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1
Ross, Kate. "Sectioned under the Mental Health Act." Thesis, University of Plymouth, 1995. http://hdl.handle.net/10026.1/2498.
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This project looks at the experience of being sectioned under the 1983 Mental Health Act for acute psychiatric patients. The view is taken that sectioning in itself is a major intervention and hence should be the subject of research scrutiny. The views of two groups of participants, sectioned and informal inpatients, are compared using a variety of survey techniques including standardised questionnaires, structured interviews and open ended questions. It was found that being sectioned did not have a major impact on patients' experience of hospital treatment or their understandings of mental health issues although the sectioned patients did place less value on the medical aspects of their care and some sectioned patients showed a degree of internality for their health care that was not present in the informal group. Locus of control and transactional analysis were both found to be useful theoretical perspectives from which to examine patients' experiences. In general, the psychiatric patients who participated in the project valued the human contacts they made in hospital far more than their medical treatment. They also tended to attribute the cause of their psychiatric difficulties to non-medically based models of mental health based on childhood experiences, life events, human relationships and stress.
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Skinner, Laura. "Negotiating uncertainty : mental health professionals’ experiences of the Mental Health Act assessment process." Thesis, University of Leicester, 2006. http://hdl.handle.net/2381/8972.
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Melkumyan, Vladimir. "The effects of the Americans with Disabilities Act Amendments Act of 2008 on people with mental illness." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1523167.
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The purpose of this thesis was to present a policy analysis of the Americans with Disabilities Act Amendments Act (ADAAA) of2008. Particular emphasis was placed on the legislation's protections for people with mental illness. Specifically, this project used David Gil's analytic framework to assess the strengths and limitations of the policy and its impact on social work clients and society as a whole The analysis demonstrates that there have been many positive changes since the passage of the Americans with Disabilities Act (ADA), and more are expected under the ADAAA. However, the analysis also suggests that there remain many issues and unintended consequences concerning people with mental disability, including access problems for minorities. By revealing these issues that must be dealt with, this analysis clearly indicates the importance of commitment to social justice and cultural competence in social work practice. The recommendations for future research are discussed.
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Morriss, L. "Accomplishing social work identity in interprofessional mental health teams following the implementation of the Mental Health Act 2007." Thesis, University of Salford, 2014. http://usir.salford.ac.uk/30876/.
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The main objective of the thesis was to explore how social work Approved Mental Health Professionals accomplished social work identity when seconded to Mental Health Trusts. The project has examined the identity work that the social workers engaged in as they located themselves within interprofessional interagency community mental health teams. Insights from ethnomethodology and conversation analysis have been used to examine the interview data. Following Wieder (1974), the findings chapters are presented in two parts. In the first part, the focus is on the interviews as a resource and thus there is a more traditional reporting of what the social workers talked about in the interviews. Throughout the interviews, the social workers were concerned to delineate what was ‘real’ social work. Real social work was depicted as involving autonomous work in the community with mental health service users; this is the ‘authentic realm of social work’ (Pithouse 1998 p.21). Social work identity was portrayed as intrinsic to the self with congruence between personal and professional identity and values. However, the social workers struggled to define social work. Instead of having a clearly defined role, social work was depicted as intangible; as being without clear margins and boundaries, filling in the gaps left by other professions. Notions of ‘dirty work’ (Hughes 1948) and the implications of being seconded to a Health Trust are also discussed. The analytic focus shifts in the second part to the interview as a topic, specifically to how social work identity was accomplished within the interview as interaction. Matters such as being a member, the part played by the use of humour in the interviews, and the interaction as a research interview are explored. Finally, there is an examination of how social work identity was accomplished through the telling of atrocity stories.
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Ball, Laurence Francis Joseph. "Older people and the use of the Mental Health Act (1983)." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/3851/.
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This thesis explores the use of the Mental Health Act (MHA)(1983) with older people(65+) by providing a multi-perspective insight as expressed by those involved in the process. In particular, it focuses on the personal and social circumstances in which decisions to compulsorily detain older people are made. The thesis comprises two elements; one documentary, one qualitative. The documentary study was over a four year period (2000-2003) gathering demographic data around various themes including numbers of older people detained, gender, age, diagnosis and the relevant section used to detain the older person under the MHA(1983) This provided an insight into the scale of the phenomenon. Within the qualitative study, 58 semi-structured interviews were conducted providing fifteen case studies which were then thematically described and interpreted using Interpretative Phenomenological Analysis. Semi-structured 1:1 interviews were adopted to allow participants the opportunity to express their personal experience. The thesis concluded that at times, some older people and their caregivers became passive recipients of mental health services, mainly through power inequalities, particularly at the time of assessment and discharge.
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Fanning, John. "Risk and the Mental Health Act 2007 : jeopardising liberty, facilitating control?" Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/14013/.
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This Ph.D thesis evaluates the impact of the concept of risk on mental health law and policy in England following the introduction of the Mental Health Act 2007, which amended the Mental Health Act 1983. First, the thesis investigates the role played by risk as the principal policy driver of the 2007 Act, arguing that the concept’s renewed significance heralds an era of ‘New Medicalism’ in which the law’s determinative power is reduced in order to foster a greater responsiveness to patients’ risks. Secondly, it argues that the works of Ulrich Beck and Anthony Giddens, which popularised the ‘Risk Society’ perspective, and Michel Foucault, who developed the ‘Governmentality’ thesis, help to illuminate the prevailing trends in mental health policy in the 21st Century. The author contends that Foucault’s Governmentality thesis may provide the theoretical foundation on which the concept of risk was deployed by the policy-makers who shaped the 2007 Act. Thirdly, the thesis discusses the reason why risk is such a difficult concept to understand from a legal point of view. It shows that risk-based statutory provisions have the potential to undermine certainty in decision-making processes and notionally make it difficult for patients to predict the nature and extent of their engagement with mental health services. It also demonstrates that risk is a problematic concept for the courts, which have preferred to leave it as a matter of fact. Fourthly, and as a corollary, the thesis hypothesises that because of the greater prominence given to risk there is now more control of, and less liberty for, patients with mental disorder following the introduction of the 2007 Act. To test this, the author draws upon literature examining the current state of play in mental health practice, the legal oversight of psychiatric decision-making, and the significance of law reform on mental health practice. He finds that in fact the law is rarely determinative of mental health decision-making and that legislative changes do not fundamentally alter the functioning of the compulsory powers. As a result, there is no evidence to suggest that the 2007 Act has jeopardised patients’ liberty whilst facilitating greater control over them. For that reason, the final chapter offers a defence of the concept of risk in mental health law. It argues that while the law can never achieve certainty, the concept’s inclusion reflects the realities of mental health practice and allows decision-makers to operate according to their training and expertise. This chapter argues that mental health practitioners possess a level of knowledge and understanding of risk which defies objective explication. While mental health policy may be shaped by the desire to control deviance and the law may be drafted to accomplish that end, the reality is that practitioners invariably achieve the ‘right’ outcome notwithstanding legal and policy uncertainties. The thesis concludes that the 2007 Act has aligned the law with the realities of mental health practice and, for that reason, has not directly jeopardised liberty.
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Seebold, Marianne. "Service users' experiences of being sectioned under the Mental Health Act." Thesis, University of Southampton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442868.
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Crow, Maartje Gezina Seinen. "Police intervention under the Mental Health Act: A comparison of rural and urban approaches." Thesis, University of Ottawa (Canada), 1997. http://hdl.handle.net/10393/10106.
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Description of research. This thesis explores how police intervene with clientele signalled as mentally ill, or acting in such a way that the presence of a mental health problem is perceived. Officers were interviewed in rural and urban detachments and forces in neighbouring jurisdictions in Eastern Ontario. All of the officers interviewed were bound by the same legislation and guidelines with respect to mental health and to policing, described in the theoretical framework of this thesis. Rural and urban perceptions are compared to determine differences in the areas explored: available information, general knowledge, descriptions of incidents, causes of disturbed behaviour, police actions, and interactions with community or health authorities to whom clients may be referred for further mental health interventions. Research method. The thesis compares non-directive interview material for differences in and within themes addressed. Seven interviews, all with male officers, are analyzed. Three interviews were conducted in urban stations; four in rural detachments. In both of the compared groups, one officer is a senior officer and all others are constables. The choices of topic, research subject, and other features of the methodology are defended based on feminist and other critical analyses of traditional sociological research. (Abstract shortened by UMI.)
