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Molaba, Ramatsobane Granny. "Adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental health institution in the Limpopo Province". Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1148.
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Thesis (M.Cur) --University of Limpopo, 2013Adherence to antipsychotic medication is very important to patients with schizophrenia. Therefore, if patients with schizophrenia are non-adherent to treatment, they are at risk of relapse and being re-admitted at a mental health care institution in the Limpopo Province. Despite the proven benefits of antipsychotic medications, half of the patients with schizophrenia do not take their prescribed drugs. The researcher has observed the following occurrences during practice: • Lack of adherence to antipsychotic medications of schizophrenic patients results in symptoms not being relieved, poor drug effectiveness and patients developed other serious or costly consequences, such as being violent and damaging property; • High rate of relapse; and • High rate of re-admissions. This research questions has guided the study: • What are the factors affecting adherence of mentally stable schizophrenic patients to antipsychotic medications at a mental health institution in the Limpopo Province? • Do mentally stable schizophrenic patients adhere to prescribed treatment? • Are there any guidelines used to promote adherence to antipsychotic treatment? The aim of the study has been to determine the level of adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental healthcare institution in the Limpopo Province. The objectives of the study have been to describe adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental health institution in the Limpopo Province. It implies that participants have been given the opportunity to describe their experience while on medication. vi Their responses have led to the development of guidelines to promote adherence of mentally stable schizophrenic patients to antipsychotic medication. The study site has been the Thabamoopo Mental Healthcare Institution in the Capricorn District of the Limpopo Province. A descriptive, exploratory and contextual qualitative research design has been used in this study. The population has consisted of all mentally stable schizophrenic patients and all the carers of such patients. Non-probability purposive sampling has been used to select participants in this study. The researcher has used a semi- structured interview with two schedule guides for the patient and carers/relatives, which have specified the issues and questions covered. It has assisted the researcher with gathering information about the problem studied (De Vos et al. 2005).A total of twenty (n = 20) participants, consisting of fourteen (n = 14) mentally stable schizophrenic patients and six (n = 6) carers/relatives has been included voluntarily in the semi-structured interview sessions. The steps of data analysis as described by Tesch (1990) in Cresswell (1994) have been followed in this study. The findings of this study reveal a central storyline which indicates that participants share the same point of view in connection with aspects of adherence to antipsychotic treatment and also knowledge about the causes of mental illness and its prognosis. The following four themes and their sub-themes have emerged during data analysis: Theme 1: Participants share the same point of view related to aspects of adherence to antipsychotic treatment; Theme 2: Knowledge related to mental illness; Theme 3: Health seeking behaviours of mentally ill patients; and Theme 4: Experiences of relatives caring for mentally stable patients on treatment. Guidelines and recommendations based on the findings of this study are described in Chapter 4. The criteria for establishing the trustworthiness of qualitative data maintained in this study have been: Credibility, dependability, confirmability and transferability. The following ethical principles have been adhered to: The principle of beneficence, justice, the principle of human respect and dignity, permission to conduct the study, informed consent and confidentiality, privacy and anonymity.
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Sigenu, X. "Mental health nurses’ knowledge, attitude and practices related to tobacco dependence among mental health care users at a psychiatric institution in the Western Cape". University of Western Cape, 2021. http://hdl.handle.net/11394/8283.
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Magister Curationis - MCurResearch reported that it is very challenging for mental health care users to quit smoking and the risk of relapsing after quitting is high. However, tobacco dependence treatment is possible and potentially lifesaving for people. The delivery of tobacco dependence treatment by nurses is influenced by a variety of factors, including lack of knowledge and skills, limited professional leadership, and smoking within the profession. There is a strong link between mental illness and smoking-related diseases, including cancer, respiratory diseases and heart diseases that are linked with depression. There is a high incidence of cancer in people with bipolar mood disorder and schizophrenia due to smoking. In spite of this, smoking is regarded as part of the culture of psychiatric institutions and tobacco is seen as “necessary self- medication for the mentally ill”.
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Zonke, Lulama Henrietta. "The newly qualified professional nurses' proficiency in utilizing psychiatric nursing skills in mental health institution and community health care facilities". Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/d1001098.
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The aim of this study was to determine the ability and proficiency of the newly qualified professional nurses in utilising psychiatric nursing skills at Chris Hani District Psychiatric Health Care Services in the Eastern Cape, South Africa. The research method was a qualitative, phenomenological approach. A purposive sample of newly qualified professional nurses and supervisors participated in the study. The data were collected through interviews and focus group discussions, using semi – structured interview guides. Interviews responses were recorded on the interview guide. Data were analysed using the computer software Atlas ti and manually. Positive and negative themes were identified. Ethical considerations were ensured by means of privacy, anonymity and confidentiality. Ethical clearance was obtained from the University of Fort Hare and permission from the Provincial Department of Health and Chris Hani District Health and Mental Health Institution at Queenstown was sought. The findings revealed that newly qualified professional nurses performed well, according to the perception of their supervisors. Newly qualified professional nurses were faced with challenges such as shortage of resources, mental illness not considered as a priority and lack of skills development. The study also revealed that newly qualified professional nurses focussed on the curative aspect of ailments, rather than preventive care. However community health workers (CHW) focussed on the preventive aspect of care. Limitations and recommendations based on the findings of the study are presented.
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Tanner, Carolyn A. "Perception of palliative care practice of health care professionals in a mental institution : a descriptive study". Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29703.
