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1
Getz, William L. "Social Workers' Perceptions of a Rural Emergency Mental Health Trauma Service". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3607.
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Studies have shown that emergency mental health trauma (EMHT) services can significantly reduce the long-term effects of trauma after a disaster. However, rural municipalities may find they do not have the capacity to create such a service, or may not realize that their disaster planning includes no provision for emergency mental health care. Such was the case in a rural island community in the state of Washington, where, in 2014, several residents initiated a discussion that helped to identify the community's lack of EMHT services. This project, framed by action research and based on collaboration theory, sought to advance the potential for the community's 21 resident social workers to address this issue collaboratively. Accordingly, the project's research question asked how social workers on south Whidbey Island perceived the issue of a rural EMHT service in their community. Data consisted of responses from 8 participants who completed mailed questionnaires and participated in brief telephone interviews. Descriptive coding analysis of the data confirmed a nearly universal lack of knowledge about an EMHT service, a clear perception of the need for such a service, and a unanimous commitment from the respondents to participate in addressing this problem. Such collaborative activity is expected to have a positive impact on the micro, mezzo, and macro levels of social work practice in south Whidbey, as well as on the community itself, not only in spearheading a dialogue about EMHT but also in activating a group of social workers who had no prior association.
2
Kling, Michael Patrick. "Needs Assessment for Mental Health Support Towards Emergency Medical Service (EMS) Personnel". Thesis, Regent University, 2021. http://pqdtopen.proquest.com/#viewpdf?dispub=27961789.
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Understanding and assessing the needs of Emergency Medical Service (EMS) personnel and other first responders is crucial for providing these individuals with the resources needed within their community. The literature discusses how EMS personnel are at risk for psychological impairment due to routine exposure to traumatic events and occupational stressors within EMS organizations. Additionally, the research has supported the importance of positive coping abilities, organizational belongingness, and social support within the lives of EMS personnel to enable them to resiliently handle the occupational stress of their job. This study investigated the occupational needs of EMS providers to determine if they are receiving resources within their organization to cope with occupational stressors. Participants for this study comprised (n=153) paramedics and fire-fighters from the Tidewater EMS Council organization. A needs assessment was conducted to explore correlations between quality of life, resiliency, years of service, level of education, burnout, secondary traumatic stress, interpersonal support, positive and negative religious coping, and the occupational needs of EMS personnel. The results revealed that burnout (r=4.27**) and secondary traumatic stress (r.215*) were important factors for determining occupational turnover among EMS personnel. Furthermore, EMS providers reported occupational needs such as easier access to mental health, improved staff relations, adequate staffing, and improved shift hours are needed within their organization. Future research should explore differences in occupational needs with EMS providers among EMS organizations in metropolitan and rural communities. Keywords: Emergency Medical Services (EMS), Burnout, Occupational Stress, Traumatic Critical Incidents
3
D'Antonio, Pamela L. "Deinstitutionalization and its implications on mental health emergency services in Berks County". Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1993. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1993.Source: Masters Abstracts International, Volume: 45-06, page: 2937. Abstract precedes thesis title page as [2] preliminary leaves. Typescript. Includes bibliographical references (leaves 59-61).
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Ferens, Christine L. "Treatment of Patients with a Mental Illness in Emergency Services". Thesis, Capella University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10936352.
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The purpose of this action research study was to examine the effects of the stigma of mental illness towards individuals with mental illness on services provided by medical professionals, specifically, registered nurses who work in an emergency department (ED). There have been numerous studies on how attitudes towards mental illness can be present in health care professionals; however, none that focused specifically on the attitudes of ED nurses. Nurses working in the ED are often the first health care professional a patient with mental illness sees and their attitude can influence the rest of the ED visit. The Opening Minds Scale for Health Care Workers (Modgill, Patten, Knaak, Kassam, & Szeto, 2014. “Opening Minds Stigma Scale for Health Care Providers (OMS-HC): Examination of Psychometric Properties and Responsiveness”) and the Caring Nurse Patient Interaction Short Form (Cossette, Cote, Pepin, Ricard, & D’Aoust, 2006. “A Dimensional Structure of Nurse-Patient Interactions from a Caring Perspective: Refinement of the Caring Nurse-Patient Interaction Scale (CNPI-Short Scale)”) were used to measure attitude towards stigma and the perception of the care a nurse gives a patient. Thirty-four nurses from two emergency departments participated in the research with the expectation of there being high levels of stigma which would in turn affect the care given to the patients with mental illness. Descriptive statistics, multiple regression and ANOVA were used to find low to moderate levels of stigma of mental illness, and these nurses had a perception of providing excellent care to their patients. This is in contrast to other studies finding moderate to high levels of stigma in general among health care professionals. This information can be useful in exploring and then using any policies and procedures present in the research sites for the benefit of other emergency departments. Additional research is planned to further review these sites and other emergency departments within the hospital network to ascertain if these results hold true, and if so, identify the dynamics involved.
5
Duff, Amanda. "Emergency Room Utilization of Participants with Mental Health Conditions Enrolled in Health Home Services". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3154.
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Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeated-measures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions.
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Saurman, Emily Kay. "Using technology to improve access to emergency mental health care in rural and remote Australia: an evaluation of the Mental Health Emergency Care-Rural Access Program (MHEC-RAP)". Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13572.
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The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) aims to improve access, safety, and service coordination of specialist emergency mental health care via telehealth technologies. The program was planned and developed in response to the population needs and unique geographic conditions to provide specialist care while maintaining and supporting the role of existing local services. It is the first to provide 24-hour access to a regionally-based team of specialists offering relevant and responsive information, support, and clinical services for all providers, patients, and residents needing emergency care from the rural and remote communities across western New South Wales (NSW), Australia. This evaluation of MHEC-RAP applied a case study methodology and the theory of access to determine whether the program provides accessible specialist emergency mental health care. The five individual studies reported here contribute to the evaluation aims of describing program activity, assessing the provision and experience of emergency mental health care through MHEC-RAP, examining program impact on access, and informing further program development, adaptation, and transferability. This evaluation is the first to examine emergency telepsychiatry use in EDs, to apply the time and motion study method to assess program efficiency, and to present a telepsychiatry model structure that may be adapted or implemented elsewhere. This evaluation offers evidence of a practical telepsychiatry program that is providing accessible emergency mental health care for consumers in communities across western NSW and is changing local practice and perspective. It also enhances the theory of access proposing a modification to the theory with the inclusion of a sixth concept - awareness. The individual study results can be used to guide the continuing development of MHEC-RAP as well as provide insights for program transferability or the development, delivery, and evaluation of other new and existing telepsychiatry services across Australia and abroad.
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Leon, Stephanie L. "Pediatric Mental Illness in the Emergency Department: Understanding the Individual, Family and Systemic Factors in Return Visits". Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37246.
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This dissertation addresses some of the gaps in the research on pediatric mental health (MH) repeat visits to the emergency department (ED). The primary objectives of this thesis are to systematically review the existing literature on youth MH return visits to the ED and to determine the incremental contribution of family factors in predicting these repeat ED visits.
The first study systematically reviewed and qualitatively summarized the available literature to better understand predictor of repeat visits. A search was performed using the following databases: PsycINFO, PubMed, and CINAHL. Reporting followed the PRISMA statement checklist and methodological quality was assessed using the following eight criteria: design, generalizability, breadth of predictors, reporting of effect sizes, additional outcomes, interaction terms, confounding variables, and clear definition of outcome. A total of 178 articles were retrieved; 11 articles met inclusion criteria. Findings revealed that repeat visits to the ED for MH concerns is a complex phenomenon that can be attributed to various demographic, clinical, and MH care access and utilization factors. Common predictors associated with repeat ED MH visits included socioeconomic status, involvement with child protective services, as well as previous and current MH service use. For studies using a six-month repeat window, the most common factors were previous psychiatric hospitalization and currently receiving MH services. This systematic review concluded that in order to further elucidate which variables are most significantly associated with repeat ED visits; future research should consider the use of prospective designs and the inclusion of family factors. Investigating recency and frequency outcomes may also be of importance. The second study aimed to determine if family characteristics are significantly associated with repeat ED visits over and above the contribution of demographic, clinical or service utilization factors. A retrospective cohort study of youth aged six to18 years treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Of 266 participants, 70 (26%) had a repeat visit. Receiving MH services within six-months of the index visit, having a parent with a history of treatment for MH concerns, higher severity of symptoms and living closer to the hospital were significantly associated with repeat visits as well as earlier and more frequent repeat visits. Prior psychiatric hospitalization was associated with repeat visits and more frequent repeat visits, while presenting with suicidality was associated with more frequent repeat visits. Family functioning and perceived family burden were not associated with repeat ED visits.