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Rapaport, Joan. "A relative affair : the Nearest Relative under the Mental Health Act 1983." Thesis, Anglia Ruskin University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249787.
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Ashmore, Russell John. "The implementation of Section 5(4) of the Mental Health Act 1983." Thesis, Sheffield Hallam University, 2012. http://shura.shu.ac.uk/20619/.
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Section 5(4) (nurse's holding power) of the Mental Health Act 1983 empowers mental health nurses to legally prevent an informal in-patient from leaving hospital for up to six hours. The section may be applied for the patient's health or safety or the protection of others. Since its introduction in September 1983 there have been 34,000 applications of the section, an average of 1460 per annum. The application of Section 5(4) is likely to: lead to further detention under the Act; have implications for the practice of nurses; and affect the care received by patients in the aftermath of its use. However, the literature review revealed a paucity of research on the subject. The existing research has focused on three main areas: nurses' opinions of their holding power; their knowledge of Section 5(4); and trends associated with the implementation of the section. However, no attempts have been made to examine the events before, during and after the implementation of Section 5(4). This qualitative study sought to address this deficit by examining why and how Section 5(4) was implemented from the perspective of the nurses and patients involved in the process. A collective case study approach was utilised to generate data from one mental health NHS Trust over a period of one year. Data were generated from three sources: archival (statistical) records on 803 applications of the section; documentary accounts of the detention process, for example nursing notes; and interviews with 30 nurses and four patients. Within- and cross-case narrative analysis was undertaken on the data set. The method of narrative analysis employed was developed specifically for this study. The analysis produced a six-part typology of nurses' stories that explained why Section 5(4) was implemented. The six types were: 'health, safety or protection'; Tack of knowledge'; 'catalyst'; 'medical inaction'; 'self-protection'; and 'last resort'. The analysis also constructed a collective story of nurses' experiences that identified the key stages in the detention process. Stories were also constructed from patients' experiences of being detained. These stories generated in-depth accounts of patients' admission to hospital, the events leading up to their detention, the implementation of Section 5(4), and the aftermath of their experiences. The implications of the study's findings are considered for education, policy, practice and research and focus on four main areas: informal admission to hospital; information giving; reasons for implementing Section 5(4); and the consequences of the detention for both nurses and patients.
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Orabueze, Ngozi Nkechi. "Challenges for Providers Working in Assertive Community Treatment." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6363.
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This project explored the challenges confronting clinicians who work with the Assertive Community Treatment Program (ACT), a government-sponsored clinic-based program providing services for individuals with persistent and recurrent mental health challenges in a large metropolitan city in the southern United States. The project involved semi-structured interviews with 15 health care clinicians to explore what they perceived as challenges and their recommendations for addressing them. Themes were organized around the 6 dimensions of the the relationship-based care model: leadership, teamwork, professional nursing, care delivery, resources, and outcomes. Identified patient challenges included transportation, lack of health insurance, housing, acceptance of certified peer specialists, the stigma of seeking help for mental health issues, problems with tracking patients, family interference, and fear of discharge from the program. Challenges related to the work environment were identified as poor pay for mental health staff, increasing paper work, professional boundaries, and balancing work demand and personal experiences. Recommendations to address challenges included open communication, interdisciplinary meetings to improve coordination of resources, increased support for family participation, and community support for mental health services. This project adds to the knowledge on ACT programs and will assist organizations planning or delivering ACT services in channeling resources to areas recommended by ACT clinicians. Recommended organizational changes will provide a positive social change to improve care of individuals with mental health challenges in the community.
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Valdez, Karla. "Taking a closer look at the mental health services act of 2004| A policy analysis." Thesis, California State University, Long Beach, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1590186.
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The purpose of this policy analysis was to analyze the Mental Health Services Act (MHSA) of 2004 using research articles and state and governmental documents. The analysis explored the expansion of mental health services and the challenges of implementation. The programs that were developed to meet the specific needs of the MHSA included early intervention, prevention, curriculum development, education, training, and community services. A thorough examination of the act provided an understanding of how the funds are distributed and how the MHSA will continue to support specialized mental health program services. The information presented in this policy analysis focused on children and youth and in detailing the services they received through the MHSA.
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Berzins, Kathryn Mara. "Mental health service users’, carers’ and professionals’ perceptions of the named person provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/927/.
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Background: The Mental Health (Care and Treatment) (Scotland) Act 2003 reduced the role of the nearest relative, identified by a hierarchy of relationships, who previously could admit and discharge a patient as well as receive information about their care. This role is now reduced to one of receiving basic information only and the hierarchy for identification has been modernised. Service users may now nominate a named person with similar rights to service users to help protect their interests. This person cannot admit or discharge but is entitled to information and consultation about their care. If a patient has not appointed a named person, then the primary carer is appointed by default and, if there is no primary carer, the nearest relative assumes the position. Aims: To explore service users’, carers’ and professionals’ perceptions and experience of the named person provisions. Method: Twenty service users, ten carers, seven MHOs and nine professionals with influence on government policy were interviewed about their experiences. Interviews were carried out face-to-face (service users and some carers) and by telephone (carers, MHOs and policy influencers). The resulting transcripts were analysed using thematic analysis. Findings: The majority of all interviewees welcomed the introduction of the named person provisions because of the increased choice it gave service users. Service users often did not wish to nominate their nearest relative, many choosing to nominate a friend. Important factors in making a nomination were that the nominee knew the service user’s wishes and could be trusted to carry them out. Some service users chose not to nominate relatives to spare them responsibility. However, the provisions were not without their problems; uptake was perceived to be low and there were particular problems in relation to the level of understanding of the implications of a nomination by service users and of the lack of accessible information and support to increase this understanding. The imbalance of power in relationships between service users, carers and professionals was thought to impact on the autonomous choices of service users and carers. Further problems were identified with named persons appointed by default in relation to service user choice and confidentiality. Conclusion and recommendations: Although the choice is welcome to some service users, there appears to be a lack of full understanding of the role, and continued awareness-raising is required with service users, carers and professionals which should further be supported by accessible information for both service users and carers. There is currently a lack of support for carers in particular and it is recommended that this be addressed using carers’ services. It seems that many named persons are being appointed by default (itself an anomaly in Scots law) which threatens human rights, because of the lack of choice of the service user about who is involved in their care and their inability to prevent the sharing of confidential information with the default named person. The current lack of a right of service users to reject having a named person at all restricts choice and autonomy, and may further place unwanted responsibilities on carers and relatives which are difficult to remove. To ensure that service users’ rights are fully protected, the named person should become an optional nominated position and the default mechanisms removed.
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Chan, Kon-hang Tommy. "The role and experiences of approved social worker (ASWs) relating to the impletmentation of sections 31(1) & 71A of the Mental Health Ordinance (revised 1989) /." Hong Kong : University of Hong Kong, 1994. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13991577.
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Kofman, Olga Loraine. "Deinstitutionalization and Its Discontents: American Mental Health Policy Reform." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/342.
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In 1963, President John F. Kennedy signed the Mental Retardation and Community Mental Health Centers Construction Act, establishing the beginnings of deinstitutionalization in the United States. By some counts, this Act was a stupendous policy success—by others, a dismal failure. 50 years later, no cohesive national mental health care policy has emerged to deal with increased rates of mental illness among the homeless and the incarcerated. However, California has made enormous strides to create a state policy which provides adequate services to the mildly, moderately, and severely mentally ill as well as adequate funding for those services through Proposition 63, the Mental Health Services Act, passed in 2004. This paper reviews mental health policy history from Colonial America to the present, paying special attention to JFK's deinstitutionalization in 1963 and the discontents that followed. It takes a special look at California's mental health care policy history and the strides the state has made to better serve the mentally ill.
