Dissertations / Theses on the topic 'Managed mental health care Australia'
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1
Hasson, James M. "The ramifications of managed care in the behavioral health care setting in Berks County." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1997. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1997.Source: Masters Abstracts International, Volume: 45-06, page: 2943. Abstract precedes thesis as 1 preliminary leaf. Typescript. Includes bibliographical references (leaves 66-67).
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Walker, Benjamin F. "The advent of managed care an examination of the impact on behavioral human service delivery /." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 2006. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A. )--Kutztown University of Pennsylvania, 2006.Source: Masters Abstracts International, Volume: 45-06, page: 2963. Typescript. Abstract precedes thesis as 2 leaves. Includes bibliographical references (leaves 77-84).
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Alex, Theodore P. "An investigation of the impact of HealthChoices managed behavioral healthcare on the Lehigh Valley." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1999. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1999.Source: Masters Abstracts International, Volume: 45-06, page: 2928. Typescript. Abstract precedes thesis as preliminary leaves iii-iv. Includes bibliographical references 122-127.
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Angelotta, John Walton. "Clinical social workers' involvement in and adoption of managed mental health care technology." Case Western Reserve University School of Graduate Studies / OhioLINK, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=case1057687689.
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Kaissi, Lana. "SOCIAL WORK PERSPECTIVES ON THE CONSTRAINTS OF MANAGED CARE AND MENTAL HEALTH TREATMENT." CSUSB ScholarWorks, 2019. https://scholarworks.lib.csusb.edu/etd/869.
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Approximately 46.6 million adults in the United States live with a mental illness as of 2017. Therefore, managed care being the system that facilitates access to mental health treatment needs to be addressed. Managed care (such as healthcare plans) seeks to facilitate healthcare service delivery by providing direction and guidance to utilization and prevention of services. The purpose of this qualitative study is to explore social work perspectives on the constraints of managed care as it impacts access to mental health treatment. This study conducted qualitative interviews through a non-random sample of professional colleagues of social workers in the in the manage care field. This study found five emerging themes including long wait times, lack of providers (to provide timely, effective mental health treatment), over diagnosing to justify services, profit-driven service delivery, and managed care not aligning with social work values. The implications of this study urge the need for accountability and consistency through policy change and reform.
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Hattingh, Leandri. "Participant profiles and symptom responses in the initial stages of a South African Mental health managed care programme." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31530.
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Introduction
Continuously rising health care and workplace costs associated with mental illness is demanding attention from health care funders in South Africa’s private health care sector. The majority of mental health care costs are generated by in-hospital care, whilst funded access to ambulatory care is limited in this sector. The Medscheme Mental Health Programme (MMHP) is a collaborative care project which aims to promote the integration of good quality mental health care into the primary care setting. In a “treatment-to-target” approach, symptom score trackers are used to systematically monitor response to treatment in order to help identify and modify suboptimal treatment plans timeously (Hattingh 2017b).
Aims
This study describes the MMHP participants and pathways into and through the MMHP, and its initial clinical outcomes.
Methods
Principal members and dependant beneficiaries of two participating medical schemes screened for enrolment on the MMHP between 1 August 2016 and 28 February 2018 were included in the study. Persons younger than 18 years were excluded. Symptoms of major depressive disorder (MDD), generalised anxiety disorder (GAD), posttraumatic stress disorder (PTSD) and alcohol abuse were screened for by using the Patient Health Questionnaire-9 (PHQ-9) (Spitzer, Williams, and Kroenke 2002-2015; Kroenke and Spitzer 2002), the Generalised Anxiety Disorder Questionnaire-7 (GAD-7) (Spitzer, Williams, and Kroenke 2002-2015; Spitzer and Kroenke 2006), the Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD) US Department of Veteran Affairs (2015); (Prins, Ouimette, and Kimerling 2003) and the Alcohol Use Disorders Identification Test (AUDIT) (Babor et al. 2001). The Medscheme Care Manager administered these questionnaires telephonically to screen candidates for enrolment on the Programme and communicated regularly with the associated clinical practitioner regarding treatment response. A specialist psychiatrist reviewed and provided recommendations on problematic cases at set intervals.
Using logistic regression, the association between demographic characteristics and scheme type and the presence of moderate or severe symptoms of 1) depression, 2) generalised anxiety disorder, and 3) post-traumatic stress disorder, was assessed. Percentages of the sample with a single condition, one, two and three comorbidities were also analysed, as well as the proportions of co-occurrence per various combinations of conditions. Wilcoxon signed rank tests were used to determine the change in symptom severity between baseline and 10 weeks in those receiving intervention through the MMHP. Linear regression models were created to analyse the predictors of change in clinical scores.
Results
In the screened group, 48.6% were found to have moderate to severe symptoms of anxiety on the GAD-7, 53.2% of depression on the PHQ-9, and 33.2% of PTSD on the PC-PTSD. Relatively high rates of possible comorbidity were found in this study, especially between depression and anxiety: of those screening positive for any one condition, 73.8% screened positive on the combination of PHQ-9 and GAD-7. Screening positive on the PHQ-9 was found to be a very strong predictor of concomitant positive screening on the GAD-7 (OR = 36.4, CI = 25.3 - 52.2), and vice versa - screening positively on the GAD-7 strongly predicted positive screening on the PHQ-9 (OR = 36.6, CI = 25.4 - 52.6). Strong associations were demonstrated with females and potential depression (OR = 1.51, CI = 1.03 - 2.21) and/or PTSD (OR = 1.65, CI = 1.18 - 2.31), while younger age was significantly associated with higher likelihood of screening positive for potential depression (OR: 0.99, CI= 0.98 - 1.00), PTSD (OR = 0.97, CI 0.96 - 0.98) and/or generalised anxiety disorder (OR = 0.97, CI = 0.96 - 0.98). There were statistically and clinically significant improvements in clinical scores for all four conditions at Week 10 after enrolment on the MMHP, compared to baseline: 21% reduction in mean scores in the AUDIT, 43% in the GAD-7, 45% in the PHQ-9, and 36% in the PC-PTSD.