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The purpose of this descriptive study is to investigate the perception of practice of health care professionals at a mental institution, as it pertains to their work with dying patients, and also to identify areas of change. The conceptual framework is constructed of six factors important to palliative care that have been identified from the literature. These are personal death anxiety, organizational structure of the hospital system, role expectations of professionals, teamwork, education and training for care of the dying, and conveyance and exchange of diagnostic information. The sample surveyed by a written questionnaire included physicians, psychiatrists, health care workers, social workers and pastoral care workers from the Geriatric Division of Riverview Hospital, Port Coquitlam. The findings indicate that age, sex, marital status and length of working experience at Riverview Hospital had no significant association with personal death anxiety. Informal education such as workshops and in-services had a significant correlation with personal death anxiety, as did perception of being competent and/or confident about working with the dying. The study also raised concerns that not all was being done for the dying patients and their families at this institution. Suggestions such as education and training, support mechanisms, and less stereotyping of professional roles were
offered to improve this situation. As well, findings indicated that there was a need for palliative care service either in the form of a team or separate unit, or simply the practicing of the palliative care philosophy.Arts, Faculty of
Social Work, School of
Graduate
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Rajeus, Samuel E. "Institution versus Family home : A comparison of community establishment and utilization of mental health services among unaccompanied refugee adolescents placed in samll residential care and family homes". Thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-23268.
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In this study I investigated the community establishment and utilization of mental health services among refugee adolescents who received resident permit in Sweden in 2010. I compared a group of 20 adolescents –boys and girls- mainly from Afghanistan and Somalia, living in small residential care by the Social service management in Stockholm – Socialförvaltningen (SF) - with a group of 10 adolescents from the same countries, living in family homes. The study showed clear differences in adolescents´ adaptation processes. Those who were living in small residential care by SF had a better chance to adapt quickly into their new society compared with the other group. The study showed that refugee adolescents from both groups underutilized mental health services.
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Pilkington, Christopher. "The architecture of the unwanted : crisis in the implementation of the community-scale institution case study: mental health facilities in Massachusetts". Thesis, Massachusetts Institute of Technology, 1985. http://hdl.handle.net/1721.1/88805.
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Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1985.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.
Bibliography: p. [120]
by Christopher Pilkington.
M.S.
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Martin, Penelope Dawnette. "The development of a model of emotional support for undergraduate nursing students working in mental health care settings". Thesis, University of Western Cape, 2013. http://hdl.handle.net/11394/3246.
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Philosophiae Doctor - PhDThe mental health care environment is a stressful environment because of the environment, perceived unpreparedness of students and the emotional demands placed on the students which are inherent in the nature of the work. The use of the self as a therapeutic tool also presents challenges for students. Whilst researchers have identified supportive interventions and strategies to address students support needs in mental health care settings, these interventions/strategies focus on meeting clinical learning objectives with the assumption that if the student learning needs are met, they will feel emotionally supported. Literature and experience indicates that it is imperative that in this field of study, students should be prepared to cope emotionally with the demands of mental health work. The aim of this research was to develop a model of emotional support for student nurses working in mental health care settings. A theory-generating design based on a qualitative, explorative and descriptive research approach was used to achieve the aim of the study. Purposive sampling was employed to select participants namely: students, educators and clinical staff who met the eligibility criteria. A sample of 40 students, nine educators and nine clinical staff who worked in the four psychiatric hospitals and community mental health clinics in the Western Cape participated in the study. Data collection was by means of focus group interviews (students) and indepth individual interviews (educators and clinical staff). Data was analysed by means of Tesch’s method of content analysis. The model was developed by means of the four steps of the theory generation process. Step one was concept development which consisted of two sub-steps namely concept identification and concept definition. A total of 22 concepts were identified which was further synthesised into six main concepts. The main concepts which were used to develop the model were: positive self-concept; positive work environment; academic and professional development; effective communication; formal and informal supportive interventions and collaboration between the Higher Education Institution and the mental health care setting. Step two of the theory generating process was model development. These main concepts were placed in relation with each other which formed an emotional support model for students working in mental health care settings. Step three was model description. The model was described using the three phases of interpersonal communication namely orientation phase, working phase and the termination phase. A visual application of the model which depicts the main concepts, the process and the context was shown. Step four dealt with the development of the guidelines for the implementation of the emotional support model. A critical reflection of the model was done using five criteria for model evaluation according to Chinn & Kramer. Trustworthiness of the data was ensured by means of applying Guba’ model of truth value, applicability, consistency and neutrality. Reflexivity was used by the researcher to further enhance trustworthiness. Permission to conduct the study was obtained from the relevant authorities. The ethical principles of respect for human dignity, beneficence and justice were applied throughout the study. Limitations were identified and ecommendations for nursing practice, education concluded the study.
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Simar, Melinda. "“It’s All About You Being Successful as a Student”: Mental Health and Wellness at a Post-Secondary Institution in Ontario: A Governmentality Analysis". Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40346.
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A mental health crisis is happening on post-secondary campuses in Ontario today. Post-secondary institutions provide mental health services to students in an effort to respond to this crisis and manage students in distress. The management of students and the implementation of these mental health services is the main concern of this thesis, more specifically, the ways in which these services expose conscious and/or unconscious beliefs about student mental health. By extension, these beliefs constitute the ways in which we can think about, talk about, and know about patient safety. The object of study is the intersection of the neo-liberal university with the ‘good’ student and the resulting effects of this relationship on the development and implementation of mental health services. These intersections themselves create possibilities for acting on students in distress, but that also create unintended contradictions in the services themselves. An examination of this intersection can address a gap in the literature on post-secondary student mental health.
The conceptual framework used in this study is primarily built from Michel Foucault’s concepts of subjectivity, and governmentality. The object of consideration is limited in this study to senior employees directly involved in student mental health at a university in Ontario. Documents are analysed to show how student mental health problems have been problematized nationally, provincially and locally and, thus, a behaviour to be regulated with governing practices. Data from interviews with senior University employees and observations of wellness events are analysed to examine the imbrication of advanced liberal rationalities and techniques in the implementation of mental health services on campus. The thesis argues that the development of these services is not an unproblematic process, whereby services and activities act simply as neutral tools to improve the mental health and well-being of students. Rather, these services aim to produce successful, enterprising students. Discourses of mental health and student success produce certain truths about practices and student subjectivities, obscuring and narrowing the definition of health and well-being and creating contradictions for students experiencing mental distress. In particular, this thesis shows how the University’s objectives for providing mental health services have implications for the development of mental health services and the governing of post-secondary in advanced liberal ways.