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Palmer, Michelle Dawn. "Exploring Section 136 of the Mental Health Act (1983/2007) from a psychological perspective." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5345/.
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This thesis brings together a series of work undertaken in partial fulfilment of the Doctorate in Clinical Psychology. Volume I – Research: Literature review; empirical paper; and public dissemination document providing an accessible summary of this volume. The literature review draws together the extant literature on what is known about what happens when the police detain people experiencing mental health crises. It offers a systematic search of relevant bibliographic databases, and findings are discussed within the context of the limitations of the review and the implications for future practice and research. In building on the work of this review, the empirical paper goes on to explore how police officers understand and experience the use of Section 136 of the Mental Health Act (1983/2007). This study employed interpretative phenomenological analysis to explore ten officers’ (from the English Midlands) experiences of this aspect of their work. Volume II – Clinical practice reports: Outlining work undertaken on placements from adult, older adult, learning disability, and physical health specialties. The reports consist of: a case study illustrating a dual formulation approach; a service evaluation; a single case experimental design study; a case study; and the abstract for an oral presentation of a case study.
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McNally, Carolyn Anne. "People with intellectual disabilities (ID) : experience of detention under the Mental Health Act (1983)." Thesis, University of Sheffield, 2006. http://etheses.whiterose.ac.uk/14879/.
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BACKGROUND: Fundamental to the development of research knowledge are studies establishing user views and experiences of service delivery. However, currently there are no published studies providing insight into the experience of detention for people with intellectual disability. SPECIFIC AIMS: This study explores the experiences of people with intellectual disability of detention under the Mental Health Act (1983). The study seeks to provide insight into their perceptions of the act of detention and associated emotional responses. METHOD: Transcripts of semi-structured one to one interviews (N=7) were analysed using Interpretative Phenomenological Analysis. Participants had mild-moderate ID and been detained under the Mental Health Act. All participants had been detained in the 2-year period, prior to the study. FINDINGS: Four themes common across participants were identified: (a). 'perception of self in the world'; (b). 'a negative event', (c). emotional response to the act of detention; and finally Cd). family relationships. A number of valuable insights emerged including: the impact of perceived lack of control over self and experiences of vulnerability, powerlessness and victimisation, both prior to, and following the act of detention; participants' sense of care Vs punishment; the development of 'role' within the system and attribution of blame. DISCUSSION: This study expands the current literature regarding the experiences of people with intellectual disabilities from their perspective, the emotional impact of traumatic experiences and differences in coping styles: Ideas for future research are also provided.
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Maclean, Kirsten. "ACT at work : feasibility study of an acceptance based intervention to promote mental health well-being and work engagement in mental health service staff." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4630/.
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Background: Acceptance and Commitment Therapy (ACT) aids individuals to accept difficult experiences that may be beyond their control and commit to behaviour that is consistent with their values. Previous research highlights that ACT interventions can: improve mental health, reduce worker stress and engender effective learning and performance. Work engagement has been defined as having an energetic and effective connection to work activity. As yet, no studies have investigated whether ACT interventions lead to improvements in work engagement. Aim: To investigate the feasibility of using ACT at Work Training (ACTw) to improve mental well-being and foster work engagement in staff working in mental health services. Method: A prospective, non-randomised, cohort controlled, repeated measures design was utilised. The parameters of this feasibility trial were formulated around the PICO (population, intervention, control, outcome) framework. 25 staff were recruited to take part in ACTw. 20 staff were recruited separately to a control group. The control group did not receive any input. ACTw was implemented over three sessions. The Utrecht Work Engagement Scale, General Health Questionnaire, Michigan Job Satisfaction Scale and Hospital Anxiety and Depression Scale were administered as outcome measures, while the Acceptance and Action Questionnaire - measuring psychological flexibility - and the Valuing Questionnaire - measuring value based living - were administered as therapy-specific measures. Following the completion of baseline assessments, measures were conducted 6 and 10 weeks post-baseline. Results: Despite initial recruitment problems, ACTw and control group participants were successfully recruited. Positive feedback from those who completed ACTw, suggested the intervention was acceptable. However, a third of ACTw participants missed training sessions, which was related to work and personal stress factors. The lack of significant differences between ACTw and control participants’ in scores on outcome and therapy-specific measures across the time points does not provide support for treatment signal changes in these measures. However, the lack of significant differences in outcome measures may be due to the low number of individuals presenting with high stress and low work engagement levels. For the group as a whole, changes in stress, anxiety, depression and work engagement were significantly correlated with changes in therapy-specific measures i.e. measures of psychological flexibility and value based living. Conclusions: Results of this study highlight factors that will help inform a larger trial of ACTw for health professional staff. Suggestions for future implementation include considering a larger sample and catchment area, staff stress level, potential barriers to participation and implementation of change at an organisation level.
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Taylor, Alexis Anne. "Secret practices : an evaluation of the discourse and decision making practices of a child mental health agency." Thesis, University of Exeter, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294479.
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Trowell, Vanessa. "Talking about the mental health act reforms : a discourse analysis of forensic clinical psychologists accounts." Thesis, University of East London, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532562.
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Lee, John. "Purchasing, providing and participating in mental health services." Thesis, University of Bedfordshire, 1999. http://hdl.handle.net/10547/336986.
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This thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.
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Gallagher, Erin E. "Does Depression Act as a Mediating Variable Between Post-Traumatic Stress Disorder and Experienced Physical Dysfunction?" Xavier University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1396350937.
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Williams, Robert D. "A study of the effect of an integrated continuum of Intensive Crisis Intervention Services (ICICIS), including Assertive Community Treatment (ACT), on civil commitments in north central West Virginia." Morgantown, W. Va. : [West Virginia University Libraries], 2005. https://etd.wvu.edu/etd/controller.jsp?moduleName=documentdata&jsp%5FetdId=3950.
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Thesis (Ph. D.)--West Virginia University, 2005.Title from document title page. Document formatted into pages; contains v, 136 p. Includes abstract. Includes bibliographical references (p. 105-113).
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Bowden, Stacie. "The experiences of black Caribbean carers when their relatives are detained under the Mental Health Act." Thesis, University of Surrey, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.540720.
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Spamers, Marozane. "A critical analysis of South African mental health law : a selection of human rights and criminal justice issues." Thesis, University of Pretoria, 2016. http://hdl.handle.net/2263/60097.
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This thesis is concerned with determining whether South African mental health law and its application in practice is in need of reform. In order to reach its objectives, the thesis measures mental health legislation and criminal law that affect the mentally ill individual or offender against international and local human rights standards, and generally accepted principles and scientific principles applicable in the mental health profession. Particular focus is placed on the admission of a mentally ill person as a voluntary, assisted or involuntary mental health care user, State Patient or mentally disordered prisoner in terms of the Mental Health Care Act 17 of 2002 (?MHCA?), as well a critical review of the MHCA forms used to translate the Act?s provisions into practice. The thesis critically discusses the regulation of mental health care practitioners in terms of the Health Professions Act 56 of 1974, including psychology and psychiatry and the expert witness, and the new Traditional Health Practitioners Act 22 of 2007 and its regulations. An outline of the role of the National Health Act 61 of 2003 in the administration of the health system is provided.The thesis analyses the manners in which mental health affects criminal liability, and Chapter 13 of the Criminal Procedure Act 51 of 1977. Finally a desktop study into the current state of mental health care provision and the implementation of legislation in practice is conducted, followed by conclusions and recommendations for reform to legislation, policy, and the MHCA forms where anomalies have been identified.Thesis (LLD)--University of Pretoria, 2016.
Public Law
LLD
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Were, Dorothy L. "Advanced Nurses' Perspectives on the Drug Addiction Treatment Act, 13 Years Later." ScholarWorks, 2014. https://scholarworks.waldenu.edu/dissertations/79.