Conclusion
In its current form, the MMHP appears to be successful in reaching significantly symptomatic medical scheme beneficiaries, with possible scope to expand its reach. Certain key design elements such as using clinical data to determine risk and need for intervention, treatment target calculation adjusted for baseline, screening for comorbidity, and current referral sources, appear to be appropriate. Given the absence of a control group, however, further research is required to confirm the outcomes of the intervention.
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Conner, Therese Marie. "Assessment of first-line SSRI therapy for major depressive disorder and outcomes in a mental health managed care organization /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.
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Huang, Kun. "THE RELATIONSHIP BETWEEN EMBEDDEDNESS AND ORGANIZATIONAL SOCIAL PERFORMANCE IN A COMMUNITY MENTAL HEALTH NETWORK UNDER MANAGED CARE." Diss., Tucson, Ariz. : University of Arizona, 2005. http://etd.library.arizona.edu/etd/GetFileServlet?file=file:///data1/pdf/etd/azu%5Fetd%5F1211%5F1%5Fm.pdf&type=application/pdf.
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Descoteaux, Jill. "Dancers’ Reflections on Their Healthcare Experiences: Perspectives from Australia and the USA." Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1530538560639848.
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Cunningham, Daniel Morton. "The impact of aggressive case management service in reducing the frequencies of acute episodes of the chronically mentally ill." CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1287.
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Byrne, Mitchell K. "Medication alliance development and implementation of a mental health staff training program for the enhancement of patient medication adherence /." Access electronically, 2008. http://ro.uow.edu.au/theses/2070.
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Thesis (Ph.D.)--University of Wollongong, 2008.Typescript. Computer optical disc inserted in pocket on p. 195 entitled: Medication alliance core skills demonstration. Includes bibliographical references: p. 147-179.
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John, Jaison, Jessie Feathers, Tyler Morgan, Neha Barakam, and Jodi Polaha. "Utility of Incorporating Behavioral Therapy in Transitions of Care Clinics." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/14.
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TCC (Transitions of care clinic) is a specialized clinic visit where patients present to their primary clinic after a hospital stay. TCC deploys an interprofessional team to address a gamult of patient concerns. Traditionally, TCC interprofessional team includes a nurse and a doctor. The nurse calls the patient’s house within 2 days to check up on the patient and then they schedule a clinic visit, usually within 7-14 days. However it has been proposed that addition of team members from other disciplines could contribute to better health outcomes for patients seen in TCC. We studied a TCC model with an interprofessional team of not only physicians and nurses but also pharmacists and behavioral therapists for two months. Our aim was to uncover the utility of having a behavioral health team member in TCC visits. This was a prospective study of patients who attended a TCC clinic in a residency setting. An observer collected data on the time the behavioral health provider was in the patient room and the interventions/consultations he/she provided. Data collection is ongoing. We expect to find the following: the percentage of patients within TCC who utilized some form of behavioral therapy in their TCC visits; the percentage of common interventions that were used; average time spent in each visit; average age of patients; and average number of hospitalizations per patient. We expect that these results will demonstrate how behavioral health providers function on interprofessional TCC teams.
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Howrie, Paul. "How general practitioners and aged care workers perceive incidences of elder abuse." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1351.
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As the Australian population is expanding and ageing, there is an associated need for a focus to be placed on the Individual rights of elderly people, and for the general populus to be made more aware of areas related to our older generation. Elder abuse, as an area of concern, developed as an offshoot of investigations into child abuse and general domestic violence, and initially surfaced in the 1970s and 80s. Some sections of the medical profession were made specifically aware of the problem initially in 1975, through a letter that was sent to the British Medical Journal. However, throughout some of the literature, GPs have been criticised about their level of awareness of the issue of elder abuse, and for their lack of involvement in this area. The purpose of this study was to explore how General Practitioners and Aged Care workers perceive incidences of elder abuse. Due to the limited amount of research which has been undertaken on elder abuse within Australia, the study looked at exploring the issue rather than trying to measure its cause, or trying to identify the extent of the problem. The study investigated the perceptions of general practitioners (GPs) toward the area of elder abuse, and looked further to explore how general practitioners were perceived by aged care workers. The approach used for data collection consisted of circulating 100 mailed out questionnaires to general practitioners within metropolitan Perth, and follow up face-to-face interviews with some of the respondents to this questionnaire. Additionally, face-to-face interviews were also held with key informants who worked in the aged care industry, to ascertain their perceptions of elder abuse. The mailed questionnaires were analysed by adding the frequencies of responses given to each question. The data from the face-to-face doctor interviews and the key informant interviews were transcribed verbatim from the tape recordings and then assessed by looking for consistent regularities from each response made, therefore using a cross-case analysis. From this analysis, patterns emerged in the data, from which themes were developed. The recommendations from the data suggest that a clear and concise definition of elder abuse needs to be developed, to assist in clearly Identifying the prevalence of the problem. The data further recommended the need for an awareness campaign on the area of elder abuse to be undertaken. This should focus on raising the awareness of the possible characteristics of individuals who are vulnerable to being abused, as well as the characteristics of likely perpetrators of abuse. This study also recommended that a coordinated approach to dealing with the area of elder abuse should be developed, which should include the development of specific roles that should be undertaken by professional and non-professionals. Training of people across the Human Services field in the area of elder abuse, and in particular, GPs, social workers and paraprofessionals who work with elderly people, was identified as a recommendation of the study. Areas of training should include: awareness of the problem's existence; providing people with the required skills to detect cases of abuse; providing insight to referral agencies who may be able to assist; having a clear and exhaustive list of interventions to use to assist with addressing the problem; and having knowledge of the characteristics that abused individuals, and perpetrators are likely to have. This study also Identified that more research is required to ascertain if the amount of time which GPs spend with elderly people, is sufficient for them to identify cases of elder abuse, and if the allocated time from Medicare is adequate for GPs to Identify elder abuse.
