Dissertations / Theses on the topic 'Community mental health personnel Australia'

Many people with a mental disorder are desperate to improve their situations. It is therefore timely that a substantive theory on what it means to live with a mental illness in Western society is developed that explores a way forward for them. This study goes back to the grassroots and finds out from the people diagnosed with major depression, bipolar disorder or schizophrenia what they say helps them. Although many studies have been carried out on the impact of mental disorders, the voice of mental health consumers has not featured prominently. This study aims to redress this in reporting on what they identify as their main concern and on how they resolve it.This thesis presents the substantive theory of transforming oneself and society to resolve life being a struggle. It is based on interviews with 35 mental health consumers living in the Western Australian community. Relevant national and international literature is also included as additional data. This study used the grounded theory method to identify a commonly shared pattern of behaviour in how participants resolved their main concern. The main concern, called the basic social psychological problem of life being a struggle, was brought on by eight disempowering conditions, which disempowered participants in both personal and social spheres. Participants then engaged in a personal struggle, including identifying their intrinsic value as a person, and their struggle with relationships. This culminated in the struggle with getting through daily life.Participants resolved the basic social psychological problem of life being a struggle through the basic social psychological process of transforming themselves. This process consisted of two stages separated by a turning point. In the first stage, participants found that neither withdrawing nor trying to get on top of having a mental disorder was successful in dealing with basic social psychological problem of life being a struggle despite their best efforts. In their powerlessness at making a difference to their lives they reached a breaking point, which became a turning point, where they were forced to confront their hopeless situation. The successful confrontation, or turning point, marked the change from their hitherto powerless position into one where participants had some power for the first time. They pinpointed this as the beginning of their transformation.In stage two of the basic social psychological process of transforming themselves, participants built up their power by deciding to tackle the struggle to identify their intrinsic value as a person first rather than focusing on trying to get on top of having a mental disorder. By refocusing on getting better as a person, participants managed to gain a new perspective, which in turn allowed them to learn new strategies and take action that made a difference in their lives. This second stage was fulfilled when participants felt at peace.However, as participants pointed out, being at peace remained fragile because the disempowering conditions that had brought on the basic social psychological problem of life being a struggle were still operating and therefore these conditions also had to be changed. Empowering conditions could achieve this in given participants sufficient power or influence and authority so that the disempowering conditions could be countenanced and then banished on a permanent basis. Participants' lives would then no longer be a struggle and they could live in peace. Participants suggested that enacting these empowering conditions would amount to transformation of society, where society treated people with a mental disorder with justice and provided effective help. In accord with other identified theories and models, the substantive theory of transforming oneself and society to resolve life being a struggle established that the transformation of society was the way forward to improve the situations of people with a mental disorder and relieve their desperation.

Wildfires in Canada and around the world are increasing in frequency each year from factors such as accumulated fuel load, climate changes, and pine beetle infestation. Due to an increased proportion of individuals living in the wildland–urban interface areas within Canada and due to the increasing need for firefighters to fight the growing number of fires that burn each year, the potential threat for humans is also becoming greater. Conducted on the 2009 West Kelowna, British Columbia wildfires, this descriptive, exploratory, qualitative study incorporates quantitative validity measurements to investigate factors related to individual variations in psychological distress and posttraumatic growth (PTG). The findings revealed that perception of control, social support, compounding stressors (i.e., dual roles, ongoing responsibilities and personal issues), and coping methods (i.e., debriefing, humour, self-care behaviours, and reflection) were precursors to psychological health and resilience. Since wildfires are increasing in Canada as well as on a global scale, understanding how they affect residents and firefighting personnel from a mental health perspective is important to research, as it can lead to identifying more effective interventions, better provision of disaster relief services, and increase individual resilience.
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This descriptive• study discusses the development of community mental health (CMH) in Western Australia (WA) and describes the current practising population of CMH nurses. The study explores literature pertaining to the emergence of the CMH movement and the deinstitutionalisation of the mentally ill. A conceptual framework was developed by adapting Lewin's change theory. CMH nurses practising in WA (n= 130), were invited to participate in the study and were asked to complete a survey questionnaire. This resulted in a 66% response rate (n = 86). Quantitative data was analysed using the Statistical Package for the Social Sciences (SPSS). Open ended questions were analysed using Colaizzis steps. The study found that mental illness has been treated according to contemporary beliefs. In the 1950s multiple forces within society led to the movement away from institutionalisation of the mentally Ill toward deinstitutionalisation. The first community clinic was established in 1956 to manage the deficit between the ever expanding population needing mental health care and the paucity of available hospital beds. The need for follow up of clients in the community resulted in the development of CMH nursing. The study also provides a profile of the current practicing population of CMH Nurses in WA, demographic details, qualifications, the work environment, educational needs, work role and job satisfaction have been described. Recommendations have been developed from the findings and are directed towards, the dissemination of information, the need for role identification/development, staff development needs, future education needs, industrial issues, clinical practice issues and areas for further nursing research