This thesis contributes to the growing literature on ED use in pediatric patients with mental illnesses and may be clinically useful to professionals working with repeat visitors. The identification of key factors could provide essential information to ED decision-makers and lead to the development of best practices with this population.
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Zauhar, Sean Russel-Jacque. "Effects of Police-Mental Health Collaborative Services on Calls, Arrests, and Emergency Hospitalizations". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7265.
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With the increasing amount of police calls involving persons experiencing a mental health crisis (PICs), agencies are looking for ways to reduce the overuse of emergency services and criminal confinement. Police-mental health collaborative (PMHC) programs were developed to utilize the expertise of both mental health and law enforcement practitioners to provide immediate linkage to psychiatric services in an effort to prevent unnecessary involvement in the criminal justice system. The theoretical framework for this study was built on the sequential intercept model (SIM) along with the theories of social network and social support. The SIM identifies 5 key points where PICs can be diverted away from the criminal justice system. PMHC programs fall within the first intercept where persons with mental illness can be diverted at their first initial contact with law enforcement. Limited empirical research exists that show PMHC programs are reaching their intended objectives. The purpose of this quantitative study was to determine the effect of PMHC services on the likelihood that PICs will have future mental health calls (MHCs), arrests, and emergency hospitalizations (EHPs). Archival data from 1 midwestern police agency and online public court records was used in the analysis. The study employed OLS and logistic regression techniques, which revealed no statistically significant relationships between the PMHC interventions and the likelihood of future MHCs, arrests, and EHPs. However, significance was achieved for several covariates including transient status, prior history of MHCs, arrests, and EHPs. These findings will contribute to positive social change by informing policymakers and practitioners on best practices in community mental health crisis response.
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Galeano, Richard. "Understanding the health of operational personnel in an ambulance service: A mixed methods study". Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134241/2/Richard_Galeano_Thesis%5B1%5D.pdf.
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This mixed methods study was designed to review the health of ambulance operational personnel and to better understand the complex relationship between the organisation of the work and the working and organisational environment in which the work is done. The study found that the physical and mental health of ambulance operational personnel is worse than the Australian population due to the interplay of long working hours, shift work and a perceived lack of support. Ambulance services need to take a lead role in designing health support approaches that may better protect the health and wellbeing of ambulance operational personnel.
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White, Andrew William. "Frequent use of psychiatric emergency services : a multilevel approach /". View online ; access limited to URI, 2007. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3277011.
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Waters, Heidi C. "Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3374.
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Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between IHC enrollment and physical health and ACS-specific service utilization for consumers with SMI when controlling for demographic characteristics and disease severity. Secondary administrative healthcare data, including authorization and electronic medical record data, were provided by the CMHC. Logistic regressions assessed the odds of experiencing an inpatient admission or ED visit before or after IHC enrollment; the predictive relationship between IHC enrollment and service utilization was assessed using multiple linear and Poisson regression analyses. There was no statistically significant impact of integrated care clinic enrollment on physical health or ACS-specific utilization. The sample had lower levels of physical health utilization than would have been expected. In terms of positive social change, results may help the CMHC assess the IHC program, overall clinic success, and use of data. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.
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Armstrong, Deanne Maree. "Investigating well-being and mental health in Queensland fire-fighters". Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/66801/1/Deanne_Armstrong_Thesis.pdf.
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This thesis used survey and interview methods to examine how organisational and interpersonal factors impact on the mental health of fire and rescue workers. It was the first published research to assess and predict multiple indicators of mental health; psychological distress, well-being, posttraumatic growth and posttraumatic stress disorder symptoms. The results provide valuable information for supporting fire and rescue workers through psychoeducation and proactive intervention programs.
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Gallagher, Mark. "From mental patient to service user : deinstitutionalisation and the emergence of the Mental Health Service User Movement in Scotland, 1971-2006". Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8078/.
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Until recently research on the history of psychiatry was largely focused on the institutions where this controversial branch of medicine emerged, on its practitioners, treatments, theories and clinical practices, and the shifting social, institutional and legal contexts in which it has developed. Two pioneering figures in the histories of psychiatry and medicine, Michel Foucault and Roy Porter, opened the historiographical field up to much broader perspectives, expanding the range of sources and interpretations to encompass a wide-lens focus on matters such as the relationships between histories of madness and rationality, ‘the patient’s view’ and ‘anti-authority struggles’ by psychiatric patients. The study undertaken here seeks to develop aspects of the historiographical approaches advanced by Foucault and Porter by investigating how psychiatric patients engaged in collective action and campaigned for reform to mental health services in late twentieth-century Scotland. Through an excavation, description and analysis of untapped archival and oral history sources, I chart the spaces of emergence and trace the intersecting lines of descent of the ‘Scottish user movement’ in the era of deinstitutionalisation. By examining the records of patient groups and oral history interviews with activists, I reveal how this small but significant social movement was formed through the interplay between top-down social and governmental practices and bottom-up resistance and action by patients. The study makes visible the characters, voices, settings, events and actions, which made up the changing discursive and social practices of patients groups in Scotland over the last half-century.
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Paschal, Beverly J. "16PF® Traits as Predictors of Emergency Medical Service Worker Tenure". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2226.
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The United States is experiencing a severe shortage of Emergency Medical Service (EMS) paramedics. The job outlook for paramedics (EMT-P) for the years 2012-2022 is predicted to increase by 23%-33%, which is much faster than the 4% average increase of other first-response professions. The average tenure of paramedics is less than 4 years. There is a significant gap in the literature concerning paramedic personality traits and tenure. The primary objective of the current study is to provide empirical data on the personality traits possessed by long-term paramedics (5+ years), and compare them to those with shorter tenure (< 5 years). Using Allport's Trait Theory, I predicted that personality would affect paramedic longevity. The 6 personality traits tested were warmth, reasoning, emotional stability, liveliness, social boldness and openness to change. A socio-demographic questionnaire, determined the length of their EMS career, while the 16PF® Assessment, tested their personality traits. Using t tests, Mann-Whitney U tests, and a set of regression analyses, data were examined to determine if length of career and personality traits predicted paramedic tenure. The research sample consisted of long term paramedics and former paramedics. The results showed that of the 6 personality traits, only warmth was a significant predictor of paramedic tenure. A logistic regression showed for every additional point in warmth, the odds of leaving EMS prior to 5 years increased by a factor of 2.77. This study provides support for positive social change by helping EMS to learn how to increase recruitment and tenure. It also helps by advising EMS agencies to attend to the mental and emotional health of their paramedics by being aware of the level of their warmth personality trait.
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Barbosa, Sara Pinto. "Atendimento ao paciente psiquiátrico: cotidiano de um serviço de pronto atendimento do interior do estado de São Paulo". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22131/tde-06112012-183302/.