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Finn, Michael P. "Perceptions of discharge planning needs : A study of discharge planning in the mental health setting." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1158.
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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.
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Mills, David. "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia /." Title page, table of contents and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09MD/09mdm6571.pdf.
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Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).
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Ibell, Bernadette Mary, and res cand@acu edu au. "An Analysis of Mental Health Care in Australia From a Social Justice and Human Rights Perspective, With Special Reference to the Influences of England and the United States of America: 1800-2004." Australian Catholic University. School of Philosophy, 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp113.25102006.
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The aim of this thesis is to analyze mental health care in Australia from a social justice and human rights perspective, in order to demonstrate that social justice as a philosophical manifestation of justice and fairness, is an essential ingredient in the theory and practice of mental health care. It is contended that the needs of the mentally ill would be most appropriately answered by the utilization of a Natural Law model, based on Finnis’s Natural Law theory. The Scope of the Thesis.The needs and care of the mentally ill are discussed, together with the treatment meted out to these vulnerable members of society since, approximately, the year 1800. Neither the criminally insane, nor the intellectually disabled are included in this discourse. Each group of people merits a thesis on its own: criminal insanity requires a debate to include the history, psychiatric and legal approaches to the subject, and current management of the insane. The intellectually disabled are not mentally ill; their ability to function as all round, naturally competent individuals is diminished by an inadequacy and/or impairment of their intellectual capacities. The needs of these two groups are far too broad and demanding to be included within the current thesis. Rationale for the Timeframe The timeframe, 1800 until 2004, has been established because it approximates to the transition from the end of the Classical through the Modern Age to the Post Modern Age, together with the predominance of Enlightenment philosophical theories, and the development of a scientific approach to medicine. Further, many politico-economic and social changes were taking place, associated with the Industrial Revolution. All are shown to have affected the introduction of asylumdom, and the institutionalization of those unable to participate actively in the industrial workforce. Of significant importance to the development of institutionalization for such marginal groups is the philosophy of Jeremy Bentham. Bentham espoused Classical Utilitarianism which will be shown to believe that the ultimate standard of utility is not the individual’s happiness but the greatest amount of happiness altogether. The thesis will demonstrate that this philosophical view prevailed from the beginning of the Industrial Revolution, with Benthamism influencing the sequestration of the unemployable into institutional life. Development of the Thesis.The thesis is developed against a background of prevailing philosophical, and other changes as stated above, including the medicalization of mental illness and the development of psychiatry as a branch of medicine. There is manifestation of many social injustices to those incarcerated in the asylum in all three countries under consideration: England, USA, and Australia. It is demonstrated that social justice and human rights of their work forces were disregarded by many employers at the time of the Industrial Revolution. Such values were, therefore, unlikely to prevail with regard to the mentally ill. Asylumdom continued with few changes in its practices until after World War II. It is shown that the predominance of post Enlightenment theories, together with further politico-economic, social and pharmaceutical revolutionary change followed the Second World War. Encouraged also by the founding of the United Nations and World Health Organizations as well as provision of the Declaration of Human Rights, circumstances led to the process of de-institutionalization of the mentally ill. The latter were decanted with apparently unseemly haste into a community ill prepared for such a change, and with little evidence of infra- structure to support the move. Need to conduct a National Inquiry. There was, then, a need to investigate what was now an overt issue of mental health care. The two subsequent inquiries by the Australian Health Ministers Advisory Council, (AHMAC) and the Burdekin Report, both focused on social justice issues, and addressed epidemiological, economic, sociological and justice considerations. Within the thesis, both investigations are critiqued against a Natural Law model, using Finnis’s Natural Law theory. It is demonstrated that contrary to Enlightenment principles of social justice as described by Miller, such a theory is eminently practical, and answers the needs of all members of the community, providing not merely ‘the greatest happiness for the greatest number’ but the common good of all Conclusion. Evidence shows that such a Natural Law theory is required to give a firm foundation to the needs of the mentally ill, especially at a time when relativism, economic rationalism and negative aspects of globalization prevail. Without such a basis the mentally ill are left insecure, uncertain and adrift in a world uncaring of their plight, while all the earnest exhortations espoused by Reports remain platitudes, subject to the whims of whatever government is in power. Our responsibilities to all our fellow human beings demand better from us than this.