Major mental disorder, with prolonged periods of dysfunction that require long term care, is an issue of concern amongst mental health professionals. Although substantial effort and resources are devoted towards returning mentally ill individuals to the community, one of the most distinctive and consistent features of the persistently mentally ill (PMI) is their high rate of readmission to hospital. Existing studies into discharge planning revealed that no research had been undertaken to determine if this is the case in Western Australia. This study sought to investigate perceptions of discharge planning held by patients, carers, nurses and allied health workers involved in discharge preparation in a major metropolitan psychiatric hospital operated by the Health Department of Western Australia. Eighty one subjects were selected from the four principal groups involved in care in this mental health setting, consisting of patients ( n = 21 ), carers ( n = 20 ), nurses ( n = 22 ) and allied health workers ( n = 18 ). Perceptions of discharge planning of these subjects were evaluated and compared using the Discharge Priorities Rating Scale. Farran, Carr & Maxson's model of goal congruence in discharge planning was used to guide this study. Significant differences were found to exist in the perceptions of discharge planning between patients, carers, nurses and allied health workers. Differences in perceptions are seen to have a detrimental effect on the discharge planning process, resu1ting in unnecessary and frequent readmission to hospital and the perpetuation of institutional dependency. Whilst the results of this study can only be applied to similar institutions, the findings are relevant for the persistently mentally ill who have patterns of frequent readmissions across the public and private mental health service settings. The results obtained indicate that nurses can facilitate effective discharge planning practices by adopting a more assertive role in the hea1th care team, in communicating patients' and their carers' concerns and promoting a more collaborative approach to care.

Background: Suicidal behaviour is a major public health problem that has not abated over the past decade. Adopting machine learning algorithms that allow for combining risk factors that may increase the predictive accuracy of models of suicide behaviour is one promising avenue toward effective prevention and treatment. Methods: We used Canadian Community Health Survey – Mental Health and Canadian Forces Mental Health Survey to build conditional inference random forests models of suicidal behaviour in Canadian general population and Canadian Armed Forces. We generated risk algorithms for suicidal behaviour in each sample. We performed within- and between-sample validation and reported the corresponding performance metrics. Results: Only a handful of variables were important in predicting suicidal behaviour in Canadian general population and Canadian Armed Forces. Each model’s performance on within-sample validation was satisfactory, with moderate to high sensitivity and high specificity, while the performance on between-sample validation was conditional on the size and heterogeneity of the training sample. Conclusion: Using conditional inference random forest methodology on large nationally representative mental health surveys has the potential of generating models of suicidal behaviour that not only reflect its complex nature, but indicate that the true positive cases are likely to be captured by this approach.

Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers

The South African government has initiated the transformation of health services in the country towards primary health care (PHC) in order to provide comprehensive care to individuals and families. The move to PHC involves an increased need for collaboration between health professionals. It is proposed that for effective team-work to take place, an understanding of the roles and functions of team members is imperative in providing quality mental health care. This study explored health professionals’ perceptions of the role and function of clinical psychologists working as part of a health care team in a community context. Three focus groups and three individual interviews were conducted with social workers, nurses and doctors. The data was then processed and analysed using a grounded theory method. The research highlighted the importance of knowledge, and how this affects referrals, perceptions, inter-professional relations and the perceived usefulness of clinical psychology and clinical psychologists. What is of significance is the potential power that the health professionals have as gatekeepers between the general public and clinical psychologists.