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The United States experiences opioid addiction at epidemic levels. In 2012, the National Institute of Drug Abuse reported that 23.1 million Americans were in need of addiction treatment services, although only 2.5 million were enrolled in treatment. Following an amendment to the Drug Addiction Treatment Act of 2000 (Public Law 106-310), advanced practice nurses were qualified as providers who could bridge the healthcare gap in treatment access. The purpose of this project was to determine the interest of advanced practice nurses in (a) prescribing buprenorphine and (b) establishing guidelines that would allow them to do so. This quantitative project used a 10-question Internet-based survey with a convenience sample of 95 nurses (recruited online) who were currently practicing in advanced nursing roles. Social media platforms, including Facebook, were used to recruit participants. The survey included questions about expanding the scope of practice in addiction treatment and establishing guidelines that would allow nursing knowledge and expertise to be used in outpatient opiate addiction treatment. Critical social theory and Kingdon's theory of policy analysis were applied to support the project. The Survey Monkey data analysis tool was used to generate descriptive statistics, which demonstrated respondents' support for an expanded scope of practice. If the recommendations of this project are adopted by national legislation, increased accessibility to addiction treatment services will save millions of dollars in justice system, healthcare system, employment, and societal costs. Nursing policy advocates nationally can apply these results to support efforts to expand scope of practice to include prescribing buprenorphine.
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Dixon, Mandy. "Risk assessment for compulsory detention under the Mental Health Act (1983) : a grounded analysis of psychiatrists' perspectives." Thesis, Birmingham City University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435528.
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This thesis explores how psychiatrists assess risk when making decisions about detention under the Mental Health Act (1983). It comprises two studies. The first study, a content analysis of the legal justifications provided for detentions, found that matters of risk were central to psychiatrists' decisionmaking. It also found relatively high levels of disagreement between doctors about the nature of risk posed. This raised the possibility that risk assessment may not be as straightforward as implied by sparse legal guidelines, by mathematically generated lists of 'risk factors', or by the under-specified 'clinical approach' to risk assessment in psychiatry. The second, more substantial study of the thesis employed a grounded theory methodology to explore psychiatrists' own understanding of their risk assessment practices when making detention decisions. Indepth interviews were conducted with psychiatrists, using the Critical Incident Technique to focus interviews on critical, or 'boundary' cases. The grounded theory methodology was employed as it allowed for a theoretical account of psychiatrists' risk assessment approach to emerge directly from psychiatrists. It also overcame some of the limitations of other potential approaches to the study of risk, namely the overly narrow focus on the individual characterised by the psychometric approach and the overly broad focus of the socio-cultural approaches to risk. A grounded analysis of this interview data produced a model that describes and explains psychiatrists' approach to risk assessment. This model makes two main arguments. First, it provides a theoretical account of the previously hidden 'clinical approach' adopted by psychiatrists when assessing risk. Here, it argues that psychiatrists organise their assessment of risk around the concept of a 'risk trajectory'. Second, the thesis highlights the inherently contextual nature of risk assessment for detention. Here, it identifies three forms of context which shape psychiatrists' risk trajectories and ultimately their decisions about detention. The first is an epistemic context, in which various forms of knowledge inform both the construction and management of the risk trajectory. Psychiatrists encounter multiple forms of uncertainty, and respond by employing particular strategies to reduce their uncertainty. The second form of context refers to multiple relationships, particularly the therapeutic relationship, which influence the risk trajectory. Finally, the tempotal context of risk is explored as it impacts upon psychiatrists' assessments. The thesis concludes with a discussion of these two contributions for psychiatry, particularly its implications for future research, for legal and policy developments, and for psychiatric services.
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Eastman, Nigel Lyons Gwynne. "Ethical and policy implications of legal and administrative developments since enactment of the Mental Health Act 1983." Thesis, St George's, University of London, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395838.
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Groenow, Chanique C. "A Change Is Going to Come| A Policy Analysis of the Mental Health Services Act of 2004." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10785630.
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The purpose of this study was to analyze Proposition 63, which later became the Mental Health Serviced Act (MHSA) of 2004. This legislation imposed a 1% increase in taxes for California residents with adjusted gross annual income over $1 million. MHSA provided funding to expand the mental health programs and services including prevention, early intervention, education and training programs. The analysis intended to explore the benefits and consequences of the tax increase, and how mental health services were impacted under MHSA. This study scrutinized a historical review of mental health services in the United States, in the first years of the 20th Century, Deinstitutionalization, and enactment of policies related to mental health. Using David Gil's 1992 modified policy analysis framework, the analysis concluded that the MHSA legislation has potentially increased mental health services for individuals with mental illness and their families. However, this study also found that the lawmakers failed to provide proper guidance for effective program evaluation.
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Grace, Jonathan Doyle. "The experience of being assessed and detained under the Mental Health Act (1983) : an interpretative phenomenological analysis." Thesis, Staffordshire University, 2015. http://eprints.staffs.ac.uk/2243/.
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This thesis aims to explore some of the key perspectives of service users and mental health workers regarding assessment and detention under the Mental Health Act (1983). The first paper is a critical review of the research literature on service user and mental health workers’ perspectives of the Mental Health Act assessment. The main finding of the review is that context, relationships, agency and risk are issues that influence people’s perspectives. A relative paucity of qualitative research may reflect an under-representation of service user perspectives and needs. Qualitative research targeting service user experiences of assessment was recommended. The second paper employs interpretative phenomenological analysis (IPA) (Smith, Flowers and Larkin, 2009) to conduct an empirical investigation of the assessment and detention process. The main aims of this paper were: to determine how people make sense of their experience of being assessed and detained; and, to identify key interpretative themes that can help inform communication in the assessment setting. The main findings were that participants predominantly perceived their treatment experience as negative. This negative perception might be explained by individual psychological factors associated with negative bias and cognitive perceptual disruption, and relational processes associated with labelling theory. The third paper is a critically reflexive commentary of the research thesis process. The epistemologies that underpin the development and application of psychological theory are considered. IPA method is critiqued and suggestions for its development provided. Particular attention is paid to the importance of reflexivity in the gathering and interpretation of data. The paper concludes that IPA, not without limitations, is mainly successful in operationalising its theoretical concepts.
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Herrrera, Elmer Ivan. "The Mental Health Services Act of 2004 and its impact on transitional age youth served in Los Angeles County| A policy analysis." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10046246.
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The Mental Health Services Act (MHSA) of 2004 was analysed using David Gil’s (1992) analytic framework. The strengths and weaknesses of the Act were assessed and special attention was placed on transitional age youth (TAY) who are consumers of Full Service Parternship (FSP) services in Los Angeles County. This analysis found that there have been some improvements in the provision of services to TAY as a result of the MHSA (2004). However, TAY continue to be a group that remains underserved despite the availability of MHSA (2004) funds. The lack of infrastructure of Department of Mental Health to oversee MHSA (2004) funded projects is likely one of the main reasons why new programs for TAY have not been developed. This analysis did find that TAY, who have been served under MHSA (2004) funded programs, have lower rates of incarceration and hospitalization. The recommendations for social work practice, policy and research are discussed.
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Oshegbo, Godwin. "Effects of Patient Protection and Affordable Care Act on Behavioral Health Access." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4978.
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About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study explored the lived experiences of 10 behavioral health service recipients to identify the benefits and challenges of the PPACA on behavioral health services. Participants from Anne Arundel County, Maryland, were purposefully selected and interviewed face-to-face. Relative advantage, compatibility, and complexity were characteristics of the diffusion of innovation theory used for the exploration of this research. Based on the interpretive phenomenological approach, Nvivo 11 Pro was used for data coding, management, organization, and analysis. There was the shared belief among participants that the PPACA improved their access to adequate and affordable behavioral healthcare. Effective network of care and having health insurance seemed to have improved health outcomes. Findings from this study highlight issues of common interest to healthcare stakeholders while providing reasonable platforms for objectively addressing complex challenges, which tend to undermine the possibility of adopting policies that could yield positive dividends for all parties involved.