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A presente pesquisa caracteriza-se como estudo qualitativo, de cunho descritivo exploratório realizado numa Unidade Básica Distrital de Saúde (UBDS) da região Oeste da cidade de Ribeirão Preto, interior do Estado de São Paulo. Tal local é um Centro de Saúde Escola vinculado à Faculdade de Medicina da Universidade de São Paulo. Objetivou-se com o estudo conhecer o cotidiano de atendimento das demandas de saúde mental realizadas no pronto atendimento deste serviço. O estudo justifica-se por, após início do processo de Reforma Psiquiátrica, os serviços emergenciais, tanto os que funcionam dentro de hospitais gerais quanto os alocados em unidades de pronto atendimento nas Unidades de Saúde, importantes pontos da rede de atendimento em saúde mental. Como instrumento de coleta de dados utilizou-se a observação participante e entrevista semiestruturada com 17 participantes. Foram realizadas cerca de 90 horas de observação participante registradas em diário de campo. Os participantes da pesquisa foram interrogados sobre o atendimento dos usuários com demandas em saúde mental no serviço. Os dados das entrevistas foram analisados quanto ao conteúdo, sendo realizada análise do tipo temática. A discussão apoiou-se nos preceitos atuais de atendimento aos usuários de saúde mental. Do processo de análise emergiram quatro categorias: No pronto atendimento o atendimento ao paciente psiquiátrico é rotina...; O atendimento depende muito do médico que está atendendo...; A grande maioria é dependente químico... E aí?; A gente não tem uma preparação para lidar com paciente psiquiátrico... A partir da análise pudemos entender que a demanda em saúde mental é constante no serviço e que essa vem, quase sempre, acompanhada de uma angústia por parte dos profissionais que não se sentem capazes de atender usuários com essa demanda de saúde. Através da observação e da entrevista constatou-se ainda que, no serviço, o modelo de atendimento é ainda o médico-centrado, sendo que os demais profissionais da equipe, quase sempre, se limitam apenas executar prescrições médicas como, por exemplo, medicação e, quando necessário, contenção. No que se refere ao atendimento ao usuário de substâncias psicoativas, não nos pareceu que esses são vistos como usuários com demandas em saúde mental. Tais usuários são atendidos com condutas guiadas por pré-conceitos e julgamentos morais, ações pouco adequadas aos atendimentos em saúde. As dificuldades encontradas no serviço, no que se refere ao atendimento a usuários com demanda em saúde mental, parecem ser principalmente advindas de uma formação profissional pouco adequada. Diante disto, torna-se necessário, neste serviço, que haja investimento no sentido de melhorar formação para o atendimento a usuários com esse tipo de demanda. Mesmo com as dificuldades encontradas no serviço estudado, acreditamos que por meio de um trabalho de educação permanente possam surgir novas potencialidades na atenção em saúde mental e, assim, um fortalecimento da rede de saúde local.This research is characterized as a qualitative study, descriptive exploratory held in a District Health Unit Basic (UBDS) the region west of the city of Ribeirao Preto, interior of São Paulo. This service is also a Health Center linked to the Faculty of Medicine, University of Sao Paulo. The goal this research was to study the day-to-day of care of the demands of mental health conducted in the emergency room of this service. The study is justified because, after initiation of the Psychiatric Reform, emergency services, both those who work within general hospitals as allocated in the emergency units in the health units, are important to point in the network of mental health care. As an instrument of data collection used the participant observation and semistructured interviews with 17 participants. Were performed about 90 hours of participant observation, which was recorded in a field diary. Survey participants were questioned about the service demands of users with mental health service. The interview data were analyzed as contents, and performed analysis of the thematic type. The discussion is supported in current concepts of care for mental health users. The process of analysis four categories: In the emergency room care to psychiatric patients is routine...; The service relies heavily on the physician who is answering...; The vast majority are dependent of drugs... What\'s make?; We do not have a preparedness to deal with psychiatric patients... Thus, from the analysis we understand that the demand for mental health service is constant and that, almost always, is accompanied by an anxiety on the part of professionals who do not feel able to meet this demand users with health. Through observation and interview it was found that, in the service studied, the service model is still the physician-centered, and the remaining team members limited to just execute medication. With regard to the users of drugs the service, did not seem that these are seen as people with demands on mental health. Such users are assisted with postures guided by prejudices and moral judgments, actions inadequate to health care. The difficulties encountered in service, in relation people with mental health demand, appear to be due to an unsuitable formation. Given this, it becomes necessary, this service, investment in improving training to meet this demand. Even with the difficulties encountered in the service studied, we believe that through a continuing education may arise new possibilities and thus a strengthening of local mental health network.
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Woods, Ginger Lee. "Post Traumatic Stress Symptoms and Critical Incident Stress Debriefing (CISD) in Emergency Medical Services (EMS) Personnel". Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etd/2035.
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EMS personnel were examined for Post Traumatic Stress symptoms and the usefulness of Critical Incident Stress Debriefing (CISD) using the Los Angeles Symptom Checklist (LASC) and a demographics questionnaire. This study revealed that women in this group show higher PTSD symptoms than male coworkers. Level of Training (LOT) of the EMS provider did not demonstrate a significant difference in whether a provider developed PTSD. EMS personnel receiving debriefing actually suffered greater levels of PTSD than those that did not receive debriefing. And 16% of EMS providers in this study suffered from PTSD, while approximately 20% suffered from partial PTSD or PTSS. The results suggest that there are high levels of PTSD within the EMS community, especially in women. This study also suggests that CISD does not help with PTSD symptoms and may actually worsen them.
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Holland, John Jeremiah. "Assessing the effectiveness of social work emergency certificates on linkage to services". Thesis, Boston College, 2009. http://hdl.handle.net/2345/981.
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Thesis advisor: Thanh V. TranABSTRACT This dissertation has the following specific aim: to measure outcomes of social work emergency certificates produced by a Mobile Crisis Team to determine the effectiveness of these certificates at linking clients to services. Linkage to services is a programmatic goal and is achieved by ensuring clients receive adequate crisis and follow up services as a result of Emergency Certificates. In doing so, risks of homicide, suicide and grave disability are mitigated. Under its administrative umbrella, Mobile Crisis Team operates a police-social work collaboration known as Crisis Intervention Team, and both are administered by the State of Connecticut Department of Mental Health and Addiction Services in southeastern Connecticut. The data comes from 233 consecutive cases that involved Emergency Certificate's to transport clients to the local emergency department for psychiatric evaluation and treatment. Data was gathered post-hoc by reviewing copies of each specific certificate and cross-referencing those certificates with an agency risk management report and an electronic data base that stores demographic data on all clients. Descriptive, bivariate and multivariable analysis, such as cross tabulations and binary logistic regression, were used to analyze the data in this study. Additionally, the chi-square automatic interaction detector (CHAID) was used to construct outcome trees to describe subgroups of interest. This research is a continuation of previously published research on the various permutations and outcomes of mobile crisis programs, and contributes two unique programmatic features: the use by social workers of a legally proscribed coercive tool to send people to the emergency department for assessment, and the effectiveness of police-social work collaborations compared to social work only referrals. Overall, linkage occurs in over 80% of cases, with significant predictors of linkage identified as substance abuse, Hispanic ethnicity, criminal justice involvement, suicide, affective disorders, and insurance status. Implications for program evaluation, future research and limitations of the study are also discussed
Thesis (PhD) — Boston College, 2009
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work
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Randall, Jeff. "Differences in age-related appraisals in children's and adolescents' coping processes in a fire emergency situation". Diss., This resource online, 1993. http://scholar.lib.vt.edu/theses/available/etd-06062008-170439/.
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Alves, Ana Alexandra Marinho. "Perfil de utilização da urgência metropolitana de psiquiatria do Porto : um contributo para a análise dos cuidados de Saúde Mental da região". Master's thesis, Faculdade de Ciências Médicas, 2013. http://hdl.handle.net/10362/12161.
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RESUMO: Foram identificadas várias situações problemáticas no sistema de Saúde Mental (SM) português, designadamente o recurso preferencial aos Serviços de Urgência (SU), traduzindo dificuldades no acesso aos serviços públicos especializados. O padrão de utilização dos serviços de SM, nomeadamente a urgência psiquiátrica e as características dos seus utentes, podem fornecer indicações importantes sobre a acessibilidade aos cuidados. Este estudo investiga estes aspetos e apresenta uma caracterização sociodemográfica dos utentes da Urgência Metropolitana de Psiquiatria do Porto (UMPP) e o seu padrão de utilização dos serviços de SM, tendo em conta antecedentes psiquiátricos. É também caracterizada a intervenção efetuada no SU.
Foi recolhida informação relativa a variáveis sócio-demográficas, antecedentes psiquiátricos e de utilização do SU, através da aplicação de um questionário aos utentes que recorreram à UMPP no período do estudo. Foram obtidos 213 questionários correspondendo a 210 utentes.