Community arts is often criticised for its tendency to be more about welfare than art. This thesis investigates this claim through the environment of a growing number of arts projects taking place in healthcare settings. Healthcare settings inherently deal with the field of welfare. This research has recognised that many of these projects are participation-based community arts projects. I have termed these projects arts-inhealth and they form the case studies of this research. Arts-in-health is not art therapy. Arts-in-health is a community arts-based approach to artmaking which enables people to access art processes and skills which are not part of the treatment or diagnosis of their illness. This thesis recognises that people belong to a communal web of relationships which can often be severed when they become ill. Because arts-in-health encourages artmaking beyond a treatment framework, it can re-connect people to their communal web. is thesis claims that for community art to have this impact it must be designed and implemented through artistic processes and not treatment, therapeutic or clinical ones. If community art processes do become distorted by therapeutic processes, they will become more about welfare and less about art; consequently, they contribute less to the community in which individuals live.

Mental health reflects an array of causal influences that span biological, psychological, and social circumstances, with resultant underlying causal pathways to poor mental health outcomes in childhood that are complex. Key features of this complexity are reciprocal interactions between person and environment that take place over time. The core of this thesis seeks to attend to the complexity of development to move the field of developmental health forward toward greater explanation, and more successful prediction and prevention. The focal point of the thesis is the psychosocial determinants of childhood mental health, the resource domain of the developing child, and the interplay between characteristics of the individual child, the family, and the community. The eventual goal is to better understand why and how socioeconomic circumstances impact on developmental health. One component of this thesis focuses on the expansion of extant developmental theory. The other component focuses on the development of an analytic strategy that more appropriately reflects the intricacies of this theoretical expansion. In the process, data are analysed, principally as a heuristic strategy, to illustrate the analytical approach needed to support the theoretical framework. The specification of a bioecological conceptual framework suitable to guide research and policy in developmental health is the first principal objective of the thesis. A critical examination of the resource framework proposed by Brooks-Gunn, Brown, Duncan, and Anderson Moore (1995) reveals it to be centred on family and community resources, but otherwise silent with respect to the physical and psychological resources of the child. The quintessential point of this thesis is that theory in developmental health must be able to account for the contribution individuals make to their own development. A modified resource framework is proposed that acknowledges financial, physical, human, and social capital, within the domains of the individual child, the family, and the community. The second principal objective of the thesis, the development of analytical methods that focus on the individual child and the complexity of data generated by this theoretical approach, is then introduced. Theory and method are thus integrated when comprehensive measures of characteristics in multiple domains across developmental periods are modeled using longitudinal data from the Western Australian Pregnancy Cohort (Raine) Study (Newnham, Evans, Michael, Stanley, & Landau, 1993). The mothers of 2,860 children were enrolled at 18 weeks in pregnancy and the children have been followed at birth, one, two, three, five, and eight years of age. Eighty-nine per cent (2,537 /2,860) of families were available for follow-up at eight and 74 per cent (2,126/2,860) of families responded. Extensive demographic, psychological, and developmental data were available for the children and their families and a limited amount of data were available for the communities in which they reside. A measure of mental health morbidity, the Child Behaviour Checklist (Achenbach, 1991), was available for the children at two, five, and eight years of age. In the first instance, dichotomous summary variables are derived for the demographic, psychological, and developmental variables of interest. Variables are then selected for inclusion in one of several explanatory models. To create a mathematical representation of resource characteristics, the information for each child is concatenated as a series of binary strings. Frequency tabulation is then used to aggregate the data and odds ratios are calculated to determine the degree of risk associated with each string of code, or pattern of factors relative to a nominated mental health outcome. The results provided a scaffold from which this theoretical and analytical approach is compared and contrasted with the reviewed literature. Two principal themes of investigation are pursued. The first theme to be examined is the interplay between characteristics of the child, family, and community and the contribution children make to their own development. The specific approach models the interaction between selected characteristics of the child, family and community in each of four developmentally significant time periods. The theoretical position adopted in the present study suggests that the effect of any personal or contextual factor on later development, if a relationship does truly exist, is most likely to be differential. That is, it is a combination of influences that determines developmental outcomes for children, not any single factor acting independently. The modelling process demonstrates that, for the children involved, personal and contextual factors impact mental health differentially depending on various other individual, family and/or community characteristics. The modelling process identifies patterns of factors that impact relatively small, but significant, numbers of children because the models focus on the effect for individual children rather than the effect for the group. For example, one model suggests that the effect of intra-uterine growth restriction for the group as a whole may be minimal, but the impact for some children could be critical depending on the combination of family and community influences, such as the mothers level of education, the family’s experience of significant life stress, and residence in a relatively disadvantaged community. The second theme to be examined is the possibility that the accumulation of resource deficits or risk characteristics, over time, amplifies the likelihood of mental health problems in childhood. The approach models selected characteristics of the child in each of the four periods of development collectively, and it also models selected characteristics spanning each of the four time periods discretely. The results suggest that latency, pathway, and recency effects may operate simultaneously, and that timing and accumulated burden may both be important determinants of risk. For example, with regard to children whose family experienced life stress, these three effects operated in a systematic way to increase the degree of risk of a mental health problem. In summary, the aggregation of data at the individual level is a productive approach in seeking to explain population level social phenomena. While seemingly paradoxical, the identification of the joint, interactive effects between individual, family, and community characteristics, better allows for the quantification of family and community characteristics operating through multiple causal pathways.