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Krzyzaniak, Patrice. "Georges Daumézon (1912-1979) : un camisard psychiatre et pédagogue : une contribution singulière aux sciences de l’éducation". Thesis, Lille 3, 2017. http://www.theses.fr/2017LIL30031/document.
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L’intention de cette thèse est d’étudier la démarche novatrice du psychiatre/pédagogue G. Daumézon (1912-1979) sur la question des relations entre le soin et l'éducation en institution psychiatrique, caractérisées au milieu du XXe siècle par l’émergence et le développement de la psychothérapie et de la pédagogie institutionnelles.L’hypothèse générale est que la mobilisation d’une démarche réflexive et compréhensive de cette œuvre singulière permettra de souligner la pertinence et l’importance de son apport au titre des Sciences de l’éducation.Il est montré, par la convocation d’une approche socio-historique, d’une étude documentaire et archivistique de l’œuvre de G. Daumézon et en mobilisant la pluralité et la transversalité de divers champs disciplinaires, que complète la réalisation d’entretiens d’enquête, en quoi et comment l’asile, puis l’hôpital psychiatrique ont été questionnés par l’éducation, la pédagogie et la formation.Il est enfin mis en perspective que cet héritage empirique et réflexif peut encore être aujourd’hui un enjeu et une ressource contributive, pour éviter le développement de la normalisation des modalités de la prise en charge psychiatrique de la maladie mentaleThis thesis intends to study the pioneering approach of the psychiatrist/pedagogue G. Daumézon (1912-1979), concerning the relationships between both caring and education in psychiatric institutions, marked by the emergence and the development of institutional psychotherapy and pedagogy. The general hypothesis is that the use of a comprehensive and reflective approach of this singular work will enable underlining the pertinence and the importance of its contribution in accordance with educational sciences.Both through a sociohistorical, documentary and archival study of G. Daumézon’s work, and a pluralist and cross-disciplinary analysis, completed with researching interviews, it is shown how the asylum, later on the psychiatric hospital, has been questioned by education, pedagogy and training.In the end, it is underlined that the empirical and reflective legacy might be nowadays a contributory recourse to avoid development and standardization of terms and conditions of psychiatric care of mental illness
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Gonaver, Wendy. "The Peculiar Institution: Gender, Race and Religion in the Making of Modern Psychiatry, 1842--1932". W&M ScholarWorks, 2012. https://scholarworks.wm.edu/etd/1539623354.
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Modern psychiatry in the United States emerged at the same time as debate about slavery intensified and dominated public discourse, contributing to dramatic denominational schisms and to the greater visibility of women in the public sphere. as the only institution to accept slaves and free blacks as patients, and to employ slaves as attendants, The Eastern Lunatic Asylum of Williamsburg, Virginia, offers unique insights into the ways in which gender, race and religion transformed psychiatry from an obscure enterprise in the early nineteenth century to a medical specialty with wide-reaching cultural authority by the twentieth century.;Utilizing a variety of sources, including a collection of un-catalogued and largely unexamined papers, this dissertation employs interdisciplinary methods to explore the meaning of interracial medical encounters, and the role of the asylum in promoting rational religion and normalizing domestic violence.;The dissertation begins by examining the life and writings of asylum Superintendent John M. Galt, whose experience at the head of an interracial institution led him to reject proposals for separate institutions for whites and blacks and to promote the cottage system of outpatient care. The following chapter addresses the labor of enslaved attendants, without whom the asylum could not have functioned and for whom moral rectitude and spiritual equality appear to have been the ethical foundation of care-giving. Discussion of ethics and spirituality, in turn, prompts consideration of the role of religion in asylum care. The association of enthusiastic religion with slaves and with abolitionism contributed to the regulation of religious expression as a common feature of asylum medicine. Religious evangelism was viewed by hospital administrators as a symptom of insanity, while religious rationalism was enshrined as normative and, paradoxically, as secular.;Asylum medicine also normalized domestic violence by treating the social problem of violence, from wife beating to the rape of slave women, as the medical pathology of individuals. In so doing, the asylum undermined the religious authority from which many women derived comfort, meaning and purpose; and overemphasized the role of female sexual and reproductive organs as an alleged cause of insanity. Ultimately, the struggle over efforts to contain interracial alliances, women's autonomy and enthusiastic religious expression coalesced in the state's promotion of eugenics in the early twentieth century.
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Ganyaza, Thulisile Zioner. "Multi-disciplinary teamwork in an admission unit of a psychiatric institution". Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51837.
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Reis, Kellen Dionísio dos. "A lógica gerencialista e a saúde mental do servidor público de uma instituição de ensino superior". Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/7532.