Na amostra estudada, o utente padrão da UMPP correspondeu a uma pessoa do género feminino, com idade média de 45 anos, casada, com baixo nível de instrução, desempregada ou reformada. 48,6% dos utentes eram acompanhados em consulta de psiquiatria. 69% tinham antecedentes de acompanhamento prévio ao nível dos cuidados especializados e destes 51,7% afirmaram ter tido pelo menos 1 episódio prévio de internamento. O motivo mais frequente de referenciação para a UMPP foi a necessidade de avaliação do risco de suicídio (25,7%). 21.4% dos utentes da amostra necessitaram de internamento. De acordo com a impressão subjetiva dos profissionais de saúde que observaram os utentes, 50% dos casos foram considerados pertinentes do ponto de vista psiquiátrico, mas não urgentes.
Este estudo contribui para um conhecimento mais aprofundado do recurso à urgência de psiquiatria e mostra que aquele serviço é preferencialmente utilizado por doentes em acompanhamento psiquiátrico. Contudo, funciona também como “porta de entrada” mais rápida para os cuidados especializados. Metade dos casos observados não foi considerada urgente, constituindo uma utilização pouco adequada daquele serviço e que parece ser decorrente de problemas de acessibilidade e continuidade nos cuidados de SM.
ABSTRACT: Several problematic situations in Portuguese Mental Health (MH) System were identified, namely the preferred use of Emergency Department (ED), reflecting difficulties in access to specialized psychiatric care. The pattern of use of MH Services, including psychiatric ED and the characteristics of their users, can provide important information about the accessibility to care. This study investigates these aspects and presents a sociodemographic characterization of users of the Metropolitan Psychiatric Emergency Department of Oporto (UMPP) and its pattern of MH Services use, taking into account psychiatric history. It also characterized the intervention within the ED.
Information about sociodemographic variables, psychiatric history and previous use of ED, have been collected through the application of a questionnaire to users who presented to UMPP during the study period. 213 questionnaires were obtained corresponding to 210 users.
In this sample, the user's pattern corresponds to a woman, mean age 45 years, married, with low level of education, unemployed or retired. 48.6% of users were having consultation in a psychiatric facility. 69% had a history of prior consultation in specialized care and 51.7% reported having had at least 1 previous episode of hospitalization. The most common reason for referral to the UMPP was the need to assess the suicide risk (25.7%). 21.4% of the sample users required hospitalization. According to the subjective impression of health professionals who observed users, 50% of cases were considered relevant from a psychiatric point of view, though not urgent. This study contributes to a deeper understanding of users who resort to psychiatric ED and shows that the service is primarily used by patients in psychiatric care. However, it also serves as a "gateway" for specialized care. Half of the cases observed were not considered urgent, reflecting an inadequate use of ED which suggests difficulties in access to regular care in MH services.
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Burchett, Nicole. "Receiving a mental health diagnosis : an exploration of service users' experiences and staff responses to emergent themes". Thesis, Cardiff Metropolitan University, 2018. http://hdl.handle.net/10369/9916.
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In recent years, the personal and financial cost of mental illness has gained attention in the UK. Research indicates mental illness will affect one in four of the population at some point in their lives. This statistic is recognised in the increasing pressure on mental health services, which have historically been underfunded. Rhetoric surrounding the lack of investment, has led to a drive to ensure parity of esteem between physical and mental health services. To achieve full parity, it is essential this translates into the field of research. Although literature on mental illness is vast, the specific experience of receiving a mental health diagnosis has received little attention. This is an area of importance as it is an experience that can change people’s lives and impact on their identity. The current research, based in South Wales, gave voice to both service users and staff. Therefore it contributes to the knowledge base on the experience of receiving a diagnosis from two perspectives. This is achieved through the implementation of a novel concurrent multi-method design that incorporates a Research Advisory Panel of people with lived experience of mental illness. In-depth interviews and Interpretative Phenomenological Analysis were used to capture the experience of the service user (Study 1). Emergent themes from this analysis were taken to staff focus groups and Thematic Analysis was conducted (Study 2). Study 1 findings evidenced the ‘bitter sweet’ nature of receiving a diagnosis, where support could be accessed but diagnosis did not mean cure and was accompanied by stigma. Study 2 indicated staff were aware of the service users’ journey, however they highlight the problems in the healthcare system that led to difficulties in fulfilling their roles and supporting recovery. Synthesising these two sets of findings resulted in ‘Recommendations for practice’ which emphasised: the importance of the relationship between the service user and staff, the opportunity at diagnosis to positively ‘frame’ new knowledge and the need for a community approach to mental illness.
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Lek, Yvonne. "Sjuksköterskors upplevelser av hur tidsbrist och stress påverkar deras välmående. : En kvalitativ studie på akutmottagningen på Akademiska sjukhuset". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-154311.
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Nyckelord: Akutmottagning, sjuksköterska, tidsfaktorer, stress, välmående Bakgrund: Stress och tidsbrist är vanligt förekommande inom sjukvården, och arbetet som sjuksköterska på akutmottagning genererar höga nivåer av stress. Syfte: Att undersöka hur sjuksköterskor på en akutmottagning upplever att tidsbrist och stress påverkar deras välmående. Metod: Kvalitativ studie där tolv stycken semistrukturerade intervjuer utfördes med sjuksköterskor på akutmottagningen på Akademiska sjukhuset. Intervjuerna analyserades med latent innehållanalys enligt Graneheim och Lundman samt Aaron Antonovskys hälsomodell. Huvudresultat: Sjuksköterskornas intervjuer resulterade i fyra kategorier och tio underkategorier vilka tillsammans bildade två domäner och ett tema. Kategorier som erhölls var hanterbarhet, meningsfullhet, begriplighet samt brist på hanterbarhet. Sjuksköterskornas välmående påverkades positivt av stress som upplevdes som hanterbar, meningsfull och begriplig, medan välmåendet påverkades negativt av brist på hanterbarhet. Tidsbrist påverkade sjuksköterskornas välmående endast negativt. Slutsats: Tidsbrist påverkade sjuksköterskornas välmående negativt, medan sjuksköterskorna upplevde att stress kunde ha både positiv och negativ inverkan på deras välmående.Keywords: Emergency Service, Hospital, Nurse, Occupational stress, Time factors, Mental health. Background: Stress and lack of time often occur in medical care treatment, and working as a nurse at the hospital´s emergency service generates high levels of stress. Aim: To explore nurses´ perceptions about how lack of time and occupational stress at a hospital´s emergency service affect their mental health. Method: A qualitative study with twelve semi structured interviews with nurses were carried out at Uppsala University Hospital´s emergency service. The interviews were analysed with latent content analysis according to Graneheim and Lundman, and Aaron Antonovsky`s health model. Main results: The interviews with the nurses lead to four categories and ten sub categories which altogether made two domains and one theme. The categories that were derived were manageability, meaningfulness, comprehensibility and lack of manageability. The nurses’ mental health was affected in a positive way by stress which was perceived as manageable, meaningful and comprehensable, while a lack of manageability affected the mental health in a negative way. Lack of time affected the nurses’ mental health only in a negative way. Conclusions: Lack of time affected the nurses´ mental health in a negative way, while the nurses experienced that stress could affect their mental health both in a positive and a negative way.
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Aquin, Edward Herman. "Impact evaluation of a 'brief intervention program' for clients who deliberately self harm : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Nursing (Clinical) /". ResearchArchive@Victoria e-thesis, 2009. http://hdl.handle.net/10063/1238.
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Snyder, Hal Steven 1959. "AN EVALUATION OF COUNSELING SERVICES FOR FIRE DEPARTMENT PERSONNEL". Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/276426.
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Ringnell, Katarina, e Britt-Louice Vince. "Vårdpersonalens attityder till och erfarenheter om personer med psykisk ohälsa inom akutsjukvård : en litteraturöversikt". Thesis, Sophiahemmet Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2638.