Intercountry adoption is a globally politicised institution that triggers strong discourses about whether transplantation to a markedly different country and culture, often into families with racially different parents, negatively affects the children ' s well-being and identity. Although empirical intercountry adoption research has increased elsewhere, Australian-based research has lagged behind. This thesis presents a body of evidence about the well-being and identity of over half the population of 14- to 26-year-old intercountry adoptees in Western Australia, how their well-being changed from 1994 to 2004, how they compare with non-adopted migrant peers and the influence of risk and threat factors. In 2004, participants consisted of 110 intercountry adoptees, three partners, 120 adoptive parents of 160 adoptees, 80 migrant peers and 44 parents of 56 peers. Data were collected by mail survey. From theoretical perspectives in subjective well-being, identity processes and transracial adoption, well-being was examined in terms of physical health, happiness, satisfaction with life and adoption/migration, self-esteem, self-efficacy, competence and adaptive and problem behaviours. Identity was examined in terms of adoptive/migrant status, heritage, community membership, ethnicity, culture, race and place.

This research program on burnout and work environment perceptions in personnel working directly with unemployed individuals in Australia is reported in three studies. Using a survey methodology and taking a quantitative approach, burnout was investigated using the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1986) on two occasions, before and after the privatisation of Australia's employment services industry (Job Network). The most widely accepted survey instrument measuring burnout (Lee & Ashforth, 1996), the MBI defines this stress related syndrome in terms of three subscales, Emotional Exhaustion, Depersonalisation and Personal Accomplishment. Perceptions of the work environment experienced by employment service staff were concurrently surveyed using the Real form of the Work Environment Scale (Moos, 1994). Heeding advice of researchers from the job stress area (e.g., Mccrae, 1990), this program of research also concurrently investigated the personality trait Neuroticism, the disposition to perceive and report negative experiences. In 1995, burnout in two groups of public sector personnel engaged in assisting individuals experiencing unemployment were compared. Staff employing a case management style of service delivery and staff engaging in an over-the-counter production-line style of service were surveyed and their responses on the MBI, the WES and the Neuroticism subscale of the revised short form edition of the Eysenck Personality Questionnare (EPQR/ s; Eysenck & Eysenck, 1991) compared. As hypothesised, case managers reported significantly higher burnout scores on all three subscales of the MBI, and perceptions of higher work pressure. The personality trait Neuroticism was found to account for significant variance in the burnout scores of the public sector respondents. The second study was conducted in 1999 after the full privatisation of the Australian employment services industry. At this time (T1 ), burnout in case managers throughout Australia was investigated with a postal survey which sampled 86 case managers from 38 different private sector organisations providing case management services to the long-term unemployed. The same respondents were surveyed again after six months (T2}. Study 2 demonstrated that case manager burnout levels in the new Job Network were significant. The design also allowed for the prediction of future burnout (T2) from personality and work environment data collected at an earlier time (T1) to be correctly modelled. As hypothesised Neuroticism was a significant predictor of all three MBI subscales both at T1 and T2. In what amounts to a comparison of public and private sector personnel, the third study compared the burnout levels and work environment perceptions of case managers surveyed in 1995 with the responses of case managers surveyed in 1999. Case managers from the public and private sector reported similar high levels of Emotional Exhaustion and Depersonalisation. Private sector case managers also reported significantly higher mean Personal Accomplishment scores, corresponding to a lower mean burnout level, and significantly higher levels of involvement and commitment to their work than public sector case managers. The results of these studies addressed a significant gap in the burnout literature which had hitherto failed to report investigations into employment service personnel, and highlighted the importance of considering the personality trait of Neuroticism in future burnout research. Results were discussed in the contexts of the evaluation of the current Job Network and the process model of burnout (Leiter, 1993).