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Ibell, Bernadette Mary. "An analysis of mental health care in Australia from a social justice and human rights perspective, with special reference to the influences of England and the United States of America, 1800-2004." Phd thesis, Australian Catholic University, 2004. https://acuresearchbank.acu.edu.au/download/08cd80266073cee2195a33e254f4a9298144ba8d6f3a2eece63325aee6b2021c/3481468/64925_downloaded_stream_150.pdf.
Full textAbstract:
The aim of this thesis is to analyze mental health care in Australia from a social justice and human rights perspective, in order to demonstrate that social justice as a philosophical manifestation of justice and fairness, is an essential ingredient in the theory and practice of mental health care. It is contended that the needs of the mentally ill would be most appropriately answered by the utilization of a Natural Law model, based on Finnis's Natural Law theory. The Scope of the Thesis.The needs and care of the mentally ill are discussed, together with the treatment meted out to these vulnerable members of society since, approximately, the year 1800. Neither the criminally insane, nor the intellectually disabled are included in this discourse. Each group of people merits a thesis on its own: criminal insanity requires a debate to include the history, psychiatric and legal approaches to the subject, and current management of the insane. The intellectually disabled are not mentally ill; their ability to function as all round, naturally competent individuals is diminished by an inadequacy and/or impairment of their intellectual capacities. The needs of these two groups are far too broad and demanding to be included within the current thesis. Rationale for the Timeframe The timeframe, 1800 until 2004, has been established because it approximates to the transition from the end of the Classical through the Modern Age to the Post Modern Age, together with the predominance of Enlightenment philosophical theories, and the development of a scientific approach to medicine. Further, many politico-economic and social changes were taking place, associated with the Industrial Revolution. All are shown to have affected the introduction of asylumdom, and the institutionalization of those unable to participate actively in the industrial workforce.;Of significant importance to the development of institutionalization for such marginal groups is the philosophy of Jeremy Bentham. Bentham espoused Classical Utilitarianism which will be shown to believe that the ultimate standard of utility is not the individual's happiness but the greatest amount of happiness altogether. The thesis will demonstrate that this philosophical view prevailed from the beginning of the Industrial Revolution, with Benthamism influencing the sequestration of the unemployable into institutional life. Development of the Thesis.The thesis is developed against a background of prevailing philosophical, and other changes as stated above, including the medicalization of mental illness and the development of psychiatry as a branch of medicine. There is manifestation of many social injustices to those incarcerated in the asylum in all three countries under consideration: England, USA, and Australia. It is demonstrated that social justice and human rights of their work forces were disregarded by many employers at the time of the Industrial Revolution. Such values were, therefore, unlikely to prevail with regard to the mentally ill. Asylumdom continued with few changes in its practices until after World War II. It is shown that the predominance of post Enlightenment theories, together with further politico-economic, social and pharmaceutical revolutionary change followed the Second World War. Encouraged also by the founding of the United Nations and World Health Organizations as well as provision of the Declaration of Human Rights, circumstances led to the process of de-institutionalization of the mentally ill. The latter were decanted with apparently unseemly haste into a community ill prepared for such a change, and with little evidence of infra- structure to support the move. Need to conduct a National Inquiry. There was, then, a need to investigate what was now an overt issue of mental health care.;The two subsequent inquiries by the Australian Health Ministers Advisory Council, (AHMAC) and the Burdekin Report, both focused on social justice issues, and addressed epidemiological, economic, sociological and justice considerations. Within the thesis, both investigations are critiqued against a Natural Law model, using Finnis's Natural Law theory. It is demonstrated that contrary to Enlightenment principles of social justice as described by Miller, such a theory is eminently practical, and answers the needs of all members of the community, providing not merely 'the greatest happiness for the greatest number' but the common good of all Conclusion. Evidence shows that such a Natural Law theory is required to give a firm foundation to the needs of the mentally ill, especially at a time when relativism, economic rationalism and negative aspects of globalization prevail. Without such a basis the mentally ill are left insecure, uncertain and adrift in a world uncaring of their plight, while all the earnest exhortations espoused by Reports remain platitudes, subject to the whims of whatever government is in power. Our responsibilities to all our fellow human beings demand better from us than this.
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Marquis, Ruth. "The meaning of quality in living service environments: An analysis of the experiences of people with disabilities, elderly people and service workers." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/976.