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Psykisk ohälsa är utbrett inom samhället och riskerar att påverka individers hälsolitteracitet negativt. Samsjukligheten för psykisk ohälsa är hög och personer med psykisk ohälsa löper stor risk att drabbas av andra sjukdomar. För att kunna ge personcentrerad vård krävs att vårdpersonal synliggör och tillgodoser psykiska behov i lika hög utsträckning som fysiska. Situationen inom akutsjukvården är ansträngd och en stor del av patienters klagomål som anmäls handlar om bristande kommunikation. Trots att personer med psykisk ohälsa har rätt till jämlik vård ses förbättringsbehov inom somatisk vård.Syftet var att beskriva vårdpersonalens attityder och erfarenheter avseende personer med psykisk ohälsa inom akutsjukvård. Metoden var en litteraturöversikt och genomfördes med hjälp av databassökningar i PubMed, Cinahl och PsycINFO samt manuell sökning. Sjutton kvalitativa och kvantitativa vetenskapliga originalartiklar inkluderades i litteraturöversikten. Resultatet visade att vårdpersonalens attityder gentemot personer med psykisk ohälsa var negativ inom akutsjukvård. Attityderna varierade beroende på vilket psykiskt ohälsotillstånd som åsyftades. Attityder till att personer med psykisk ohälsa inte hörde hemma inom akutsjukvård förekom och uppfattningen om att personer med psykisk ohälsa fick sämre vård jämfört med andra patienter lyftes fram. Vårdpersonal upplevde att attityder till personer med psykisk ohälsa hade förbättrats över tid men att stigmatisering fortfarande existerade. Erfarenheter och upplevelser som framkom i resultatet var bristande kompetens i form av okunskap om psykisk ohälsa och oförmåga att kunna ge likvärdig vård och omvårdnad till personer med psykisk ohälsa. Arbetsmiljö och arbetsbelastning var framträdande faktorer i vårdpersonalens erfarenheter och upplevelser om personer med psykisk ohälsa. Tidspress och personalbrist framhävdes som orsaker som påverkade vården av personer med psykisk ohälsa negativt, liksom bristfälliga lokaler. Känslor som frustration, rädsla och oro beskrevs av vårdpersonal. Kommunikation med personer med psykisk ohälsa ansågs nödvändig men svår med tanke på olika tillstånd av psykisk ohälsa. Utbildning i psykisk ohälsa efterlystes av vårdpersonalen. Slutsatsen var att på grund av vårdpersonalens negativa attityder till personer med psykisk ohälsa finns det anledning att utveckla medvetenheten och kunskap kring psykisk ohälsa för att kunna utveckla vård och omvårdnad inom akutsjukvård.Mental illness is widespread in society and could affect individuals mental health literacy negative. The co-morbidity of mental disorders is high, and people with mental illness are likely to suffer from other diseases. In order to provide person-centered care requires health professionals identifies and meet the psychological needs to the same extent as physical. The situation in emergency care is strained and a large part of the patients' complaints are notified about a lack of communication. Despite the fact that people with mental illness have the right to equal care a need for improvement is seenin somatic care. The aim was to describe the health professionals' attitudes and experiences regarding persons with mental illness in emergency care. The method was in form of literature review and was carried out with database searches in PubMed, Cinahl and PsycINFO and manual. Seventeen qualitative and quantitative scientific original articles were included. The results showed that the nursing staff attitudes towards people with mental illness were negative in emergency care. Attitudes varied depending on the mental illness as alluded. Attitudes towards people with mental illness do not belong in emergency care occurred, and the perception that people with mental illness got not as goodcare than other patients was highlighted. Health professionals felt thatthe attitudes to people with mental health had improved over time but that stigma still existed. Experiences that emerged in the result was a lack of expertise in the form of ignorance about mental illness and the inability to provide equal care and nursing for people with mental illness. Time for caringand workload were prominent factors in health professionals' experiences and perceptions of taking careof people with mental illness. Time pressure and staff shortages were highlighted as factors that affectedthe care of people with mental health negatively, as well as flawed premises. Emotions like frustration, fear and anxiety was described by health professionals. Communication with people with mental illness was considered necessary but difficult given the various states of mental illness. Training in mental health was wishedby the health professionals. The conclusion showed that because of the health professionals' negative attitudes towards people with mental illness, it is necessary to develop awareness and knowledge about mental health to develop health care and nursing in emergency care.
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Yost, David M. "Hardiness and Perceived Work Stress as Predictors of Professional Quality of Life Among Emergency Services and Assessment Clinicians". Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1466085691.
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Ambrosini, Daniele Lamberto. "Professional perceptions of psychiatric advance directives : a view of multiple stakeholders in Ontario and Québec". Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112377.
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Psychiatric advance directives (PADs) are legal documents allowing competent individuals to declare their treatment preferences in advance of a mental health crisis. The objective of this thesis is to examine psychosocial perceptions of legal and mental health professionals in Ontario and Quebec regarding their knowledge and willingness to implement PADs. Two hundred professionals---psychiatrists, psychologists, lawyers and administrative tribunal members---participated in an Web-survey measuring psychosocial perceptions of clinical, ethical, legal and implementation factors of PADs. Results indicate Quebec professionals are more willing to begin using PADs than Ontario professionals. Mental health professionals reported more concern than legal professionals for medical malpractice lawsuits for overriding PADs. Advantages of PADs most commonly reported are patients' ability to declare their clear wishes ahead of time, respect for autonomous choice, and establishing a collaborative treatment plan with physicians. Disadvantages included patients' lack of awareness, treatment refusal, and being self-bound to an earlier decision.
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Hill, Robert Gareth. "Calling ourselves to account : the emergence, practice and rationale of quality assurance in mental health services". Thesis, Brunel University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264815.
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Knott, Jonathan Charles. "Management of mental health patients in the emergency department /". Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002656.
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Aschan, Lisa. "Health inequalities and mental health service use in mental-physical comorbidity". Thesis, King's College London (University of London), 2015. https://kclpure.kcl.ac.uk/portal/en/theses/health-inequalities-and-mental-health-service-use-in-mentalphysical-comorbidity(6f2c678e-1d94-40c0-9622-333539e46c4b).html.
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Although mental and physical health are likely to share common social causes, most mental-physical comorbidity research has focused on immediate mechanisms between mental and physical illness. This thesis takes a social epidemiological approach to mental-physical comorbidity, where social disadvantage and the disproportionate availability of resources are central. The amplified burden of comorbidity in terms of poor health and functioning may have implications for the relationship between comorbidity and mental health service use (MHSU). Whilst much research examines the impact of comorbidity on physical health services, MHSU is under-researched. Furthermore, comorbidity inequalities may be perpetuated through processes of cumulative disadvantage. For example, barriers to social participation may deplete resources over time, thus leading to worse health outcomes and more adverse social circumstances. This project therefore aims to: 1. Estimate the prevalence of comorbidity, and describe inequalities in mental-physical comorbidity by key socio-demographic and socioeconomic factors 2. Describe and explain the association between comorbidity and mental health service utilisation and quality 3. Describe the trajectories of social functioning by comorbidity Analyses make use of survey data from the South East London Community Health Survey (SELCoH) phases 1 (N=1698) and 2 (N=1052) (73% response among those approached at follow-up). Statistical methods used include weighted cross-sectional and longitudinal regression analyses. The results indicate that comorbidity is associated with distinct socio-economic inequalities (most consistently by household income), increased MHSU over time, and persistent social exclusion. This suggests that comorbidity reflects a process of cumulative disadvantage, which has important implications for comorbidity and health inequality research, and local services and policy makers. Altering the downward spiralling trajectories of health and social disadvantage among those with mental-physical comorbidity may be addressed through integrated care models, while interventions aimed at reducing social inequalities may effectively 3 prevent comorbidity and interrupt its downward spiralling course of disadvantage.
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Fox, Amanda R. "Factors influencing sustainability of health service innovation, emergency nurse practitioner service". Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/92994/1/Amanda_Fox_Thesis.pdf.
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Escalating health care delivery costs and consumer expectations have led to a range of health service and workforce innovations in the provision of high quality cost effective patient care. This research has operationalised a theoretical framework to examine factors that influence sustainability of health service innovations, in particular, emergency nurse practitioner service. The results of this research will inform health service policy and practice for future implementation of innovative workforce models and add to the understanding of factors that influence sustainability.
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Dixon, Decia Nicole. "Mental health service delivery systems and perceived qualifications of mental health service providers in school settings". [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002991.
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Macpherson, Elinor Carol. "Manpower substitution in mental health service delivery". Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/27988.