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The aim of this study is to analyze the influence of the management model on the mental health of the public servants of a higher education institution located in Goiás state. Therefore three specific objectives were defined: i) to identify the perception of the servers on the management of the public HEI studied; Ii) to identify the presence of psychological suffering and the conditions of affection in the servers; and iii) to confirm the strategies of facing the IES management model. The literary base was the State reform and the psychodynamics of work (PDT), which deals with the worker´s health. The State reform refers to changes that has taken place in HEIs through the University Restructuring and Expansion Program (REUNI), in 2007, and originated from the state reformist movement in the 1970s, known as the New Public Administration. New Public Management (NPM), which emerged in response to the Welfare State crisis or “Social welfare”, proposing the reduction of the public machine, spreading the managerial management in state bodies, already consolidated in private companies. It is a neoliberal postmodern ideological reform, guided by the Toyotista sayings of flexible and lean production, which have created a growing wave of precarious labor, underemployment and world unemployment. The second theoretical support of this research was given by the “Dejours school”, which analyzes the dynamics between the subject and the company, and how does the experience of pleasure and suffering of the individual react before the incoherence of the work organization. This school also approaches the consequences for the worker when he faces unbeatable suffering at work, when he assumes defensive strategies to preserve the psychic health; And which complications occur when these failures are used excessively by the Individual, causing illness and social pathologies in the workplace. The research designed was qualitative, assuming the phenomenon related to the Subjective Subject. The methodological bias was the Critical Discourse Analysis (ACD), analyzing the sets of the interviewees for the identification of the ideological announcements of neoliberal social culture. The research tool used was the interview with semi-structured questions and the target audience was chosen from statistical data secondary medical licenses of Administrative Technicians and Teachers, electing the Academic Units (UA) of HEI with a higher incidence of medical licenses for Mental Disorder Behavioral (TCM) in 2015. The results pointed out characteristics of managerial management style (control, productivity, individuality). Within this context, the workers feel that pleasure is linked to the nature of the work they perform, but also suffering, when they use psychic defenses for confrontation. It was also identified that there are signs of excessive use of defense or the failure of its use, causing social pathologies in the work environment of the HEI studied. It is suggested that new research should be carried out, approaching other motivators of illness (physics, accidents) of these servers and that there are also studies that propose the implementation of a reintegration process of servers that were removed due to mental disorder in HEI.
O objetivo deste estudo é analisar a influência do modelo de gestão na saúde mental dos servidores de uma dada Instituição de Ensino Superior (IES) pública, situada no estado de Goiás. Para tanto, definiu-se três objetivos específicos, a saber: i) identificar a percepção dos servidores sobre a gestão da IES pública estudada; ii) identificar a existência de sofrimento psíquico e as condições de acometimento nos servidores; e iii) evidenciar as estratégias de enfrentamento frente ao modelo de gestão da IES. A base literária foi a reforma do Estado e a psicodinâmica do trabalho (PDT), que trata da saúde do trabalhador. A reforma do Estado se refere às mudanças ocorridas nas IES através do Programa de Reestruturação e Expansão das Universidades (REUNI), no ano de 2007, e se originou do movimento reformista do Estado na década de 1970, conhecido como a Nova Administração Pública (New Public Management - NPM), surgido em resposta à crise do Welfare State, ou “Estado do bem-estar social”, propondo o enxugamento da máquina pública, difundindo a gestão gerencialista em órgãos públicos, já consolidada em empresas privadas. É uma reforma de fundo ideológico pós-moderno neoliberal, guiado pelos ditos Toyotista da produção flexível e enxuta, que criaram uma onda crescente de precarização do trabalho, subemprego e desemprego mundial. O segundo suporte teórico desta pesquisa foi dado pela escola dejouriana, que analisa a dinâmica existente entre Sujeito/empresa, e como se dá as vivências de prazer-sofrimento do Sujeito diante das incoerências da organização do trabalho (OT). Esta escola também aborda as consequências para o trabalhador quando enfrenta sofrimento insuperável no trabalho, quando adota estratégias de defesa para a preservação da saúde psíquica; e quais complicações ocorrem quando estas falham ou são utilizadas excessivamente pelo Sujeito, ocasionando adoecimento e patologias sociais no ambiente de trabalho. O desenho de pesquisa foi qualitativo, assumindo o fenômeno relacionado ao Sujeito de caráter subjetivo. O viés metodológico foi a Análise Crítica de Discurso (ACD), analisando os enunciados dos entrevistados para a identificação das anunciações ideológicas da cultura social neoliberal. O instrumento de pesquisa utilizado foi a entrevista com perguntas semiestruturadas e o público alvo foi escolhido a partir de dados secundários estatístico de licenças médicas de Técnicos Administrativos e Docentes, elegendo as Unidades Acadêmicas (UA) da IES com maior incidência de licenças médicas por Transtorno Mental Comportamental (TCM) no ano de 2015. Os resultados apontaram características do estilo de gestão gerencialista (controle, produtividade, individualidade). Dentro deste contexto, os trabalhadores sentem prazeres ligados à natureza do trabalho que realizam, mas também sofrimentos, momento em quando se utilizam de defesas psíquicas para o enfrentamento. Também se identificou que existem sinalizações de uso excessivo de defesa ou o fracasso de sua utilização, ocasionando patologias sociais no ambiente de trabalho da IES pesquisada. Sugere-se que ocorram novas pesquisas abordando demais motivadores de adoecimento (física, acidentes) destes servidores e também que haja estudos que proponham a implantação de processo de reintegração de servidores que foram afastados por transtorno mental em IES.
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Ossola, Laurence. "Une sexualité cérébralement handicapée ? : représentations sociales de la sexualité des adultes handicapés cérébraux vivant en institution, pour une éducation pour la santé". Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0147.