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The purpose of the study was to examine the experiences of both people with disabilities and elderly people and to identify their perceptions of quality as it relates to living in a service or being supported by a service to live in the community. The study was naturalistic in design and used a phenomenological approach and inductive analysis. It involved immersion in living services for a two year period, in-depth interviews with people living and working in services and participant observation. Fifty service users between the ages of twenty-one and ninety-six, and twenty-six service workers between the ages of twenty-six and fifty-four were informants in the study. The study comprised of three phases, the first phase involved repeated in-depth interviews with service users in two disability and two aged care living services to examine the experiences of people living in services and their perceptions of quality. As a result of the consistency with which relationships with key staff members emerged in the context of quality experiences, selected service workers who were named by service users were also interviewed. The findings in this phase indicated that relationships experienced by service users in their encounters with service workers were more significant in service users' evaluation of quality than tangible acts of physical and environmental care. Relational experiences of people living in services were variable. Some informants experienced consistent validation and socio-emotional support, whilst others experienced role distancing and negative communication experiences. Service workers who were interviewed as a result of being identified by service users in the context of quality, attached importance to the relational domain in the acts and behaviours of providing a service. They also attached personal meaning to their roles as service workers and shared the view that their role as service worker was underpinned by an ethos of communality. The second phase of the study involved accessing another five disability and five aged care services to collect further data to support or refute the findings from phase one. As a result a large data bank was established to confirm the consistency with which relational experiences in living services were linked to perceptions of quality by both service users and service providers. Acts and behaviours which were consistently present in the context of quality were also identified and the need for emotional support in the living context was further confirmed. The third phase of the study involved an in-depth analysis and identification of commonly experienced categories of relationships between service users and workers. Relationships were categorised into ethical and technical living service experiences and exemplars used to illustrate findings. Data analysis indicated that service experiences lie on a continuum, with mutually supportive relationships between service users and workers at one end, and physical and psychological abuse at the other. Experiences were variable in singular service contexts. This highlighted the individual nature of service relationships between service users and workers and the need to articulate human service as relationship. It also highlighted the inadequacies of using standard measures to evaluate quality in living services.
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Trotter, Vinessa Kaye. "The Relationship Between Psychological Well-Being and Work Productivity: Validation of the OQ Productivity Index." BYU ScholarsArchive, 2008. https://scholarsarchive.byu.edu/etd/1867.
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Managed Mental Health Care (MMHC) began blanketing the United States when cost of care rose exponentially. MMHC is one avenue many employers and insurance companies have chosen to provide employees with mental health treatment at controlled costs. However, not all employers view supplying their employees with mental health treatment beneficial, as they do not know mental health problems can significantly decrease work productivity. Brown and Jones (2005) used the Social Role Scale (SR) of the Severe Outcome Questionnaire (SOQ) to estimate work productivity in employees under the assumption that the scale measures work productivity. The purpose of this study was to move closer to an estimation of the relationship between improved mental health and improved workplace functioning by examining the relationships among a self-report measure of mental health (i.e., the SR), a self-report measure of work productivity (i.e., the Work Productivity and Activity Impairment Scale [WPAI]), and objective measures of work productivity (i.e., the quality and timeliness of institutional records, supervisor ratings, and sick hours used). It was thought that understanding the relationships among these measures might assist in estimating the cost/benefit of investing in psychotherapy. Participants in this study were employees and inpatients at the Utah State Hospital. Statistical analyses indicated the SR did predict two WPAI scales (i.e., Presenteeism and Activity Impairment) for employees. Specific relationships among measures, and suggestions for future research, are discussed.
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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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Hennessey, Ann Laureen. "Reducing California's special education costs by improving access to early childhood intervention: A policy review." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2156.
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This project addressess the importance of early childhood intervention for California's infants and toddlers and how the managed care trends are affecting families' ability to obtain help for their children.
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Erb, Christopher T. "State level mental health policy making under managed care /." 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3314764.
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Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008.Source: Dissertation Abstracts International, Volume: 69-05, Section: B, page: 2902. Adviser: Robert F. Rich. Includes bibliographical references (leaves 243-252) Available on microfilm from Pro Quest Information and Learning.
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Gaies, Samantha Elizabeth. "The impact of managed care on psychologists' ability to accurately diagnose, treat and perceive their clients." Thesis, 2013. http://hdl.handle.net/2152/24008.
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It has been demonstrated psychologists are more likely to over-diagnose clients to obtain reimbursement if clients are using insurance (Pomerantz & Segrist, 2006). Although diagnoses are helpful in providing direction for treatment plans, incorrect diagnoses may be stigmatizing and result in flawed care (Wahl, 1999). Using an experimental design with video vignettes simulating therapy sessions, this paper will explore whether psychologists tend to excessively believe in false diagnoses when forced to provide them, as well as whether those labels negatively affect psychologists' opinions of clients. Hierarchical multiple regression will be used to determine if those in the group forced to diagnose a client tend to over-diagnose and have a more negative opinion of the client.text
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Urry, Kristi Lauren. "Sexuality and Sexual Health in Mental Health Care Settings: Perceptions of Psychologists, Psychiatrists, and Mental Health Nurses in Australia." Thesis, 2020. http://hdl.handle.net/2440/128125.