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The study developed a model for projecting potential economies from manpower substitution among the four core mental health professions and applied the model to a proposed substitution situation which would substitute psychologists for psychiatrists in the delivery of a proportion of present private practice (fee-for-service) psychiatry services in British Columbia. The model identifies three controlling variables: treatment substitutability (TS), practice privilege constraints (PPC), and relative payment rates (RR). In the model, TS and PPC are conceptualized as determining the estimated substitutable share of costs (SSC%); RR, in combination with the values derived for SSC%, is then used to estimate potential cost savings (CS%). Two conditions were defined for each of the three controlling variables in order to provide a range of possible values for SSC% and CS%. For reasons of data availability, data were obtained from the Manitoba Health Services Commission for private practice psychiatry services for FY 1984 and estimates of SSC% calculated. These estimates were then applied to B.C. Medical Services Commission data for FY 1984, and projected values of CS% calculated. Calculations were made both for all services and for the subset of psychotherapy services, which accounted for 80 percent of the larger set of services. The results of the study indicated considerable possibilities for manpower substitution, ranging from 35 to 70 percent for all services and 40 to 75 percent for psychotherapy services. However, the study also found that while salaried psychologists offered the possibility of substantial cost savings, a
fee-for-service arrangement suggested virtually no potential savings. Projected values of CS% for the salaried alternative were 20 to 40 percent for all services and 15 to 30 percent for psychotherapy services but in the fee-for-service alternative, only 4 to 8 percent for all services and 4 to 7 percent for psychotherapy services. Licensure and market rigidities which might pose barriers to implementation were evaluated and a review of professional training standards (TS), licensure standards (PPC), and funding alternatives (RR) indicated that the projected economies could be achieved with no necessity for modifications in existing arrangements. PPC appear to present almost no barriers to economies from the proposed manpower substitution and those barriers which are presented by TS and RR limitations still allow considerable potential for economies. Thus, the greatest opportunities for intervention in achieving and enhancing the projected, economies appear to be in the exploration of relative payment rates and relative effectiveness of treatment methods (e.g., psychotherapy vs. pharmacotherapy). The study concludes with a discussion of factors lying outside the boundaries of the model but which impinge, nonetheless, upon the feasibility of the proposed substitution and fall, necessarily, to policy makers to address. The existing network of B.C. community mental health centres was suggested as a possible mechanism for the delivery of the substitutable share of private practice psychiatry services.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Tucker, Ian. "Deterritorialising mental health : unfolding service user experience". Thesis, Loughborough University, 2006. https://dspace.lboro.ac.uk/2134/5445.
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Mental health has a long history of proving to be a tough concept to define. Multiple forms of knowledge and representation seek to inform as to the nature of mental health, all contributing to the production of immense complexity as to the experience of living with mental health difficulties. This thesis sets out to explore this, by getting as close as possible to mental health service users' actual experiences. A range of forms of knowledge that pertain to inform as to service users' experiences are explored, prior to analysing a corpus of interviews with service users. These are analysed through the development of a Deleuzian Discourse Analysis. Service users' experiences are analysed in terms of the relation between discursive and non-discursive factors, which include forms of mainstream psychiatric discursive practice, such as the application of diagnostic criteria and administration of treatments, along with how such practices are experienced in non-discursive dimensions of service user embodiment and space. The challenges facing service users are seen to operate around identity and control in relation to forms of psychiatric knowledge, along with presenting particular problems with regard to how user embodiment is felt, primarily in relation to psychiatric medication, and how these are driven into the production of service user spaces, i.e. day centres. Finally, a politics of affectivity is offered, as a way to unfold the complexity of service user experience, and to emphasise the existence and potential for change that can be gained through deterritorialising mental health.
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Jain, Swati. "PsychWeb online mental health service| Business plan". Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10124519.
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Over the past several years, mental healthcare system in United States has evolved tremendously, however majority of people are still struggling with various forms of mental illness and find it difficult to get appropriate treatment at the right time due to barriers like lack of providers, poor access, high cost and, social stigma. This business plan proposes an online mental health service company PsychWeb, offering telemental health services, with the aim of improving access to mental healthcare in the comfort of one’s own living environment.
Chapter 1 of this business plan is about complete market analysis for the online mental health industry along with the business overview for PsychWeb and its services. It also sheds light on business target population, competitors, growth strategies and proposed future milestones. Chapter 2 shows an in depth feasibility analysis using SWOT that ensures business viability and success. In chapter 3, we have discussed the legal and regulatory issues, along with company formation, and laws around provider and patient use of PsychWeb services laying stress on HIPAA and provider licensure requirements at the state and federal level. Lastly, chapter 4 explains the financial analysis conducted to ensure the business profitability. It gives a detailed breakdown of monthly and yearly expenditures, revenues generated and profit margin projections. All financial statements generated in the process are provided in the appendix of this business plan.
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Lund, Crick. "Mental health service norms in South Africa". Doctoral thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10620.
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Bibliography: p. 297-335.This thesis includes four main aspects. Firstly, a situation analysis was conducted of current national public sector mental health services in South Africa, using nine service indicators. Secondly, a model was developed for estimating the mental health service needs of people with psychiatric conditions in a local South African population. Thirdly, a set of service norms was proposed for each of the nine service indicators, informed by data from the situation analysis. Fourthly, a practical user-friendly planning manual was developed, using the situation analysis, model and norms to provide guidelines for the planning of mental health services by local and provincial planners.
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Marsella, Sarah A. "Emergency department visits for mental health: an examination of wait times to see a provider". Thesis, Boston University, 2014. https://hdl.handle.net/2144/21212.
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Thesis (M.S.H.P.)BACKGROUND: Emergency department (ED) visits for psychiatric issues have grown at a disproportionately higher rate than other visits. This has been attributed to factors including severe cuts in mental health (MH) services and identified as a culprit in ED overcrowding. Little is known, however, about how mental health reason-for-visit (MHRFV) interacts with patient and hospital characteristics to affect wait times to see an ED provider. OBJECTIVE: To determine if wait time (WT) to see a provider at the ED differs for those presenting with MHRFV and how various patient and hospital-level characteristics interact to affect it. METHODS: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for visits to EDs throughout the United States. We examined data for patients ≥ 18 years of age who visited an ED in years 2009 and 2010. Patient weights were used to generate national estimates. Patients’ primary reasons-for-visit were used to identify the MH group for analysis and comparison to all other RFVs. Predictors of WT were chosen based on the Andersen Behavioral and ED overcrowding models. WTs were log-transformed for initial bivariate and final multivariate regression models to assure a more normal distribution. RESULTS: Mean WT was 56.5 and 55.8 minutes for MHRFV and all others respectively with a shared median of 31 minutes. As expected with our large sample (n = 47,831), all variables of interest were significantly associated with WT. Adjusting for patient and hospital level characteristics, a multivariate regression revealed that MHRFV prolonged WT by about 50%. After adjustment for independent variables, interactions with MHRFV were tested as the main outcomes of interest. Blacks with MHRFV had WTs 62% longer, patients age 41-64 31% longer, payer status of Medicare/Medicaid or no coverage had WTs about 24% and 14% longer than private insurance. Conversely, patients at government owned hospitals had WTs 145%, and non-profits 42%, lower than private hospitals. CONCLUSIONS: This is the first time that ED WT has been examined in this depth with a sample of patients presenting with MH issues. The results indicate that disparities are more pronounced in this subgroup of ED patients.
2031-01-01
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Jarvis, G. Eric. "Emergency psychiatric treatment of immigrants with psychosis". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33785.