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L’adulte handicapé cérébral, comme tout être humain, développe des sentiments d’amour, et à ce titre, a droit à une vie affective, intime et sexuelle. En institution (lieu de vie), les adultes cérébrolésés sont souvent dépendants des représentations sociales qui les ont construit, de celles des soignants qui les prennent en soins ou encore de celles des aidants-aimants-accompagnants et familles qui les accompagnent. Cette recherche a tenté de cibler les noyaux centraux et les éléments périphériques de toutes ces représentations sociales, au moyen de « l’association libre » et de « cartes émotionnelles », afin d’évaluer pour tous les acteurs, les progrès possibles en matière d’acceptation et par conséquent d’accompagnement de l’intimité et de la sexualité des personnes handicapées cérébrales institutionnalisées. Les personnes victimes de traumatismes crâniens sévères (handicap acquis) et les personnes porteuses d’infirmités motrices d’origine cérébrale (handicap congénital) ont été les principaux protagonistes de cette recherche. Les résultats montrent que selon le type de handicap (acquis ou congénital), la posture des soignants est quasiment la même ; celle des résidants eux-mêmes diffèrent légèrement ; quant à celle des aidants-aimants-accompagnants et familles, elle est radicalement différente : le handicap congénital ne laisse pas de place à un imaginaire intime et/ou sexuelle de leur part, envers leurs protégés. Quelles perspectives pour la mise en œuvre d’une éducation pour la santé sexuelle pour ces personnes handicapées cérébrales ? Quel accompagnement à la vie intime et sexuelle en structure d’hébergement ?Mentally-handicapped adults, like any other human beings, develop amorous sentiments and therefore, are entitled to an emotional, intimate and sexual life.In institution (living space), brain-damaged adults are often dependent on social representations which built them, of those of caregivers who cared them, or still of those of caregivers-loving-accompanying and families which accompanying them.This research tried to target the central cores and peripheral elements of all these social representations, by means of the “free association” and the “emotional cards”, to estimate for all actors, the possible progress regarding acceptance, and consequently accompaniment of intimacy and sexuality about institutionalized mentally-handicapped adults.Brain-damaged adults (acquired handicap) and people with mental disabilities (congenital handicap) were the main protagonists of this research.The results show that according to the type of handicap (acquired or congenital), the caregivers’ posture is almost the same; that of the resident differ themselves slightly; as for that some caregivers-loving-accompanying and families are radically different: people with congenital disabilities do not create an intimate imagination and/or sexual from them, to their mentally-handicapped adult.What perspectives for the implementation of an education for the sexual health for these cerebral disabled people? What sort of companying for privacy and sexual life in institution?
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Slabbert, Meggan. "Three's a crowd: the process of triadic translation in a South African psychiatric institution". Thesis, Rhodes University, 2010. http://hdl.handle.net/10962/d1002565.
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Mental health care in South Africa has long been governed by inequalities (Foster & Swartz, 1997). During apartheid, those who did not speak English and Afrikaans could not access mental health services in the same way as those who did (Foster & Swartz, 1997). One main reason for this is the majority of mental health practitioners could not, and were not required to speak languages other than English and Afrikaans (Swartz, 1991). The South African mental health literature suggests that language and communication must be prioritised if there is to be an improvement in mental health care services for those individuals who do not speak English and Afrikaans (Bantjes, 1999; Drennan & Swartz, 1999; Swartz & Drennan, 2000; Swartz & MacGregor, 2002). Drawing on Prasad's (2002) interpretation of Gadamer's critical hermeneutic theory and utilising thematic networks analysis (Attride-Stirling, 2001), this study investigated the process of translated clinical assessment interviews within a psychiatric hospital in the Eastern Cape Province within South Africa. Results of the study revealed that contextual factors, issues concerning linguistic and cultural heritage, clinicians' role expectations regarding translators' role performance, as well as relational dynamics regarding individual levels of control and influence within the translation triad, all impacted on the effectiveness of communication, translation and service provision. These fmdings are supported by literature on the theory and practice of translation that identifies these issues as prominent (Robinson, 2003). Specific recommendations regarding the formalisation of translation practices within the hospital setting, as well as the familiari~ation of clinical practitioners and psychiatric nurses with the intricacies of translation processes are offered.
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Grugan, Cecilia Spencer. "Disability Resource Specialists’ Capacity to Adopt Principles and Implement Practices that Qualify as Universal Design at a 4-Year Public Institution". Wright State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=wright1526997302503817.
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Moll, León Sarah. "Mental Health representations in workers of two specialized institutions of Lima City". Pontificia Universidad Católica del Perú, 2013. http://repositorio.pucp.edu.pe/index/handle/123456789/100845.
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The exploratory study aims to explore mental health representations in workers of two specialized institutions, through qualitative methodology. A total of ten members of two specialized institutions were selected, five from each, who comprise the interdisciplinary team in the area: A psychiatrist, a psychologist, a nurse, a nursing technician and a social worker. A semi-structured interview was developed to access the speech of the workers. Results show the representational world of the workers, their general conceptions about mental health, the factors that promote or interfere with it, as well as the reactions that a person that suffers mental illness generates, as well as expectations of improvement.El presente estudio busca explorar las representaciones de la salud mental en los trabajadores de dos instituciones especializadas. Se seleccionó un total de diez participantes, cinco por cada institución, representantes de los trabajadores que conforman el equipo interdisciplinario del área: un psiquiatra, una psicóloga, una enfermera, una técnica de enfermería y una asistenta social. Para acceder a la narración y al discurso de los participantes, se aplicó una entrevista semiestructurada. Los resultados dan cuenta del mundo representacional de los trabajadores, exponiendo desde lo subjetivo, sus concepciones generales en torno a la salud mental, los factores que favorecen o interfieren en la misma, las reacciones que genera una persona que sufre una enfermedad mental y las expectativas de mejoría.
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Crawford, Dana Elaine. "Black Students’ Risk for Dropout at a Predominantly White Institution: The Role of Adjustment & Minority Status Stress". Oxford, Ohio : Miami University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1250535973.
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Fung, Kit-lin Stella. "A conceptual analysis of halfway house programs in mental health services". Click to view the E-thesis via HKUTO, 1987. http://sunzi.lib.hku.hk/hkuto/record/B42574080.
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Mendes, Tiago. "Portuguese and British mental health care institutions: a cross-cultural study on social defence systems". Thesis, University of Essex, 2016. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.685729.
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Peláez, Gonzáles Nicole Stephanie. "Instituto Regional de Salud Mental en Ayacucho". Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/655453.
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En el Perú, la salud mental es un tema sumamente desatendido. Existe un déficit notable de infraestructura adecuada para el restablecimiento propicio y correcto del equilibrio en la vida de las personas que padecen enfermedades mentales, pues existen solo tres instituciones especializadas en la ciudad de Lima, centralizando la atención y dejando olvidadas poblaciones en las que también existe mucha demanda.
Al parecer no se considera el bienestar mental como base y mecanismo de cualquier tipo de sociedad que busca crecimiento en todos los ámbitos. De acuerdo al análisis de las causas, consecuencias y efectos que trae consigo lo antes mencionado, es necesario entender que cada población posee una historia, situación social y formas de vida distintas.