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Sexuality and sexual health needs are inadequately addressed in mental health settings. This is misaligned with the espoused recovery orientation underpinning mental health services in Australia, and with individuals’ self-identified needs and desire for support. How mental health clinicians currently understand and respond to sexuality and sexual health concerns is still not well understood. In this thesis, I aimed to explore how mental health clinicians in Australia perceived sexuality and sexual health, and to critically examine how they oriented toward these in their work. An exploratory qualitative design was selected to address these aims, guided by social constructionist and critical health psychology frameworks. A single dataset was generated via in-depth interviews with psychologists, psychiatrists, and mental health nurses working in Australia. Four critical thematic analyses were conducted in relation to this dataset, each driven by a different analytic aim. In Chapter Three, I provide a reflexive account of nondisclosure of sexual identity within the research interviews as a lens through which to read the four analyses presented subsequently, contributing to transparency and rigour within this thesis. Participants’ conceptualisations of sexuality and sexual health are presented in Chapter Four. There was no single shared conceptualisation of sexual health within or across disciplines, however conceptualisations were primarily biomedical, reductionist, and risk-oriented with a focus on (primarily heterosexual) sexual intercourse. Sexuality was mostly understood as sexual identity and rarely discussed beyond reference to non-heterosexual identities, contributing to the positioning of hetero-sex as normal. Participants tended to perceive sexuality as relevant within their clinical practice when they also perceived danger or risk in relation to this, and this is explored in Chapter Five. I demonstrate how participants drew on a neoliberal framework of (sexual) health and self-regulation to construct sexual danger, locating this within sexual expression itself or within distressed individuals who were perceived to lack self-regulation. Outside of perceived danger, sexuality was largely omitted from participants’ everyday practice, and this silence is examined across two analyses. In Chapter Six, I demonstrate how participants accounted for omissions of sexuality in their own and their colleagues’ everyday practice by deprioritising sexuality and locating it outside of mental health settings. In Chapter Seven, I examine how the institutional context in which participants learn and work shaped sexuality-related perception and practice, according to their own accounts. I argue that these workplaces and institutions produce and maintain a broader silencing and peripheralisation of sexuality within mental health settings. The discussion in Chapter Eight brings together the results from all four analyses and synthesises these with the broader literature to make recommendations for practice and future research regarding sexuality and sexual health in mental health settings. I argue that improved practice in mental health settings will not be facilitated through a continued focus on biomedical aspects of sexuality and on individual clinicians’ relevant knowledge, comfort, and competence. Rather, there is a need to broaden the approach to sexuality in both clinical practice and research, and to recognise the wider institutional contexts in which sexual and mental health care are conceptualised and delivered.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2020
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Parslow, Ruth Adeline. "A study of Australians' access to health services for common mental health problems." Phd thesis, 2002. http://hdl.handle.net/1885/146160.
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Kramer, Barbara. "Mental health issues for families served by a care manager under a managed care Medicaid project : b report of a research experience : submitted in partial fulfillment ... for the degree of Master of Science in Nursing ... / c Barbara Kramer." 1995. http://catalog.hathitrust.org/api/volumes/oclc/68798771.html.
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Marshall, Richard Paul. "A study of Vietnam veterans' mental health and healthcare consumption." Phd thesis, 2000. http://hdl.handle.net/1885/147251.
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Carbone, Josephine A. "The mental health and well-being of children and adolescents in home-based foster care in South Australia." Thesis, 2010. http://hdl.handle.net/2440/62331.
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Despite attempts to keep families together and investment in family preservation and reunification services, the number of children in foster care has been increasing across Western jurisdictions during recent decades. Furthermore, use of home-based foster care as the preferred placement option, as opposed to residential or community group care, is now at record levels (Barber & Gilbertson, 2001). Although there is growing evidence that children in alternative care systems and state custody experience elevated rates of mental health problems, little is known about the mental health of children residing in home-based care, and almost nothing is known about their broader well-being and quality of life. Furthermore, most studies have been conducted overseas and have not been tested for their applicability to children in care in Australia.
This is the first study to provide comprehensive information about the mental health and broader well-being of a representative sample of children and adolescents living in homebased foster care in Australia. Participants were 326 children and adolescents (aged 6-17 years) residing in home-based foster care in metropolitan Adelaide, Australia, who were under a Guardianship of the Minister court order between August 2004 and January 2006. Information about children’s mental health, health-related quality of life, and service use was obtained from foster carers and older children (13-17 years) during face-to-face interviews. Information about health-risk behaviours such as suicidal ideation and behaviour, and drug use was also obtained from older children (13-17 years). In addition, foster carers provided information about the extent to which the problems of children in their care impacted upon their personal lives. The study utilised the same measures as those employed in the Australian Child and Adolescent Survey of Mental Health and Well-Being (Sawyer et al., 2000; Sawyer et al., 2001). This enabled the mental health and well-being of children in home-based foster care to be compared with that reported for children of the same age and gender in the general community in Australia.
The results showed that, compared to their peers in the general community, children in home-based care experienced significantly more mental health problems that were of clinical significance, and much poorer health-related quality of life across a wide range of domains that impeded their ability to fulfil daily roles such as schooling and social events. A substantial proportion of children in foster care who were identified as needing help for physical or emotional and behavioural problems, had not received this help. Furthermore, rates of suicidal ideation and attempts were significantly higher amongst foster youth than youth in the general community. The results also showed that foster carers were experiencing high levels of emotional stress and limitations on their personal time, due to the psychosocial and/or physical health problems of children in their care.
The findings of this study have important implications for child protection policy and practice. Although home-based care is the preferred option in Australia and other Western jurisdictions because it is believed to avoid problems associated with institutionalisation and provide ‘normalcy’ by modelling the family environment in which most children live (Barber & Delfabbro, 2004), the results of this study raise questions about the extent to which the needs of children in home-based care are currently being met. The significant health problems and poor quality of life of children in home-based foster care identified in the present study challenge child welfare agencies, practitioners, and policy makers to identify ways of providing more effective care for this vulnerable population, so as to maximise their short and longer-term outcomes.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2010
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Kordes, Doris. "The arts of care in an asylum and a community 1925-2004: Kenmore Hospital, New South Wales and Canberra, the Australian Capital Territory." Phd thesis, 2009. http://hdl.handle.net/1885/155196.
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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
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Hardy, Ann Varelle. "“. . . here is an Asylum open . . .” constructing a culture of government care in Australia 1801 – 2014." Thesis, 2014. http://hdl.handle.net/1959.13/1045262.