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Objectives. To determine whether the emergency psychiatric treatment of patients with psychosis varies with immigrant status and ethnicity. Methods. Data on immigrant and ethnic status of psychotic patients admitted in 1999 were extracted from records of a general hospital in Montreal. Of the 217 subjects, 97 (44.7%) were immigrants, 125 were Euro-Canadian (57.6%),39 were Asian (18.0%), and 27 were Black (12.4%). All Asians and most Blacks (87%) were immigrants. Measures of emergency psychiatric treatment included use of seclusion, restraints, and medication in the emergency department. Multiple regression models examined the relationship of immigrant status and ethnicity to emergency psychiatric treatment controlling for age, gender, patient height and weight, and mode of emergency department admission (coercive versus non-coercive). Results. Immigrant status and Asian ethnicity were not associated with emergency treatment measures. Coercive mode of emergency department admission (i.e. by police or ambulance) predicted use of seclusion (p < .001) and restraints (p < .05), but being Black was independently and positively associated with received dose of emergency antipsychotic (p < .05). Being Black was also positively associated with police or ambulance contact prior to emergency department presentation (p < .01). Conclusion. While some aspects of the emergency treatment of psychosis seem to occur as a consequence of the mode of admission, the administration of antipsychotic medication may be motivated by patient ethnicity. These results point to the need for training of emergency department staff to reduce potential bias in treatment.
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Nguh, Florence. "A Practice Guideline for Triaging Mental Health Patients in the Emergency Setting". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7946.
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Today's emergency departments (EDs) are challenged with increasing numbers of patients with behavioral health (BH) issues and associated management problems. Patients presenting in the ED are increasingly in need of BH services due to a lack of available services in the community. The implication is that ED staff are faced with conducting a comprehensive review of their systems and processes for BH care delivery to ensure that the needs of this population are safely met. Specifically, this DNP project addressed the lack of evidence-based screening tools for the ED triage area for patients with BH issues. The purpose was to develop a clinical practice guideline targeting an improved triage process for providers with BH patients in the ED setting. Using a modified Delphi technique and the AGREE II model, an expert panel comprised of ED leadership was convened to (a) identify challenges; (b) review a clinical practice guideline that addressed the identified challenges; and (c) approve the implementation of the clinical practice guideline, which included an evidence-based BH screening tool that identified BH needs and expedites the appropriate process of care. Key findings included two 2 components: the expert panel agreed to full implementation of the BH screening tool including the use of the accompanying software, after an in-depth educational process is completed for the ED staff. Potential implications for positive social change include the ability to readily and effectively screen BH patients and provide them with proper BH care while reducing the overall wait time and improving the patient's ED care experience.
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Stander, Charnelle. "Prehospital emergency care provider’s understanding of their responsibilities towards a mental health care user, during a behavioural emergency". Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31266.
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Background: Prehospital emergency care providers in South Africa are regularly called to assist with the management of mental healthcare users. The Mental Health Care Act no 17 of 2002 regulates mental healthcare in South Africa but makes no reference to the roles and responsibilities of prehospital emergency care providers in the provision of mental healthcare, rather giving the South African Police Services authority over the wellbeing of a mental healthcare user outside the hospital setting. Aims: To investigate what prehospital emergency care providers understand their responsibilities are towards a mental healthcare user and the community during the management of a behavioural emergency. Setting: Prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria. Methods: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care; Basic Life Support, Intermediate Life Support and Advanced Life Support. Data from each focus group was collected through audio recordings, transcribed and analysed using a framework approach. Results: A total of 19 prehospital emergency care providers from all three main levels of care participated in the focus group discussions (4 BLS, 6 ILS and 9 ALS). Four main themes were identified: Perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. Conclusion: Participants placed high value on their moral and medical responsibilities towards a mental healthcare user and would like to have the backing of legislation to fulfil their role. There is a desire for better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.
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Eales, S. J. "Service users' experiences of liaison mental health care". Thesis, City University London, 2013. http://openaccess.city.ac.uk/13073/.
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Liaison mental health services provide mental health care, including assessment, interventions and sign posting to further specialist care, for those who present with mental health needs in non-mental health settings. Liaison mental health services in the United Kingdom most frequently exist within, but are not limited to general hospital provision. The commissioning of these services is however inconsistent, having developed in an ad hoc manner, and the evidence base for an appropriate structure remains limited. This thesis reports an extensive literature review which identifies that to date there has been no published detailed exploration of the experiences of service users of liaison mental health care. Only recently has research been published which tentatively identifies the ability of liaison mental health services to reduce costs to general hospitals of mental health presentations and co-morbidity. The empirical element of this programme of research is a study of the experiences of service users of a liaison mental health service, offered within a general hospital setting. The service users have experiences of both inpatient and emergency department care. The study utilises a secondary data analysis methodology to provide an in depth interpretation of these experiences. Data were analysed using a grounded theory constant comparative method. A core category of ‘negotiating and navigating the system’ emerged as service users’ experienced psychological distress as they attempted to manage their own resources and expectations as a personal safety net. It is only when this personal strategy fails to alleviate their symptoms that they attempt to find help from professional services within the general hospital. Gaining access to assessment by the liaison mental health service requires the service user to negotiate a complex system of care. This experience is represented in the study utilising a conceptual map of their journey, using the analogy of a road to explore the enablers and barriers to an effective experience of liaison mental health care. A model of liaison mental health care is required that ensures provision of educational support for non-mental health professionals within the general hospital setting. This education needs to acknowledge that those who are having their first experience of a mental health issue often do not know where else to seek help, other than the emergency department, because it represents the ‘front door’ of health care. The adoption of a comprehensive model of liaison mental health care is a priority for all general hospital settings in order to achieve improved service user experience, cost efficiency and integrated health care provision.
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Sutherland, Sophie. "Forensic mental health service users' narratives of recovery". Thesis, Staffordshire University, 2018. http://eprints.staffs.ac.uk/4904/.
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This thesis aims to explore the recovery experiences of forensic mental health service users. In doing so, it seeks to add to the small but growing field of literature exploring the application of recovery principles in forensic settings. Paper one is a review of the current literature, synthesising the recovery experiences and perceptions of forensic mental health service users. A total of 10 papers were included in the thematic review. Five themes were identified; hope; connecting with others; meaningful occupation, roles and identity; the powerful environment of the hospital; and coming to terms with the past and diagnosis. Paper two is an empirical paper which explores the recovery stories of five male participants who had been detained in a low secure forensic service and discharged into the community. A narrative analysis reveals the shared personal, community and dominant cultural recovery narratives. Counterstories were also identified. The findings are discussed in relation to the clinical implications, in particular how to work within a cultural narrative of openness about mental illness stories, but secrecy around offending narratives. Further research implications are also discussed. Paper three is an executive summary which seeks to provide an accessible summary of the empirical research paper. This provides an overview of the research, highlighting the key points and salient information in terms of clinical implications for service delivery in a forensic context.
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Roberts, Amanda. "Clinical psychology and mental health service user involvement". Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2014001/.
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This thesis comprises three interconnected chapters: a systematic literature review (chapter one); empirical paper (chapter two); and an extended discussion (chapter three) which incorporates an accessible version of the research findings, and a future research proposal. The systematic review aims to find, describe and critique the empirical evidence for the impact of mental health service user involvement on the design, delivery, commissioning or evaluation of mental health services. Secondary objectives are to ascertain whether any attempts have been made to apply psychological theory and whether clinical psychologists are involved in the research. The review implements a comprehensive, replicable search strategy and identifies 11 studies published between 1997 and 2014. The included studies highlight both positive and negative impacts at individual (e.g., for service users and service providers) and strategic (e.g., for services and organisations) levels. Process issues, barriers and resistance to the implementation of involvement were also found. No studies applied psychological theory. Clinical psychologists were involved in a small portion of the studies. The review does not support previous reports that user involvement lacks an evidence base. A small empirical evidence base for involvement was found. However, the majority of studies were poorly reported and had significant methodological flaws. None of the 11 studies included in the review had applied psychological theory to its findings. Therefore, this review applied psychological theories of power and empowerment, attitudes, stigma and intergroup contact to the impact and barriers reported in the included studies. The methodological limitations of the included studies and the review process were discussed. The review concludes with a discussion of the clinical implications, implications for clinical psychologists and areas for future research. It is important that the findings of the systematic review are considered in light of the numerous implications and limitations and, therefore, interpreted tentatively. The empirical paper provides empirical research designed and conducted to investigate the attitudinal and organisational barriers to involvement. In utilising the psychological therapist-client dyad, the research aims to ascertain whether there are relationships between psychological therapists’ explicit attitudes to mental illness, implicit attitudes to service user involvement, and perceptions of organisational culture. It establishes whether there are relationships between these and the quality of the client-rated therapeutic alliance. The research employs a cross-sectional design comprising 28 psychological therapist-client dyads within two North West NHS Trusts in the UK. The study found that therapists’ explicit attitudes to mental illness and implicit attitudes to service user involvement were, on the whole, positive. Most therapists perceived the organisational culture of the NHS as market-driven and results-orientated. Counter to expectation, no significant relationships were found between therapists’ explicit attitudes to mental illness, implicit attitudes to service user involvement, and client-rated alliance, and the hypotheses were unsupported. The empirical paper concludes with a discussion of the possible reasons for the lack of significant findings, with reference to methodological, theoretical, and ethical considerations, and clinical implications. The extended discussion initially provides a brief overview of the preceding chapters. It then discusses methodological and ethical considerations, research paradigms and the nature of evidence, clinical psychology, leadership and user involvement and policy. It suggests that clinical psychologists’ skills as scientist-practitioners make them well placed to research, formulate, theorise and provide psychological understandings of user involvement and its impacts and barriers. It concludes with the suggestion that the input of clinical psychologists into service user involvement strategy at individual, organisational and strategic levels could be synonymous with a recently proposed paradigm-shift for the profession of clinical psychology.