Es así como regidos bajo las estadísticas de demanda en salud mental en el Perú, dadas por el Instituto Nacional de Salud Mental “Honorio Delgado Hideyo Noguchi”, se determinó que la ciudad de Ayacucho, en la sierra peruana, es la población con mayor porcentaje de personas con problemas mentales, probablemente provocado por la violencia terrorista que fueron víctimas entre los años 1980 y 2000.
Finalmente, el objetivo de esta investigación es proponer un centro especializado llamado “Instituto Regional de Salud Mental” en la ciudad de Ayacucho, que mediante espacios arquitectónicamente adecuados y a la vanguardia con la psiquiatría moderna, relacionan directamente el bienestar mental de los pobladores con las costumbres propias del lugar para así fomentar el desarrollo económico, social y cultural.In Peru, mental health is a highly neglected issue. There is a notable deficit of adequate infrastructure for the propitious and correct restoration of balance in the lives of people suffering from mental illnesses, since there are only three specialized institutions in Lima city, centralizing attention and leaving forgotten populations in which there is also a lot of demand. It seems that mental wellness is not considered as a main topic and mechanism of any type of society that seeks growth in all areas. According to the analysis of the causes, consequences and effects brought for the above mentioned, it is necessary to understand that each population has a different history, social situation and ways of life. Therefore, under the mental health demand statistics in Peru, given by the National Institute of Mental Health "Honorio Delgado Hideyo Noguchi", it was determined that Ayacucho city, in the peruvian highlands, has the population with the highest percentage of people with mental problems, probably caused by the terrorist violence that they suffered between 1980 and 2000. To conclude, the objective of this research is to propose a specialized center named "Regional Institute of Mental Health" in the city of Ayacucho, which through adequate architectural spaces and treatments of modern psychiatry, relate the mental wellness of citizens with the local customs in order to promote economic, social and cultural development in the region.
Tesis
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Petrea, Ionela. "Institutional discrimination in mental health services : a comparative analysis of schizophrenia and diabetes in Romania". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. http://researchonline.lshtm.ac.uk/4650329/.
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Background: This thesis aims to ascertain the extent and nature of institutional discrimination against people with mental illness in specialist health care settings in Romania. The hypothesis is that such discrimination exists. Building on the definition in EU directives, discrimination is defined, for the purposes of this thesis, as harm that is caused to individuals or groups on the basis of identifiable characteristics bearing negative connotations. Harm is defined as the receipt of care that is less good than, inequitable in comparison to that received by others with similar needs, (long-term physical and mental illness), on grounds of stigma against people with mental illness. To assess the presence of discrimination, two groups were identified suffering from disorders that, although at first sight quite different, actually have much in common. They are schizophrenia and type 1 diabetes. Methods: The research method was Rapid Assessment, involving initial assessment, study area profile, contextual assessment, and health intervention assessment. The presence of horizontal inequity was determined by means of a de jure and a de facto assessment of specialist health care for people with schizophrenia and type 1 diabetes, using a set of criteria for aspects of care that are equally applicable to the management of both conditions, namely: 1) accessibility of specialist services; 2) availability of evidence-based treatment and care; 3) delivery of care; 4) quality of facilities; 5) protection of human and civil rights. The presence of stigma was determined the by ascertaining whether those in a position of authority and influence, namely the health professionals interviewed during the fieldwork, displayed stigmatising of attitudes and beliefs, language or approaches to treatment. The research triangulated data collected using a range of methods that include systematic review and comparative analysis of laws, policy documents and other literature, interview strategies (focus groups, group interviews and semi-structured interviews) and observations of practice. Analysis of the data involved three methods: content analysis, narrative structure analysis, and critical appraisal. For the fieldwork, a total of 228 participants (service users and health professionals) were selected using multi-stage sampling, covering each condition in each specialist setting (mental health acute and chronic inpatient services and outpatient services as well as inpatient and a comparative analysis o f schizophrenia and diabetes in Romania outpatient services for type 1 diabetes) in two selected locations in Romania (Bucharest and Slatina). Data collection took place between the 19th of September 2007 and the 8th of January Findings: In assessing equity, weaknesses were found in management of both conditions, particularly poor access to medication for associated health problems and lack of follow-up after discharge, poor continuity of care. In many areas, treatment and care for people with schizophrenia was worse generally, though some aspects were equitable: access to care in community-based settings, geographical accessibility of services, access to services when needed (temporal access), access to different parts of the system, as needed (referral system), financial access to appropriate care, access to social care, availability of enough staff in all settings, involvement of service users in shaping the services, involvement of families and carers, protection of service users' privacy and safety, decent living environment and hygiene of health facilities. Patients with schizophrenia were significantly disadvantaged in: access to a comprehensive range of evidence-based specialized services and to qualified and competent multidisciplinary staff, the quality of health facilities, access to care for other health conditions and, availability of individual treatment plans developed for each patient, empowerment of service users to care for themselves and live as independent a life as possible, and respect of all human and civil rights on health facilities and a number of patient rights. In assessing stigma, I found that all types of mental health professionals, in all settings, stigmatised people with schizophrenia, manifest through their attitudes and beliefs, language and approaches to treatment. Conclusions: This research found that people with schizophrenia suffer direct institutional discrimination in Romania, manifest inequities in both the legislation that applies to them and the specialist care delivered when compared with people with type 1 diabetes, and that these inequities arise in a context of stigmatising attitudes to people with severe mental health problems by those in a position of authority and influence (health professionals).
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Fung, Kit-lin Stella, e 馮潔蓮. "A conceptual analysis of halfway house programs in mental health services". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1987. http://hub.hku.hk/bib/B42574080.
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Walter, Charles Thomas. "Historical Context, Institutional Change, Organizational Structure, and the Mental Illness Career". Diss., Virginia Tech, 2013. http://hdl.handle.net/10919/52867.