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Bello, Nathalie Duque. "Balancing Act| Successfully Combining Creativity and Accountability in the Practice of Marriage and Family Therapy." Thesis, Nova Southeastern University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3721959.
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The conditions that allowed early MFTs the freedom to creatively explore different interventions and theories of change are no longer available in today’s mental health care system. Although there are many benefits to the structure of managed behavioral healthcare organizations, a thorough review of the literature demonstrates that many therapists working in managed care agencies struggle with maintaining their theoretical creativity, claiming third-party payers’ service requirements and paperwork a barrier to their creativity. A phenomenological transcendental research method was utilized to understand the phenomenon of successfully combining creativity and accountability in the practice of marriage and family therapy from the perspective of six creative MFTs who have effectively incorporated creative therapeutic techniques into their work, while adhering to the structured requirements of managed care.
The findings and themes of the study were organized into two categories. The themes in the Textural / Content Category (description and purpose of therapeutic creativity at a managed care agency) are: (1) Creatively combining the needs of the clients, the different professional entities, insurance companies and you as a therapist, (2) Translating post-modern information into the medical model language that meets the third-party payers’ requirements, (3) Completing documentation with clients, (4) Incorporating technique from a range of therapy models, (5) Keeping clients engaged through a variety of resources and activities, and (6) Utilizing metaphors and themes to uncover patterns of relational dynamics and behaviors. The themes in the Structural / Supportive Conditions Category (factors that allow the balance of creativity and accountability to occur) are: (1) Systemic understanding of how the therapeutic and business systems of managed behavioral healthcare interact together, (2) Having a supportive network of colleagues, (2a) Supportive group of coworkers within the job setting, (2b) Supportive network of MFT colleagues outside of the work setting, (3) Desire to make a difference in peoples’ lives, (4) Continuous education on all aspects of the mental health field, (5) Employers’ support of creative therapy, (6) Self-reflection, (7) Self-care, and (8) Organization and time management.
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Rosales, Robert. "If You Make it, Will They Come?: The Impact of the Affordable Care Act and Organizational Characteristics on Hispanic Mental Health Care Organizations." Thesis, Boston College, 2018. http://hdl.handle.net/2345/bc-ir:108096.
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Thesis advisor: Rocío CalvoHispanics are less likely than non-Hispanic whites to use mental health service, even after controlling for various social, environmental, and health factors. Mental health services disparities between Hispanics and non-Hispanic whites have been well-documented and consistent over time. However, very little is known about the impact mental health care organizations have on Hispanics’ access to mental health care, especially since the implementation of the Patient Protection and Affordable Care Act (ACA). The three papers in this dissertation utilize the 2010, 2014, and 2016 waves of the National Mental Services Survey (N-MHSS) to assess the impact of the ACA on Hispanics’ access to mental health care and mental health care organizations’ provision of integrated services. The N-MHSS is a national repository of data on the mental health organizations in the United States. This dataset was created to report the characteristics and client enrollment at mental health care organizations. Paper 1 uses the 2014 N-MHSS to describe the structural characteristics of mental health care organizations according to the proportion of Hispanics they serve and the organizations’ structural characteristics in Medicaid expansion and non-expansion states. Paper 2 uses the 2010, 2014, and 2016 N-MHSS waves to examines the impact of the ACA and the health safety net on Hispanic admissions at mental health care organizations. These three waves were merged together using a repeated cross-sectional design to assess whether Hispanic admissions increased after the implementation of the ACA. The final paper uses the 2014 and 2016 N-MHSS waves to assesses whether integrated care has increased at Hispanic-serving organizations compared with mainstream organizations two years after the implementation of the ACA. This paper also assessed whether the increased funding for integrated services under the ACA has disproportionately affected mainstream organizations compared with Hispanic-serving organizations
Thesis (PhD) — Boston College, 2018
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work
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Boucher, Katherine. "A qualitative study investigating the effects of being detained under the Mental Health Act (1983) on an individual's identity." Thesis, University of Surrey, 2007. http://epubs.surrey.ac.uk/804746/.
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Cadman, Louisa Jane. "A genealogy of (bio)political contestation during the reform of the Mental Health Act 1983 in England and Wales." Thesis, University of Sheffield, 2006. http://etheses.whiterose.ac.uk/14895/.
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In 1997 the Department of Health announced their intention to reform the Mental Health Act 1983. Since publishing the first Green Paper in 1999, the proposed reforms have received major criticisms from virtually all 'stakeholders' in mental health care. This PhD offers a genealogy of (bio)political action during the process of reforming the Act. The focus is on the period from August 2002 to September 2003, with particular reference to the activities of self proclaimed 'service users' and 'survivors' in two independent protest groups: 'NO Force' and . Protest Against the Bill'. The methodological premise (chapters two and three) is born from something of a lacuna in post-Foucauldian governmentality studies which, although well posited, offer little in the way of advancing a genealogy of governmental contestation. My focus is twofold. Firstly, by advancing a (post)Foucauldian understanding of resistance - which, with respect to power, 'always comes first' (Deleuze 1988) - I aim to develop the relationship between 'biosociality' or 'life politics' (Rabinow 1996, Rose 200 I) and mental health law. Secondly, I seek to draw on the correlate of governmentality: agonism, taking it into governmental contestations in broadly 'liberal democratic' societies by focusing on what Tully (1999) calls "the free agonic activities of participation" (171). Together these advance my focus on agonistic 'games of truth' enacted during the reform process. This general methodological premise underpins my three major fieldwork chapters. Chapter four focuses on agonism in actu through the process of demonstrating (in the form of a protest march undertaken by No Force). Beginning with, as Barry (200 I) notes, the techniques and technologies "of telling and witnessing the truth" (176), I move through, and beyond Foucault, with respect to the importance of mediatisation and circulation in agonistic truth telling today. Chapter five expands on my understanding of life politics to offer a genealogy of the imbrications between human rights (law) and mental health (law) during the reforms. Here recourse to (human) rights is posited neither simply as a (dangerous) 'empty category' nor exemplary of an expanding 'vital life' but having a distinct genealogy emerging from problematisations in mental health law. Finally, in chapter six, I tum to the use of testimony from 'psychiatric survivors'. This form of biopolitical truth speech is not only illuminating of agonistic games of truth but also of that which is other to it (those who do not speak) and that what falls at the limits ofbiopolitical truth speech (for those who cannot speak).
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Thomson, Victoria. "Common mental health problems in later life : considering new approaches to meet the challenges of an ageing population." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/25763.
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Provisional Question for the thesis to address: Indicated and selective prevention of common mental health problems in later life: Is there a theoretical rationale for an Acceptance and Commitment Therapy approach? Background The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in great individual, community, economic and societal cost. However, common mental health problems in later life are under‐recognised and under‐treated despite evidence in support of pharmacological and psychological intervention. Previous research regarding psychological therapy for late life mental health problems has been dominated by cognitive behavioural therapy. However, the effectiveness of this approach has been questioned, leading researchers to explore alternative approaches. Acceptance and Commitment Therapy has received increasing attention from researchers keen to explore an alternative and some have argued that this approach is particularly suited to older people. In the context of demographic change and a significant increase in the proportion of community dwelling elderly there is a need to provide evidence to support the use of alternative management strategies for late life mental health problems, for example, focusing on prevention. Methods A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’ prevention interventions for older people at risk of developing a major depressive or anxiety disorder due to the experience of subsyndromal symptoms or the presence of significant physical, socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in which the relationship between psychological processes and ageing will be explored. Specifically, this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation strategies, and the presence of psychopathology in a non clinical sample of community dwelling older people. Results Findings of the systematic review provide preliminary evidence for indicated and selective prevention of late life depression, however there is no clear evidence of benefits of these interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling. Although the study did not find age to be a specific predictor of variance in psychological variables explored, the study did provide empirical support for the potential to use Acceptance and Commitment Therapy with older people. Discussion The systematic review article provided preliminary evidence for the efficacy of selective and indicated prevention interventions for late life depression. However, further research is required to consolidate these findings. The empirical paper found significant relationships between the perception of positive health, reduced psychopathology and theoretical variables including cognitive fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide support for the use of an Acceptance and Commitment Therapy approach with older people. The theoretical and clinical implications of these findings are discussed in detail.