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

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

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

The Surgeon General of the United States in 2003 documented the existence of striking disparities for minorities and immigrants in mental health services and the underlying knowledge base. This thesis expands the knowledge base by examining the personal experiences and perspectives of community health workers (CHWs) employed in a mental health project. CHW interventions have been shown to increase access and reduce barriers to health care services. CHWs come from similar cultural and ethnic backgrounds as recipients of services and share similar life experiences. As cultural mediators between ethnic communities and a primary health care system, CHWs are able to provide valuable insight into immigrant mental health disparities. Through case study analysis, this thesis explores the personal experiences of CHWs employed by a grant-funded mental health project. Utilizing ethnographic research methods to better understand the CHW intervention, this thesis focuses on CHW motivations, their challenges and the impact of work on their personal lives. Results suggest that CHWs experienced many positive changes in their own lives as a result of their work. CHWs are better able to address their own physical and mental health needs. By increasing access to community and clinic services, CHWs help to improve the mental and physical health status of clients. Results suggest that the cultural competency of clinic staff, service providers and clients improved. CHWs help to strengthen community bonding or social capital by expanding social networks and empowering individuals to create change in their own lives.
Graduation date: 2006

Research Doctorate - Doctor of Philosophy (PhD)
The second half of the twentieth century was a period of major reform in the administration of mental health in Western democracies, when the orientation of state mental health services turned from legally certified to voluntary patients and psychiatric treatment moved from hospital to community settings. This thesis tells the story of reform of the administration of mental health during the development of community mental health services from 1960 to 1980. It positions the changing role of the patient as crucial to these reforms. I argue that Newcastle and the surrounding Hunter Valley region in New South Wales, Australia, was a site of particular importance in genealogies of patients. Newcastle, an industrial, regional city, was undergoing shifts representative of wider demographic and economic trends in the West during this period, and was the location for experimentation in the administration of mental health. These developments were linked to the emergence of patient rights and obligations, and developments influenced psychiatry and medical education. While the changing authority of patients in the administration of mental health has received little scholarly attention, in this study I argue that it has a central place in mental health histories. I demonstrate this by reconstructing the rollout of voluntary patient and community mental health services for implied patients in New South Wales in 1960-1980, with particular reference to Newcastle. I read source material against the grain to bring social and cultural perspectives to developments that shaped, and were negotiated by, patients. I draw on material from academic, health administration and community sectors, held in the David Maddison Collection in the University of Newcastle Archives, New South Wales, Australia; oral history interviews with former mental health staff and family members of patients; government reports; and interviews and published material by patients available in the public domain. In doing so I expose the lineage of twenty-first century mental health patient roles. I argue that changes in patients and services reflected an expansion in what mental health services were seen to address, and that approaches trialled in the administration of mental health have had a powerful influence on public health policy over time.

