were identified and recommendations made for addressing them. In the second paper grounded theory methodology was used to explore recovery in women who had experienced psychosis following childbirth. Semi-structured interviews were conducted with 12 participants and data were analysed using grounded theory methodology. A theory of four superordinate themes was developed from the data, including: (a) the process of recovery; (b) evolving an understanding; (c) strategies for recovery; and (d) sociocultual context. It was concluded that women experienced a complex process of recovery which was ongoing. The role of other people, including professionals in the recovery process was central. Recommendations were made for professionals to assess women's position in terms of their recovery in order to offer timely, appropriate interventions. The final paper is a critical reflection of the work reported in the previous two papers. I reflected upon how my previous experiences influenced my decision to undertake this research and other aspects of the research process. I explored the rationale for my choice of research methodology and discussed the debates which exist around the use of these methods. Finally, my personal reflections upon the entire research process are included.

archives@tulane.edu / Research has shown that populations with mental illness tend to have higher rates of obesity, diabetes, and other chronic conditions. This can be due in part to the medication treatment as anti-psychotic and anti-depressant medications have been shown to be major contributors to elevated rates of obesity, diabetes, dyslipidemia, and metabolic disorders that have the potential to lead to cardiovascular disease. Existing literature has identified many barriers that contribute to low preventive care utilization and screenings for metabolic risk factors. Consequently, national policy initiatives, such as the 2010 Affordable Care Act’s (ACA) Medicaid expansion, have aimed to improve access to care impacting adults with mental illness and expand coverage for more preventive and mental health services. Thus, this project: (1) examined longitudinal trends in diabetes preventive screenings and healthcare utilization associated with the 2016 Louisiana Medicaid expansion for a traditionally enrolled Severe Mentally Ill (SMI) Medicaid insured population, (2) assessed differences in racial and other socio-demographic characteristics associated with receiving diabetes preventive care and utilizing health care services amongst a traditionally enrolled SMI Medicaid insured population, and (3) assessed if Medicaid expansion was associated with better access to care and increased utilization of preventive care for diabetes-related complications in adults with diabetes and depression. To address these aims, adults ages 18 to 64 were analyzed through two data sources. The first is Louisiana Medicaid claims data; a longitudinal assessment of screening rates over a five-year period was used in an interrupted time series analysis to look at the change in screening rates for preventive care services and health care utilization before and after expansion for adults with SMI. Next, we used multivariable logit regression modeling, to examine the likelihood of receiving preventive care and utilizing health care services based on sociodemographic characteristics. Results from these analyses showed there was a total of 53,926 adults with a diagnosed SMI who had continuous enrollment in Medicaid between January 1st, 2014 – December 31st, 2018. Medicaid expansion was associated with significant increases in ED utilization and average inpatient length of stay for traditionally enrolled SMI adults. Racial differences in the likelihood of going to the ED were also apparent as blacks were more likely to go to the ED and for reasons that could have been prevented. For the third aim, data were extracted from the Behavioral Risk Factor Surveillance System survey for the years 2010 to 2017 for all adults with a self-reported diagnoses of depression and diabetes by a health professional. A retrospective cross-sectional study design using difference-in-differences analysis assessed relationship between Medicaid expansion and access to care and preventive care utilization for Medicaid eligible respondents in expansion states, compared to Medicaid eligible respondents in non-expansion states. Medicaid expansion significantly increased insurance coverage and the likelihood of having a personal doctor for eligible respondents in expansion states. / 1 / Alisha Monnette

This study aims to examine howdifferent forms of social support are perceived to affect the recovery process of people with severe mental health difficulties, and what factors people within this group perceive as being most beneficial for their recovery. This study was conducted in Uganda for eight weeks during November 2013 and December 2013 and is based on semi-structured interviews with people in recovery from severe mental illness such as bi-polar affective disorder and schizophrenia. This study is using Interpretative phenomenological analysis (IPA), which is a qualitative research approach, and the strength of IPA is its commitment to examine lived experience and personal meaning in detail. This study has shown that social support received from service user organisations was perceived to highly affect the recovery process in a most fundamental way. The service user organisations/associations were seen as platforms providing acceptance, understanding and recognition of what one has been or are going through. In terms of social support from family members, this was neither described as particularly helpful or hindering for the recovery process by most of the participants; this finding was somewhat unexpected but could be explained due to the complexity that proved to exist within the relationships between the participants and their family members. Medication was perceived as very important in terms of recovery, however it was strongly pointed out that medication alone was not enough. Despite this a majority of the participants had negative perceptions regarding both the dosage and the prescribed medicine itself particularly the prescription of Chlorpromazine, here feelings of being overmedicated and dealing with severe side effects were expressed, leading to some of the participants changing the prescribed dose on their own, so called manipulative medication.