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Leonard, Sarah. "A comparative study of people transferred from prison to hospital under the Mental Health Act 1983 : their pathways and outcomes." Thesis, University of Manchester, 2019. https://www.research.manchester.ac.uk/portal/en/theses/a-comparative-study-of-people-transferred-from-prison-to-hospital-under-the-mental-health-act-1983-their-pathways-and-outcomes(3d15b147-97cb-44eb-84a3-bcee55dae1cf).html.
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Background: Little is known about the treatment pathways, transition and discharge of prisoner-patients detained in secure psychiatric services and how best to support and manage remittal back to prison. Remittals to prison now constitute just over 20% of discharges from medium secure services annually. Currently, there is no formal mental health care-pathway or national targeted post-discharge service for prison remittals in the United Kingdom, and there is need for formal guidance on follow-up and after care provision which may be appropriate for this group. This collection of studies aimed to produce essential data which would characterise prison remittals, their pathways through medium secure services and aftercare received post-remittal. Method: A mixed methodological design was adopted which utilised both quantitative and qualitative data collection methods. A national prospective cohort study with a one year followup was conducted to identify factors associated with remittal to prison. All prisoner-patients discharged over a 6 month baseline period were included subject to Section 251 of the NHS Act (2006). Collection of demographic, clinical and criminological characteristics alongside ratings on 4 standardised clinical measures was informed by data extracted from medical case notes and telephone interviews with collateral informants. These data were compared across discharge destination for individuals discharged into the community and those remitted to prison. A concurrent qualitative investigation was conducted to further explore the identified key areas of interest. This involved a focus group interview and series of semi-structured interviews. Prison remittals were followed-up in the prison estate at 12 months post-discharge. Data were extracted from individual patient medical case notes to complete a proforma covering access to prison mental health services, treatment/care received post-remittal and incidents of self-harm/attempted suicide, readmission, and release into the community. Results: There were 153 eligible prisoner-patients identified across 33 medium secure services. Comparative analysis revealed that prison remittals were 4 times more likely to have a primary diagnosis of personality disorder than community discharges and had a significantly shorter length of stay; patients with a length of stay of 6 months or less were 2 times more likely to be remitted to prison. Prison remittal scored lower for the presence of protective factors with the largest difference observed for presence of motivation for and attitudes towards treatment. Prison remittals were also rated as significantly higher risk of future violence and offending, with the largest difference observed for risk of future serious offending. Interview and focus group data allowed for exploration of how clinicians account for these observed differences and exposed the internal and external processes that guide prisoner-patient pathways through medium secure services. Overall, it appeared that different factors are taken into account depending on a prisoner-patients discharge destination, and many clinicians expressed their concern for the outlook of some patients post remittal. Eighty-nine prison remittals across 56 prisons were followed-up. It was identified that post-remittal aftercare is limited and that many patients present as vulnerable upon discharge, particularly those with a primary diagnosis of personality disorder. Discussion: Evidence on the needs of prisoners requiring inpatient psychiatric care is improving and, through the data presented in this thesis, arguments for how best to respond to these needs can be further developed. It is hoped that this research will act as a platform for further development and consideration as to how best to manage prisoners who require secondary mental health care and the extent to which the medium secure estate can provide a proactive role in the care and rehabilitation of these individuals.
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Genziani, Mirella. "An interpretative phenomenological investigation of stakeholder experiences of Section 136 (Mental Health Act, England & Wales 1983 amended in 2007)." Thesis, St George's, University of London, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.706524.
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Section 136 (S136) of the Mental Health Act (England and Wales) empowers the police in the UK to detain and bring people suspected of a mental illness to a place of safety for assessment. Following assessment, individuals may either be admitted into hospital for treatment discharged and receive support in the community. The current study builds on the limited qualitative research evidence by examining the ways in which stakeholders (detained persons, carers and professionals) involved in S136 make sense of their lived experiences of the provision. Group and multiple one to one interviews were conducted with: service users, carers, police officers, ambulance workers, and mental health professionals. An analytic framework guided by Interpretative Phenomenological Analysis (IPA) showcases individual, group and shared experiences. This research has a patient and public involvement (PPI) element. Advisory contribution from service user/carer researcher has played a role in shaping data collection and analysis. The findings of this study revealed insights on S136 from the perspective of five stakeholder groups. Psychological factors such as thoughts, feelings and beliefs associated with lived experiences embedded in experiences emerged in the findings. Whilst most of the participants reported difficult experiences, some were positive: from engaging therapeutically in public space, through to an inclusive quality of care for service user, relative and professionals, that is in keeping with the concept of Triangle of Care (Carers Trust, 2010). Being detained or supporting someone who has been detained meant that service users/carers acquired a good understanding of the provision than they thought they would. Participants made pertinent suggestions for developments they would like to see happening. The findings also revealed that ambulance workers play an important role together with police in supporting individuals in a pre-hospital context. Ambulance worker participants in this study were keen to be more involved in S136 as a professional group. This was evident by their efforts to seek out practical solutions to the dilemmas they encountered. This study has shown that utilising lived experiences can be beneficial for training, practice, maximising the quality of care and future developments for S136. According to the World Health Organisation, it is envisaged that emergency workers are likely to have greater involvement in incidents in public places involving mental health. In light of this, it would be highly beneficial if mental health training be stepped up for ambulance and paramedic workers.
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Melo, Cícero Meincke. "Da expressão e dos territórios em ato : teatro, saúde, educação." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/165696.
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Esta pesquisa, em uma estratégia cartográfica de imersão no cotidiano do Serviço Residencial Terapêutico Morada São Pedro – serviço da rede substitutiva ao manicômio no cuidado em saúde mental – cria um aporte teórico, um eixo reflexivo, partindo do convite à criação de práticas de cuidado em saúde mental. A convocação ao pensamento se dá por composição, numa evolução que busca escapar de circularidades, passando por elaborações acerca do acolhimento à diferença-em-nós como um primeiro movimento de acoplamento de alteridade. Orientado pela perspectiva da composição de novos e inovadores espaços de produção de cuidado e acolhimento ao sofrimento psíquico, busca-se explorar o conceito de “território em ato” como potencial das artes, potencial do convite à participação e expressão dos coletivos (trabalhadores, alunos residentes) convocados à criação de práticas. Ao colocar-se ao lado e no lugar do cuidado, em pelo menos duas orientações iniciais para as práticas – invenção de um espaço teatral para trocas com a equipe de cuidado do serviço em questão e acompanhamento a moradores – o ator-pesquisador imergiu em uma proposta de pesquisa-intervenção na qual as práticas do cuidado em saúde mental se mostraram limitadas ao esbarrar em lógicas institucionais. O eixo de formação em serviço, com orientação multiprofissional, e o vislumbre de uma “pedagogia da implicação”, que convoca os coletivos de produção de saúde a trocas e acolhimento das demandas, em uma disponibilidade de escuta e exposição continuada, orientam as expectativas de acolhimento às expressões, busca de liberdade e capacidade inventiva.This research, in a cartographic strategy of immersion in the daily life of the Residential Therapeutic Service Morada São Pedro – service of the substitute network to the asylum in mental health care – creates a theoretical contribution, a reflexive axis, starting from the invitation to the creation of care practices in mental health. The call to thought is given by composition, in an evolution that seeks to escape from circularities, passing through elaborations about the reception to the difference-in-us as a first movement of coupling of otherness. Oriented by the perspective of the composition of new and innovative spaces for the production of care and acceptance of psychic suffering, we sought to explore the concept of "in act territory" as the potential of the arts, the potential of the invitation to participation and expression of the collectives (workers, Residency students) called for the creation of practices. By placing beside and in the place of care, in at least two initial guidelines for the practices - the invention of a theatrical space for exchanges with the care team of the service in question and follow-up of the residents - the actor-researcher immersed himself in a research-intervention proposal in which mental health care practices has been shown limited when bumping into institutional logics. The axis of in-service training, with a multiprofessional orientation, and the glimpse of a "pedagogy of implication", which calls on health production collectives to exchange and reception to demands, in readiness to listen and ongoing exposure, guide the expectations of acceptance of expressions, search for freedom and inventiveness.