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Research Doctorate - Doctor of Philosophy (PhD)This thesis explores the history and heritage of the Newcastle Government Domain from its origins in the first European settlement at Newcastle in 1801 to its uncertain present as a largely vacated site of mental health care. The Domain is a significant holding of land at the centre of a growing urban area which has remained unalienated from the imperial, colonial and now state government because it has been seen as an asset to be applied to solving a series of contemporary challenges. Drawing upon public records, works of art and newspaper reports, the shifting uses of the Domain from centre of local administration, to military base, girls’ reformatory and asylum are traced demonstrating how the site contributed to meeting the responsibility for caring for the residents of New South Wales which fell to its governments. It is argued that rather than careful planning, decisions about the use of the Domain were largely the result of outside pressures. This is followed through in detail with regard to the establishment on the site in 1871 of an Asylum for Idiots and Imbeciles. A close reading of the extant records of this institution reveal that for several years, it served mainly as a repository for long term residents of older asylums. Only in the 1890s did it become populated by the intellectually disabled. Although it was an “accidental asylum”, the site was well suited to its purpose and has successfully hosted mental health services through to the present day. Its fraught transition from active health care campus to heritage site is traced to explore contemporary issues in heritage, in particular the rising interest in cultural landscapes, the role of interdisciplinary non-governmental organisations in heritage advocacy and the possibility of overtly recognising the positive benefits of heritage conservation for mental wellbeing at this and other sites. The Newcastle Asylum represented a new form of care in the colony of NSW and as such needs to form part of the cultural heritage of Newcastle because it contributed significantly to the social welfare of people in New South Wales.
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Ibell, Bernadette Mary. "An analysis of mental health care in Australia from a social justice and human rights perspective, with special reference to the influences of England and the United States of America: 1800-2004 /." 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp113.25102006/index.html.
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Thesis (Ph. D.)--Australian Catholic University, 2004.Submitted in fulfillment of the requirements for the degree of Doctor of Philosophy. Includes bibliographical references (p. 345-375). Also available in an electronic format via the internet.
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Stroud, Peter Charles. "Obstacles to the take-up of mental health care provision by adult males in rural and remote areas of Australia: a systematic review thesis." Thesis, 2014. http://hdl.handle.net/2440/102558.
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Introduction/background: Research and practice have suggested that mental health care, and mental health care practices and practitioners, along with mental health care systems, seem to be confronted with obstacles in the take-up and delivery of mental health-care services to adult males living in rural and remote areas of Australia. The aim of this systematic review thesis is to appraise and synthesise research evidence about these obstacles. These obstacles may influence the interaction between adult rural and remote dwelling males, and mental health care providers and mental health care systems. This thesis reviews and analyses health data from health systems, provider and recipient view points, through a critical analysis of the research literature published from 1995. This field of research has warranted further exploration and understanding in both qualitative and quantitative domains. Methodology The qualitative and quantitative components of this systematic review thesis have considered studies which included adult males of all racial and cultural backgrounds residing in rural and remote areas of Australia. The quantitative component has considered studies which evaluated the nature, significance, causes of and remedies to obstacles to mental health care, and the nature and significance of such obstacles from both the provider and recipient points of view. The qualitative component has considered studies which explored the meaning and experience of obstacles from similar viewpoints. Results: The outcomes of this systematic review thesis have led to the identification and description of four categories of obstacles which impact on adult males seeking mental health care in rural and remote communities of Australia. These categories are population characteristics, environment, health behaviour and health outcomes. Conclusion Quantitative and qualitative data has revealed a constellation of statistical data and themes from men’s perceptions and experiences that clarify the everyday nature of obstacles to the take-up of mental health care by rural and remote dwelling Australian adult males. Provider (supply side) and recipient (demand side) obstacles contribute to the factors involved in the demand for and supply of services and the under-use of mental health care services by adult rural and remote males in Australia. This analysis opens a fertile ground for future research in this field.Thesis (M.Clin.Sc.) -- University of Adelaide, School of Translational Health Science, 2014.
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Smith, Terrence Gordon, University of Western Sydney, of Arts Education and Social Sciences College, and School of Humanities. "'With tact, intelligence and a special acquaintance with the insane' : a history of the development of mental health care(nursing) in New South Wales, Australia, Colonisation to Federation 1788 - 1901." 2005. http://handle.uws.edu.au:8081/1959.7/31368.
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During the earliest days of the penal colony in New South Wales in 1788, the plight of the mentally ill was given little consideration by the governing authorities, particularly the convict insane, who lived (and died) by their wits and suffered cruel punishment if their behaviour was seen as recalcitrant. This thesis traces a history of mental health carers (nursing) from the foundation of the penal colony until the Federation of the Australian colonies to form a nation in 1901. The research makes a contribution to the profession of mental health nursing by providing an understanding of the origins and development of that profession in New South Wales. The thesis also examines ways in which the historic development of mental health nursing has influenced the work of mental health nurses and nursing in the present, and exposes recurrent dominant issues of the past which will, if they remain unaddressed, continue to influence that profession in the future.Doctor of Philosophy (PhD)
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Goullet, Jillian. "Experiences, education and support needs of residential aged care staff caring for older adults with mental-palliative comorbidity." Thesis, 2021. https://vuir.vu.edu.au/42957/.