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This dissertation demonstrates how patients' mental illness treatment careers depend on the change and/or stability among differing levels of social structure. Theorists of the mental illness career tend to ignore the role that higher levels of social structural change have on individuals' mental illness career. Researchers using an organizational perspective tend to focus on the organizational environment but ignore the treatment process from the individual's point of view. Both perspectives neglect what the nation-state's broader socio-political and economic circumstances could imply for people seeking treatment for mental disorders. Organizational theory and theories of the mental illness career are independent theoretical streams that remain separate. This dissertation connects these independent theoretical streams by developing a unifying theoretical framework based on historical analysis. This historical analysis covers three phases of treatment beginning at the end of World War II to the present. This framework identifies mechanisms through which changes in larger levels of social structure can change the experience and career of mental patients. This new perspective challenges current conceptions of the mental illness career as static by accounting for the various levels of social structure that play a part in the mental illness treatment career. Taken together, the inclusion of differing levels of social structure and the subsequent reciprocal relationship between these levels of analysis produce a narrative that explains why and how stability and change within the mental health sector shape the mental illness treatment career.Ph. D.
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Dickstein, Gary G. "Student Discipline Intervention Strategies: A Case Study of Two Institutions' Processes Utilized to Resolve Misconduct of Students Who Concomitantly Experience a Mental Health Crisis". Ohio University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1312550567.
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Claux, Juan Alberto. "Social route : Peruvian psychiatrists and the politics of mental health reform". Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33227.
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This thesis is about the prospect of change in the Peruvian mental health services system as seen through the lens of public psychiatry. It is based on the depiction of the work of psychiatrists in two of Lima's mental hospitals -Hospital Valdizán and Instituto Noguchi- and the projects of mental health services reform that I found in both of these institutions and an advocacy group sponsored by the Pan American Health Organisation. Ethnographic fieldwork was conducted from April 2012 to July 2013. I portray the current paradigm of care that dominates the public psychiatric sphere by describing the practice of specialists in outpatient consultations and hospitalisation wards. What I call the empirical model of psychiatry is an objectivistic, pharmaceuticalized, and top-down practice that finds its most augmented version in the wards. It loses sight of such therapeutic mandates as cultivating rapport, giving voice, and providing social support, elements that can be encountered in alternative paradigms of care that hold a marginal position in today's mental health system, such as the community mental health model that was developed in the 1980s at Instituto Noguchi and has progressively faded into near oblivion. The multiple inadequacies of treatment reviewed in this thesis, which are fuelled by a historical relegation of mental health policy in the country, speak of a psychiatry that is far from effectively improving the lives of service users. This was the greatest blind spot revealed by the mental health reform agenda; the need to improve psychiatry as a therapeutic practice was largely absent from reform discourse. Another important issue encountered was the failure of initiatives focused on training primary healthcare professionals in detecting and treating mental health problems (task-sharing). I argue that sustainable task-sharing strategies, added to comprehensive and locally-sensitive models of mental health services, should be explored. Finally, there is a paradox to be solved in relation to mental health governance in Peru. Psychiatry has hegemony; it owns the national institute of mental health and presides over the national mental health direction at the Ministry of Health. However, as a profession it has remained alienated from public health matters, absorbed in the daily practice of public hospitals and private practices. Mental health governance, then, needs to be balanced with the contribution of other professions and this is where the social route of the mental health system gains significance: anthropology has great potential to help develop a richer understanding of people's mental health and craft effective services in socially unequal and multicultural societies.
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Abbott, Simon Nicholas. "Using the law in social work Approved Mental Health Professional practice". Thesis, University of Sussex, 2018. http://sro.sussex.ac.uk/id/eprint/77773/.
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The research study focuses on how social work Approved Mental Health Professionals (AMHPs) use the law in practice. AMHPs in England and Wales have statutory powers under the Mental Health Act 1983 (MHA) to detain people in hospital for assessment and/or treatment. The stakes in this area of law and social work are high: practitioners deal with important issues concerning individual liberty that have profound implications in relation to the power of the state to intervene in the lives of citizens, where notions of autonomy, protection, coercion and care sit in tension. The study explores the relationship between law and social work practice by interpreting meanings contained in case stories told by social work AMHPs about recent Mental Health Act assessments that they undertook. Eleven social work AMHPs, purposively selected from three different local authorities in England, participated in the study, which used qualitative in-depth interviews to collect data about using the law in circumstances where compulsory admission to hospital was a possibility. The use of case stories encouraged participants to provide a rich description of events as they unfolded over time. The data were analysed using Framework analysis (Ritchie and Spencer 1994). Computer Assisted Qualitative Data Analysis in the form of NVIVO was utilized to manage the data, and to support data analysis. Five themes are presented in the findings chapter: understanding the referral situation; understanding the individual; understanding the situation causing concern; community versus containment, and relationships and resources. The study contributes to knowledge by illuminating how the use of law in practice is an inherently socio-relational undertaking, involving embodied practice. Bourdieu's (1977) concept of habitus is used to make sense of participants' accounts of the action that unfolds when they use the law. A further contribution is made to knowledge on legal literacy in social work, where there is little empirical research focusing on how social workers use the law, and still less on how mental health social workers use the law to consider compulsory powers under mental health legislation. The organisational factors impacting on how participants relate to the law are outlined and discussed drawing on legal consciousness theory (Ewick and Sibley 1998; Sibley 2005), together with an account of how participants adapt to this, drawing on street level bureaucracy (Lipsky 1990). The thesis explores the distinction in practice between medical and social perspectives occupied by AMHPs when they use the law in circumstances where compulsory admission to psychiatric hospital is a possibility. The study findings suggest that AMHPs' perspectives are holistic and social and can be understood as occupying a socio-medical-juridical perspective. The most important factor in the decision to use compulsory powers in mental health law to detain a person involves the AMHP taking a wide perspective in terms of their understanding of the individual that is relational to the understanding of others, and understanding the person in their environment in relation to how they relate to others. The thesis outlines that the social and family situation of the person assessed, combined with views of others, and particularly the impact of risk on others, is the most influential factor in the decision to detain. This leads to the further argument that notwithstanding a holistic and social perspective, this does not necessarily lead to less coercive interventions. Medical and social perspectives thus often lead to the same conclusions in relation to decisions to use the law to detain.