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Armes, David Grahame. "Enablement & exploitation : the contradictory potential of community care policy for mental health services user/survivor-led groups." Thesis, University of Bedfordshire, 2005. http://hdl.handle.net/10547/144164.
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This thesis examines ways in which social policy supported by successive Conservative and Labour Governments has affected the British User/Survivor Movement (BUSM) since the introduction of the 1990 NHS and Community Care Act. It focuses on the formalising effects of community care policy, and the discursive resistance tactics of user/survivor activists in opposition to formalisation of their movement. The aims of the thesis are: firstly, exploration of the contradictory potential of community care policy where there is a formal relationship between local and/or health authorities with mental health services user/survivor-led groups; secondly, tracking New Labour’s policy agenda and the responses of user/survivors; finally, an attempt to develop a user/survivor theoretical standpoint towards community care policy. To achieve these aims the following were undertaken: a literature review which informed the development of a theoretical standpoint; interviews with user/survivor pioneers of the movement; and interviews with discussion groups of user/survivors who were active at local, regional, and/or national level. Analysis of respondents’ statements was completed using a theoretical standpoint based on Feminist/Foucauldian methodology. The chosen methodology resulted in an amended theoretical standpoint to take account of the use of reason by user/survivors and the creation of taxonomies which describe ways in which user/survivors discursively resist formalisation. These results formed the basis for the main conclusions which are as follows: first, user/survivors who engage in ‘consumerist’/empowerment activities, such as advocacy or involvement, can rightly claim to be challenging existing power relations; second, user/survivors entering into formal relationships with health/social services authorities do not necessarily reproduce discriminatory forms of care; third, although the culture of the BUSM has changed since the late 1980s, user/survivor activists are still trying to keep informal/empathic values alive; fourth, a danger exists that user/survivors will be pushed out of providing services and relegated to being the objects of consultation; and finally, there is a need to challenge the reason/unreason dichotomy enabling New Labour to characterise user/survivors as ‘dangerous’. The distinctive focus of this thesis on theoretical standpoint and discursive knowledge provides the basis for its contribution to theoretical and social policy debates in the field of mental health.
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Pritchard-Jones, Laura Gwynne. "Making health and welfare decisions in old age : challenging the adequacy of mental disability law and theory." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/making-health-and-welfare-decisions-in-old-age-challenging-the-adequacy-of-mental-disability-law-and-theory(f3f29f67-6454-4013-8d6e-e5a783ca97fd).html.
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Old age – and particularly the increasing numbers of older people globally and within the United Kingdom - is becoming a social and political phenomenon. Yet despite this, very little has been written on how the law – and especially mental disability law – intersects with old age. This is notwithstanding the fact that many older people may encounter conditions that impact their mental or cognitive abilities, and proportionally, may therefore be greatly affected by this area of law. By drawing on a number of theories – sometimes termed ‘relational’ theories – which are derived predominantly from feminist theory, this thesis seeks to explore the adequacy of mental disability law for safeguarding health and welfare-related decision-making of older adults in three areas; where an older person has been subjected to ageism, where they have been the victim of interpersonal abuse, and where they have dementia and may lack mental capacity. Within this broader goal, this thesis has two specific aims. First, to explicitly critique and challenge the adequacy of the law as it is applied in these circumstances. It is suggested in particular that a deeper analysis of the law in both its previous and current forms betrays the liberal and unduly individualistic roots of the legislative framework. These are roots that are predicated on non-interference, and an idealistic paradigm of the rational, autonomous, and healthy bodied individual. This – it is contended throughout – is an unsuitable philosophy to underpin the law, particularly where the law engages with older adults. Second, this thesis aims to navigate a more suitable pathway within the law as it currently exists. While operating as a tool to critique the legislative framework and its underpinning philosophy, it is argued that the theories drawn upon throughout the thesis also have the potential to highlight how the law could be implemented in such a way so as to emphasise the importance of the realities of the lived experiences of old age, and particularly the experience of ageism, abuse, and dementia. Crucially, it is also suggested that such theories can help the law pay greater attention to the complex web of relationships – both positive and negative; personal and societal – that an older person may find themselves embedded within, and that frequently take on an added significance in old age.
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Orner, Phyllis. "Gender-aware policy and planning: a feminist analysis of aspects of the Mental Health Care Bill, 2000 and the Skills Development Act, 1998." Thesis, University of the Western Cape, 2000. http://etd.uwc.ac.za/index.php?module=etd&.
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Maila, Siyavuya. "Professional quality of life among nurses in psychiatric observation units in the metropole district health services." University of the Western Cape, 2019. http://hdl.handle.net/11394/7029.
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Magister Curationis - MCurBackground: Psychiatric observation units are the units where 72-hour psychiatric observations are conducted in the district and in some of the regional hospitals. These hospitals were selected under the Mental Health Care Act No. 17 of 2002 (MHCA 2002) to admit patients suspected to be mentally ill, ascertain the cause of symptoms, exclude medical illness as a cause of the symptoms, treat and rehabilitate these patients; and at times transfer the patients to tertiary psychiatric hospitals. These units are often overcrowded as only about 30% of patients are transferred to the tertiary psychiatric hospitals. These units are fraught with challenges such as shortage of crucial facilities like seclusion rooms, specialised staff, resources and minimal budget is allocated to these units. Nursing staff in these units are faced with a number of challenges such as shortage of staff, patient overflow, prolonged patient stay, psychologically disturbed patients who can be agitated and violent, and are working long hours. Therefore, Compassion Satisfaction may be affected and these nurses are prone to Compassion Fatigue, which can lead to low Professional Quality of Life. Aim & objectives: The aim was to investigate Professional Quality of Life among nurses working in psychiatric observation units in Metropole District Health Services in the Western Cape Metropole. The objectives were to measure Compassion Satisfaction, to measure levels of Burnout and determine levels of Secondary Traumatic Stress among nurses working in psychiatric observation units in the Metropole District Health Services. Method: A quantitative research approach using a descriptive design was used to determine the Professional Quality of Life of nurses working in psychiatric observation units in the Metropole District Health Services. A self-administered survey using a structured questionnaire, the Professional Quality of Life version 5 (ProQoL 5) was used to collect data from an all-inclusive sample of 175 nurses, yielding a response rate of 93% (n=163). Data was analysed using the Statistical Package of Social Services (SPSS) version 24. Findings: The findings of this study showed that respondents experienced moderate Compassion Satisfaction, moderate Burnout and high Secondary Traumatic Stress. Advanced psychiatric nurse practitioners and registered nurses reported lower Compassion Satisfaction, higher Burnout and higher Secondary Traumatic Stress than enrolled nurses and enrolled nursing assistants. Recommendations: Qualitative research studies need to be conducted on nurses working in psychiatric observation units in order to understand experiences and factors affecting Professional Quality of Life among nurses. Qualitative research studies need to be conducted in order to understand factors affecting Professional Quality of Life of advanced psychiatric nurse practitioners and general registered nurses in psychiatric observations units.
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Hannan, Maria. "Examining and understanding the use of the police custody as a "place of safety" under section 136 of the Mental Health Act." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/examining-and-understanding-the-use-of-the-police-custody-as-a-place-of-safety-under-section-136-of-the-mental-health-act(211c788e-0ec6-48e9-ada1-c55ae3465c86).html.