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McChesney, Gillian Clare. "Adolescent trauma, psychopathology and mental health service use". Thesis, Ulster University, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.685410.
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Research has shown that, by the time an individual reaches adolescence, they are likely to have experienced at least one traumatic event, and, when compared to trauma in adulthood, exposure is at its peak during the adolescent years. Further research has examined negative sequelae associated with traumatic experiences, and has found psychological outcomes such as depression, behaviour disorders, and PTSD to be highly prevalent amongst traumatised adolescents. It has also been consistently found that, amongst those adolescents with poor psychological responses to trauma, incidences of multiple trauma experiences are prevalent, with some experiencing as many as four or five traumatic events in one year alone. This current thesis aimed to further explore the nature of trauma in adolescence by examining the trauma histories of an American general population sample of adolescents (N = 10,123), the National Comorbidity Survey - Adolescent Supplement (NCS-A). It did this by applying an advanced statistical technique, latent class analysis (LCA), to the trauma data. Utilising LCA makes the adolescents the focus of the study and not the traumatic events. It does this by identifying latent classes useful in explaining homogenous groups of individuals who display similar patterns of trauma exposure. Four classes were identified in chapter 3. A low risk class, where experiences of any trauma events are minimal, was first identified as the baseline group. Three trauma classes were then identified; high risk, sexual assault risk, and non-sexual assault risk. This thesis then aimed to determine sociodemographic profiles of those adolescents belonging to each of the trauma groups by applying multinomiallogistic regression in chapter 4. Adolescent risk factors such as being female, coming from a home where neither biological parent was present, and where a history of parental psychopathology was evident, were all identified as being indicative of trauma group membership. Confirmatory factor analysis (CFA) was then utilised in chapter 5 in order to identify an appropriate model of adolescent psychopathology. lnternalising factors of distress and/ear, and externalizing factors of social norm violation behaviours and oppositional behaviours were found to best explain the mental health symptoms of this group of American adolescents. The resulting CF A dimensions were then applied to previously identified trauma classes in order to determine associations with psychopathology in chapter 6, with significant relationships evident as a result of the regression analyses. In addition, chapter 7 of this thesis examines adolescent mental health service use and submits service categories to further regression analysis in order to determine associations with tramna and psychopathology, with significant associations found for services used by adolescents within the school environment and within the juvenile justice system. This thesis provides a fuller profile of the adolescents who are exposed to multiple types of trauma, the nature of such events, the associated psychopathology and mental health service use. Such a profile will aid in the effective intervention for those adolescents who are psychologically damaged by trauma events, and may even help in the prevention of further trauma by identifying those most at risk.
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Perez, Claudia, e Samara Yael Cardona. "Mexican Women's Perception of Mental Health Service Use". CSUSB ScholarWorks, 2018. https://scholarworks.lib.csusb.edu/etd/679.
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The purpose of this research study was to explore Mexican women’s perceptions about utilizing mental health services and to explore the barriers encountered during the process. Previous research suggested Mexican women’s diverse experiences when seeking and utilizing mental health services. The study used a qualitative approach with open-ended and closed-ended questions. The sample size of this study was fifteen individuals who self-identified as Mexican women who reside in Southern California recruited using a snowball approach. Major themes identified included Mexican family values and beliefs, cultural barriers, structural barriers, Mexican women’s strengths, and community suggestions for social work practice. This study highlighted their perspective on mental health, cultural and structural barriers, their personal experiences of utilizing mental health services, techniques on managing difficult situations, support systems, identified mental health symptoms, coping methods, cultural values and suggestions to improve mental health services in the general Latino community.
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Chung, Chia-Ling Chung. "Factors associated with mental health service utilization among young adults with mental illness". Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1499248494469518.
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Perkinson, Costilla Cindy. "Emergency Responders' Perceptions of Mental Health Patients While Providing Care in Rural Areas". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7056.
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Prior research has shown a correlation between public stigma and emergency responders' perceptions of mental health patients while providing care. However, research examining public stigma and emergency responders' perceptions of mental health patients is limited in rural areas. The purpose of this study was to explore possible relationships between the dependent variable, public stigma, and the independent variables: social distance, blameworthiness, and fear of unpredictable behavior. Link's modified labeling theory was the theoretical framework for this study. A sample of 92 emergency responders obtained from Facebook completed a questionnaire that consisted of three Likert scales. A multiple regression showed little correlation between public stigma and social distance, blameworthiness, and fear of unpredictable behavior. Only .077 of the variance in public stigma was explained by the combination of independent variables. This study has demonstrated a possible shift in societal attitudes toward mental illness. It is important to determine the cause of this change in results so that continued education regarding mental health awareness may positively affect social change.
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Bentley, Melissa. "A National Assessment of Ideal Cardiovascular Health among Emergency Medical Service Professionals". The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480456097279235.
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Krizova, Katarina. "ADHD CHILDREN AND MENTAL HEALTH SERVICE USE: MATERNAL DETERMINANTS". UKnowledge, 2015. http://uknowledge.uky.edu/hes_etds/28.
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The current study investigated maternal determinants of mental health service use, namely, individual child therapy, among preadolescent children diagnosed with ADHD. The Behavioral Model of Health Care Utilization (Andersen, 2008) was used as a theoretical framework for the study. Data from the last three rounds of ECLS-K dataset were employed to test a longitudinal model using Bayesian analysis. Socio-demographic variables and maternal mental health were tested as exogenous variables and mother-child relationship variables, discipline variables, and perceived maternal concern about child’s overall behavior and child’s emotional symptoms were tested as intervening variables. Results showed that only maternal mental health remained in the model as an exogenous variable. The effect of mental health on child therapy was mediated by maternal aggravation and maternal concern about overall behavior in one path and by maternal concern about emotional symptoms in another path, suggesting that maternal mental health needs to be considered when attempting to understand help-seeking determinants. Both concern variables were found to have large direct effects on child therapy. The results of the current study showed the importance of maternal mental health and the importance of determinants related to mother-child relationship in a mother’s decision to seek therapy for a child.
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McCrone, Paul Richard. "Economic evaluation of a sectorised community mental health service". Thesis, King's College London (University of London), 2000. https://kclpure.kcl.ac.uk/portal/en/theses/economic-evaluation-of-a-sectorised-community-mental-health-service(e054bac1-158b-4e76-b358-699efe54008b).html.
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Ortega, Victor. "RELIGION AND MENTAL HEALTH SERVICE UTILIZATION AMONG HISPANIC COMMUNITIES". CSUSB ScholarWorks, 2019. https://scholarworks.lib.csusb.edu/etd/905.
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This study aims to describe the relationship between religion and mental health utilization as perceived through Hispanic (Spanish speaking) individuals in religious communities. Previous studies have conducted research on the relationship between utilization of mental health services and religiosity, however there is limited research that describes the relationship between the two variables within the Hispanic population. This study seeks to find what the perception of mental health utilization is within the Hispanic community. Research has been conducted through a qualitative approach by interviews with individuals who have consented to be audio recorded. The data was then transcribed, for the purposes of the research.