Background: Severe mental illnesses (SMI) cause significant impairment for those living with the illnesses and often rely on caregivers for the ongoing care. Available evidence suggests that individuals responsible for caregiving may get distressed due to the caregiving experience, a phenomenon researchers call caregiver burden. Following the shift to community-centered mental health services, several studies on caregiving burden have been conducted in high income countries (HIC). However, there remains scarcity of data on the subject in SubSaharan Africa including Malawi. Therefore, the present study investigated the prevalence and associated factors of caregiving burden among caregivers of individuals with SMI at St John of God Hospitaller Services (SJOGHS) in Mzuzu-Malawi. Methods: The study adopted a hospital based cross sectional study. Recruitment took place at two outpatient departments of SJOGHS. Informal caregivers who were 18 years and above were asked to participate. The study recruited 139 caregivers and two research assistants approached participants at the waiting area. Caregivers who gave consent were asked questions about their caregiving activities using the Zarit Burden Interview (ZBI) (maximum score, 88). Data analysis was done using frequency distributions and descriptive statistics. The study used non-parametric tests such as a chi-square on all categorical measurements to test associations between variables and parametric tests such as t test on all continuous variables. The unadjusted and adjusted associations between socio-demographic factors and caregiving burden was conducted using logistic regression models. Results: On average, most caregivers experienced mild to moderate caregiving burden on the ZBI score (31.5 ± 16.7). In the adjusted model after controlling for caregivers’ gender, caregivers’ age, level of education, social support, care recipients’ age and care recipients’ gender, only caregivers’ age, social support and care recipients’ age remained significantly associated with caregiving burden. Older caregivers were more likely to experience caregiving burden than younger caregivers (OR=1.03, 95% CI 1.00-1.06), caregivers with social support were 71 % less likely to develop caregiving burden than those without social support (OR=0.29, 95% CI 0.14-0.62) and caregivers of older care recipients were less likely to experience caregiving burden than those of younger care recipients (OR=0.26, 95% CI 0.11-0.64). v Conclusion: Even though the caregiving burden found in this study was low compared to other previous studies in some arguably developed countries such as Iran and Turkey, it remains high in other developing countries such as Ghana and Nigeria. The low burden in this study, could be attributed to several factors and context in which the study was conducted. One such factor is the routine psychoeducation that the hospital often conducts for caregivers during the subsequent monthly reviews of their care recipients. An important follow up would be to investigate caregiving burden among caregivers who are unable to access the services at SJOGHS. The results of this study are important to guide policy in the formation of effective community programs that may assist mitigate the burden of informal caregivers. Finally, to understand the importance and implications of informal caregiving, further studies are needed in Malawi.

No description available.

In light of the increasing number of mentally ill inmates in the criminal justice system, felony mental health courts aim to de-criminalize these individuals and link them to appropriate types of treatment within the community. Few studies have investigated the successful linkage of community-based treatment among felony mental health court participants. More specifically, there is an absence of research on the efficacy of pharmacotherapy on recidivism status among felony mental health court defendants. This retrospective study used archival data to determine if receiving pharmacotherapy will increase duration of time between arrests and keep felony mental health court participants out of the criminal justice system longer. The study also aimed to investigate if psychotropic medication use helped to reduce the risk of violent arrests among those participating in the felony mental health program. Lastly, it evaluated whether drugs from specific classes had more of an effect on recidivism status than others. Cox regression analyses, with propensity score adjustments, were used to determine if psychotropic medication keeps felony mental health court participants out of the criminal justice system longer. Cox regression analysis was also used to determine if specific drugs from different classes had more of an effect on time to re-arrest than others. Lastly, a binary logistic regression, with propensity score adjustments, was used to determine if psychotropic medication helped to reduce the risk of future violent offenses after entry into the FMHC program. All analyses included covariates to control for any potentially confounding factors to the outcome. The study yielded non-significant results when testing whether or not the use of psychotropic medication had an impact on the time to re-arrest, and on risks of future violent offenses.

Bakgrund: En psykossjukdom är en sjukdom som inte bara drabbar personen själv utan hela dennes familj. Hela familjens livsvärld påverkas och familjelivet ansträngs hårt. Den psykossjuka familjemedlemmen erfar världen på ett annorlunda sätt. Vanliga symtom vid en psykos är bland annat hallucinationer och vanföreställningar. En bra vårdrelation mellan vårdgivare, den sjuka psykossjuka familjemedlemmen och anhöriga är en förutsättning för återhämtning. Syfte: Få ökad kunskap om och förståelse för anhörigas upplevelse av att leva med en familjemedlem med psykossjukdom. Metod: Metoden som valdes för studien var en systematisk litteraturstudie i vilken elva vetenskapliga artiklar analyserades med en kvalitativ innehållsanalys. Resultat: Tre kategorier framträdde ur data. Dessa visar att anhöriga bär på både känslomässiga och praktiska bördor samt att de har negativa erfarenheter av stöd och information av vårdpersonal. Slutsats: Resultatet i studien visar att psykossjukdom är en belastande sjukdom för anhöriga. Deras känslomässiga bördor är komplexa beroende på deras höga belastning av att vårda sin sjuka familjemedlem samt brister i bemötande av vårdpersonal.