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Australia’s ageing population is contributing to an increased demand for residential aged care services (RACS). At the same time, these services are increasingly providing care for older adults with long-standing mental disorders (e.g., major depression, bipolar disorder and schizophrenia spectrum disorders) and life-limiting physical illnesses requiring palliative care. These older adults have multiple care requirements, including cognitive, behavioural and palliative care needs. However, RACS care staff are often ill- equipped to care for them. The aims of this study were to: (i) examine the experience of RACS staff caring for residents with mental-palliative comorbidity, and (ii) identify their initial and ongoing education and support needs. An interpretative phenomenological analysis approach was used, incorporating semi-structured interviews. A purposive sample of 12 RACS staff participated in semi-structured interviews. The study identified several strategies to enhance mental-palliative care in RACS. The overarching theme was conceptualised as Adopting a person-centred approach to care. This was supported by five main themes: Understanding each person, Complexities in assessing and managing pain, Preventing and responding to behaviours of concern, Organisational provision for staff development and wellbeing promotion and Engaging in interdisciplinary collaboration. These findings may contribute to a greater understanding of the experience of RACS staff caring for residents with mental-palliative comorbidity and highlight areas for improvement in the education and support of staff caring for this cohort.
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Mills, David (Peter David Duncombe). "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia / David Mills." 2005. http://hdl.handle.net/2440/38374.
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Includes publications published as a result of ideas developed in this thesis, inserted at end."April 2005"
Includes bibliographical references (leaves 210-242)
242 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005
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Mills, David (Peter David Duncombe). "The role of goal setting in the diabetes case management of Aboriginal and non-Aboriginal populations in rural South Australia / David Mills." Thesis, 2005. http://hdl.handle.net/2440/38374.
Full textAbstract:
Includes publications published as a result of ideas developed in this thesis, inserted at end.Includes bibliographical references (leaves 210-242)
242 leaves
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.) -- University of Adelaide, Dept. of General Practice, 2005
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Furst, MaryAnne. "The local pattern of mental health care in different states/territories in Australia: a comparison of the Australian Capital Territory with other urban Australian regions and with international benchmark areas." Phd thesis, 2021. http://hdl.handle.net/1885/243882.
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This thesis is a comparative demonstration study, using a novel approach to mental health systems research, to: (i) analyse the pattern of care provision in an Australian health jurisdiction; (ii) compare it with that of other health districts in Australia, Europe and South America; and (iii) demonstrate its usability as a decision support aid for mental healthcare planners.
Background. The outcomes of policy interventions in mental health systems are shaped not only by the intervention, but also by the characteristics of systems themselves. Knowledge of the local context is critical to enable planners to identify gaps and pathways in the system, to inform modelling, and to guide resource allocation. However, current services research and planning is based on a limited, component-based approach, with service provision at local level often informed by data aggregated at national level. In Australia, this has resulted in a system of mental healthcare delivery described as fragmented, with gaps in key areas and disproportionate investment in others, poor interaction between the different sectors of care, and confusion about accountability between different levels of responsibility. A new approach has been developed--the mental health ecosystems research approach (MHESR). MHESR provides an analysis of the whole system of care delivery at small area level, allowing identification of patterns of care and gaps in service provision, and providing more reliable data for local planning and modelling. In this thesis, I demonstrate the usability of an innovative tool based on this approach-- The Integrated Atlas of Mental Healthcare--in an analysis of the mental health system in the Australian Capital Territory, and a comparison with eight other health districts in Australia, Europe, and South America. Method. Integrated Atlases (Atlases) of Mental Healthcare provide an analysis of the whole system of care delivery in a defined region. Data, including service availability, capacity, and diversity, is collected at local level using a standardised, multiaxial service classification instrument, the Description and Evaluation of Services and Directories for Long Term Care (DESDE-LTC). Atlases also include key socio-demographic indicators and other local context information and present data using visualisation tools including Geographic Information Systems (GIS).
Results. My research identified gaps in service provision in key areas in the ACT common to the Australian, but not to the international regions; as well as patterns in service provision of some types of care, particularly community care, where the ACT more closely resembled the international regions than it did its national comparators. I found that some types of care were absent or lacking in all regions of the study. ACT showed a unique difference to all other regions in its balance of psychiatrists and psychologists. The Atlas has had a moderate impact on planning agencies in the ACT. Conclusion: Integrated Atlases using a MHESR approach provide more comprehensive and reliable information about the whole system of care delivery, and are useful tools to support decision makers to improve mental healthcare planning in Australia.
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Roth, David Theodore. "'DIED TODAY' The Brief Lives of Patients at Claremont Hospital for the Insane 1909-1919." Master's thesis, 2015. http://hdl.handle.net/1885/105180.
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The Case Books of Claremont Hospital for the Insane in
Perth, Western Australia, record many cryptically explained
patient deaths in the early twentieth century . This thesis
explores the reasons for these deaths and how patients came to
harm. It examines the expectation of hospital life for the most
vulnerable groups of patients, comparing mortality at Claremont
with mortality at other institutions. The distinctive economic,
political and social conditions in Western Australia, a frontier
state, framed the ‘special path’ of the historical
development of mental health care in Western Australia. I show
that this special path was the overarching factor determining the
comparatively brief lives of Claremont patients. While general
paralysis of the insane was a major cause of death of male
patients at Claremont, I suggest that ‘senile’ patients were
the most vulnerable group. Overseas studies show that shortages
of food caused the premature deaths of thousands of asylum
patients during World War I, particularly in Britain and Germany,
but the evidence indicates that average mortality rates at
Australian asylums were not significantly affected during the
War.