Suicide rates have been relatively constant in Australia for over a hundred years, albeit peaking in 1997 and since returning towards historically average levels. Suicide now represents the commonest cause of violent deaths and exceeds deaths from motor vehicle accidents and armed conflict. There have been a number of national programs following the lead of Finland in the 1980s. Modern research has clearly demonstrated many of the risk factors, but they lack specificity in terms of prediction, and therefore the numbers needed to demonstrate the effectiveness of any intervention are particularly daunting. This makes research problematic and it is probably impossible to ever get Level 1 evidence because of the large numbers and expense required. Therefore many research studies are either epidemiologically oriented or directed to crisis care and treatment algorithms. Rural suicide presents particular challenges because of the increasing numbers of young and elderly men who take their lives, the lack of services available locally and the paucity of research in rural societies, with it usually being confined to examining risk factors and comparing them with urban populations. This thesis describes an approach to rural suicide which, whilst cognisant of the broad range of risk factors, was more directed to tackling poor mental health on a community basis, utilising local resources. It used four main approaches: educating the community to enhance mental health literacy by appreciating the causes of poor mental health; building the social capital or community capacity of existing resources; emphasising early identification and intervention of problems; and the establishment of a community child and adolescent program based in the local school, but with close liaison with the local medical practitioners. The educative approach to mental health literacy was to engage the whole community as widely as possible with special programs for general practitioners, nurses, and teachers; community capacity and social capital were increased by teaching the community warning signs, techniques to engage and refer to known entry points into the system; early identification was undertaken by screening for poor mental health within the doctors’ office, the hospital and the school; and a child and adolescent program was devised to detect dysfunctional students, formulate an assessment and management plan, and then evaluate the outcome. The most important results were a statistically significant reduction of suicides from twelve in ten years to one in the following decade, as well as a statistically significant reduction in the number of suicide attempts. In addition there was the establishment of a primary mental health service within the community which was independent of specific government finance and resources.
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Thesis(M.D.)-- School of Medicine, 2007.

This thesis examines the arts of care in an asylum in New South Wales (NSW) and a mental health community in the Australian Capital Territory in twentieth-century Australia, and describes and compares a range of governmental responses for responding to persons deemed to be in need of care. The thesis explores similarities between twentieth-century Australian care techniques and the key principles underpinning a ‘care system’ that was developed over 200 years ago. It proposes three twentieth-century care regimes, each one characteristic of a certain period: Herd Care, set in an asylum era that emphasised custodialism and confinement (1925-1958); Therapeutic Community, a period during which the asylum was reconfigured into a facilitative community (1959-1983); and Community Care, beginning around 1983, when NSW asylums were ‘rationalised’, their care techniques fragmented and outsourced in diverse settings generally referred to collectively as the mental health community. Some of the dynamics, continuities and ruptures in twentieth-century care regimes are analysed. Chapters describe the landscapes of care. They explore how environmental settings have been designed to reinforce the care regimes in which they are mobilised and how they ‘make up’ the possibilities for action of the subject of care. The dynamics of care between care providers and their recipients are examined. Some of the continuities and discontinuities of meanings associated with ‘family’ and ‘community’ in each of the care regimes are observed. Fieldwork findings are combined with the cultural narrative of psychiatric primitivism to consider why subjects have been deemed in need of care, at times in need of protection and training and at other times in need of discipline and restraint. The new possibilities for action that have emerged in Australian twentieth-century mental health governance are considered, when subjects of care have been encouraged to learn how to be free

Typescript (Photocopy)
Includes bibliographies
3 v. ;
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (M.D.)--Dept. of Psychiatry, University of Adelaide, 1990