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This thesis describes the use of police custody as a ‘place of safety’ and examines the deaths of those detained under the power to explain how they might best be prevented. The police are often the first agency to be called and attend difficult and potentially confrontational situations. They may have to deal with vulnerable, disturbed, distressed individuals behaving in bizarre or aggressive ways. However, police officers generally do not have the skills and understanding to deal with these people. There is currently very little evidence about the nature and extent to which police custody is used as a ‘place of safety’ under Section 136 of the Mental Health Act 1983 or the details of those detained. Many deaths in police custody involve people with mental health problems and deaths in custody remain a highly contentious issue. This is particularly the case for Black and Minority Ethnic (BME) communities who have experienced some of the most controversial deaths and where trust and confidence in the police have traditionally been lower. This thesis explains why variations in the use of Section 136 of the Mental Health Act 1983 occur by exploring the data gathered from police forces. In particular it explores the possibility that variation in the use of Section 136 may be linked to differences in police cultural knowledge or ‘habitus’, with some forces having more positive working relationships with health and social care than others, and differences in the wider ‘field’ with the availability of alternatives to police custody varying greatly across police force areas. The relationship between the ‘field’ and ‘habitus’ cannot be underestimated, with the availability and prioritisation of resources and cultural knowledge of the police and other agencies influencing and impacting on each other. In turn, this can be affected by a number of issues such as police leadership, training, law and policy.
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Lingard, Richard. "A Qualitative Investigation of Informal Carers' experience of the assessment and detention of therelative / friend under the Mental Health Act (MHA).ir." Thesis, University of Surrey, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485983.
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Armah, Benedicta. "The right of women with psycho-social disabilities to access mental health care in South Africa : a critical analysis." Diss., University of Pretoria, 2012. http://hdl.handle.net/2263/36793.
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Ford, Shane Alwyn. "Delivering Acceptance and Commitment Therapy (ACT) for mental health disorders across group and guided self-help formats : a meta-analysis and randomised controlled trial." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/25924.
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Background: Acceptance and Commitment Therapy (ACT) has shown promise as an effective intervention in the treatment of mental health disorders. In the last decade, the delivery of ACT has expanded to include various formats (e.g. groups, self-help, online and phone apps). Further research is needed to evaluate whether such delivery formats are a viable extension of ACT. Furthermore, the existing evidence base of certain alternative delivery formats have yet to be reviewed. This thesis portfolio sought to contribute to this area of research. Methods: A systematic review of the literature was conducted to investigate the efficacy of group-based interventions for mental health disorders using ACT. Five databases were systematically searched, manual searches were conducted and corresponding authors were contacted. Studies which used a randomised-controlled design, with adult samples and investigated group-based ACT interventions for mental health disorders were included. A meta-analysis of the included studies was conducted for post-intervention and follow-up data. In the empirical study, an ACT manual was trialled using a randomised-controlled design to investigate the efficacy of using ACT in a guided self-help context. Participants with anxiety/depression were randomly assigned to receive either the ACT intervention or treatment as usual (TAU). Those in the ACT group were posted an ACT manual and received two telephone calls. Outcome measures were analysed after the six-week intervention. Results: From the meta-analysis, 18 randomised-controlled trials were identified, 14 of which focussed on anxiety and depression. The findings suggest that ACT-based groups have a large effect on symptom reduction when compared to non-active comparisons at post-treatment and a moderate effect when compared to non-active comparisons at follow-up. Additionally, there was a small effect in favour of ACT when compared to active treatment controls at post-treatment and equivalent effects when comparing ACT to active treatment controls at follow-up. Similar effects were found when separately comparing the 14 studies which focussed primarily on anxiety and depression. The empirical study revealed that guided self-help was found to be no more effective in improving quality of life or reducing psychological distress than the TAU group. However, such results should be interpreted with caution as the small sample size and high attrition rate indicates that further research with larger samples and follow-up are needed before strong conclusions can be made. Conclusions: The findings of this research indicate that group-based ACT interventions may be a suitable alternative delivery format for service providers in the provision of common mental health disorders, particularly anxiety and depression. Further research is needed before any strong conclusions can be made regarding the efficacy of guided self-help for anxiety/depression.
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Allan, Alison Steadman. "The experience of having a son conditionally discharged under Section 37/41 Mental Health Act 1983 and then recalled to hospital : an interpretative phenomenological analysis." Thesis, University of East London, 2013. http://roar.uel.ac.uk/3838/.
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This study explores the lived experience of parents of male patients who have been detained under a hospital order with restrictions (section 37/41 Mental Health Act 1983), subsequently conditionally discharged into the community, and then recalled under the restriction order back to hospital. While much research has focused on the impact of having a relative with a diagnosis of mental illness, there has been a dearth of research into the impact of having a relative detained in a medium secure forensic unit. As yet, no research has been conducted into the experience of families where their relative has been discharged from a medium secure forensic unit, returning to the community after a long period of detention. Neither has there been any exploration into what parents experience if their son is subsequently recalled under the restriction order back to hospital. Interpretative phenomenological analysis was used as a way of exploring this experience for six parents of five sons who had been conditionally discharged and subsequently recalled to medium secure forensic psychiatry units in the South-East. The analysis yielded themes which related to the personal and emotional impact that parents experienced in terms of a cyclical pattern of hope when their son was discharged, followed by loss and fear, accompanied by a sense of powerlessness when his mental state deteriorated, and relief together with disappointment at recall. There was a reappraisal of the expectations they had of their son which enabled them to regain hope for him. A further theme of ii responsibility highlighted the responsibility that parents assumed for their son, doing what they can for him whether he was in hospital or the community. Although they desired him to progress and be autonomous, parents recognised that their son may never be fully independent and may always require their support. They hoped that when he was conditionally discharged they would be able to share this responsibility with the supervising team. However, it seemed that when their son‟s mental state deteriorated, parents struggled to enlist the help of mental health services and were uncertain as to who held responsibility for him. Feeling isolated and unsupported at this time, they also felt blamed by services, reciprocating by blaming services. Not only unable to get what they perceived as an appropriate level of help for their son from services while he was conditionally discharged, parents described trying to access a system that seemed impenetrable, and responding only when „something had happened‟. When he was finally recalled, they experienced the system as having engulfed their son, and recognised how difficult it would be to get him out. Throughout the whole process they felt that their own expertise as parents was marginalised, and they described not feeling part of the team despite Governmental stress on carers being recognised as expert partners in care by services. A number of limitations of the study are discussed, together with the researcher‟s reflexive account and implications for practice. The study offers a deeper understanding of what parents in this situation may experience, and offers a broader perspective for those who work with them.
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Dixon, Jeremy. "Identity, risk and control : the perceptions of service users subject to section 37/41 of the Mental Health Act 1983 towards risk, risk assessment and social supervision." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/46753/.
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Whilst risk assessments have come to assume an increased level of importance in mental health policy and practice in England and Wales since the 1990s, there has been relatively little focus on the way in which service users themselves experience such practices. This thesis examines the views of offenders subject to Ministry of Justice restrictions under section 41 of the Mental Health Act 1983 towards their own offending, risk assessments and supervision. A primarily qualitative methodology is used to examine the views of 19 service users. Using theories of identity, the thesis examines the way that research participants explained and justified offending behaviour. It is argued that mentally disordered offenders used illness as a form of mitigation, utilised ‘techniques of neutralisation’ or employed a combination of these approaches. The thesis moves on to use governmentality theory as a means to analyse participants’ awareness and views toward risk assessment practices and their conditions of discharge. Although participants believed that assessments were seen as important by mental health professionals, they were often unaware of the content of such assessments. Research participants usually had little or no knowledge of their conditions of discharge. Service user perceptions of the supervision process are then examined with reference to theories of social control. It is argued that service users held a range of views towards the supervision order, seeing it variously as a means of identifying and supporting them as mentally ill individuals; as a means of establishing internal controls or as a negative means of labelling socially stigmatised behaviours. The thesis concludes through considering the ways in which social workers might consider the use of risk assessment practices through an ethical framework. It I argued that social workers should seeks to bridge Kantian and utilitarian perspectives through a consideration of service user autonomy.