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Fortune, Tracy. "Establishing an occupational milieu in aged mental health units : an occupational ethnography". Phd thesis, Faculty of Health Sciences, 2003. http://hdl.handle.net/2123/5458.
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Mcphie, Jamie. "The accidental death of Mr Happy : a post-qualitative rhizoanalysis of mental health and wellbeing". Thesis, University of Cumbria, 2016. http://insight.cumbria.ac.uk/id/eprint/3333/.
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There is a growing body of evidence indicating that anxiety, stress and mental ill-health are becoming more prevalent in modern Western societies. At the same time, climate change and mass extinction have now taken root in a period of the earth’s history that has been labelled, ‘the Anthropocene’ and/or ‘Capitalocene’. Some academics have related these various issues to a ‘crisis of perception’ and a general nature-culture perceptual misalignment. This thesis/play is a deconstruction and (re)construction of human-environment conceptions in relation to mental health and wellbeing. More precisely, it is an attempt to map ‘the spread mind’ in ‘environ(mental) health’ (Mcphie, 2014a). (Intra-)Act 1 is an exploration of the performativity of particular Euclidean concepts as well as post-Enlightenment environmental and psychotherapeutic paradigms, with a particular emphasis on those that purport an innate connection with nature. The act also (re)views models that measure mental health as an objectified or subjectified essence within an anthropocentrically idealised self. By taking this approach, I highlight the distinct move in Western culture from an ontology of immanence to one of transcendence. (Intra-)Act 2 invites you to think with a post-qualitative collaborative action (re)search, using psychogeography and rhizoanalysis to map the temporal assemblages of six people-environments (a multiplicity), each with a specific diagnosed mental health concern, in order to explore how mental health and wellbeing is a distributed process. (Intra-)Act 3 and the assemblages present the rhizoanalyses in the form of (re)presentational experimentation including, Brechtian playwriting and assemblages of mental health. By thinking with a troika of emerging contemporary process-relational ontologies, I propose an alternative post-psychotherapeutic pathway for how we might conceive of mental health and wellbeing. This attempt emphasises the intra-relational co-production of material agency and is (re)presented in this study as a process distributed of the environment. This is not a conclusion.
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Drew, Helen Margaret. "Understanding the mental health and well-being of early adolescents in foster care". Thesis, University of Sussex, 2018. http://sro.sussex.ac.uk/id/eprint/74247/.
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Children in foster care are at high risk of experiencing mental health problems and tackling this issue is a key priority. Previous research suggests that the transition from primary to secondary school can be particularly challenging, as well-being declines and mental health problems increase in early adolescence. However, there is insufficient understanding of variations in the well-being and mental health of this group of children, and particularly the role played by their social interactions, relationships, and psychological attributes. This thesis includes three papers reporting on a programme of empirical research conducted to address this gap in knowledge and better understand the risk and protective factors, particularly in the peer context, for changes in mental health and well-being. The first paper focuses on current provision and reports the findings from a national survey of Virtual Schools that support the education of children in care. The second paper presents the findings of a longitudinal study with children not in care (aged 10-13 years), to test our conceptual model in the general population. This demonstrated that peer factors predict changes in mental health problems and well-being over and above parental and other adult support. The third paper presents findings from a longitudinal study of children in foster care (aged 10-14 years), to test these key pathways in our focus population. This revealed a pattern of differentiated links from peer and adult support to mental health and well-being, and identified self-efficacy as a key longitudinal predictor of change, especially when moderated by peer relationship quality. The thesis demonstrates the importance of supportive relationships with both adults and peers for the mental health and well-being of children in care. This has important implications for future work where social activities and relationship quality with peers should be considered as potential protective factors, especially in school settings.
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Soares, Julia Maciel. "Possibilidades e limites do tratamento psicanalítico da psicose infantil em instituições de saúde mental". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/47/47131/tde-17012008-134615/.
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Pretende-se problematizar os alcances e os limites do tratamento psicanalítico da psicose infantil dentro de uma instituição \"não atravessada\" pela psicanálise, particularmente, a APAE São Luís - Associação de Pais e Amigos dos Excepcionais. Parte-se da compreensão psicanalítica a respeito da psicose, situam-se características das instituições e enfoca as (im)possibilidades de interlocução entre psicanálise e instituição. Discutem-se as modalidades de inserção da psicanálise em três instituições de tratamento da psicose. Percorre a produção dos quatro discursos estabelecida por Lacan com vistas a instrumentalizar e fazer avançar a discussão da articulação entre psicanálise e instituição. A partir de uma vinheta clínica de um caso de psicose infantil atendido na APAE, localizam-se os alcances e os limites do tratamento psicanalítico. Conclui-se que algumas manobras podem ser operadas pela terapeuta. Manobras que operam tanto no sentido de barrar o Outro da psicose, quanto no agenciamento de um outro discurso, a partir da báscula instaurada pelo discurso do analista, ainda que não sejam engendrados giros no discurso institucional. No entanto, apontam-se limites do tratamento do Outro (como tratamento da psicose) quando a montagem institucional não sustenta tais tipos de intervenção.This work discusses both the possibilities and limits of the psychoanalytic treatment of childhood psychosis at a mental health institution in which psychoanalysis is not currently used, particularly, the APAE of São Luís. First, it discusses psychoanalysis\'s theory of psychosis, taking into consideration institution\'s features and emphasizing the possibilities for interaction between the field of psychoanalysis and the institutions of treatment. It discusses the types of introduction of psychoanalysis into three example institutions of psychoanalytical treatments. Next, it reviews the \"four discourses\" proposed by Lacan in order to develop and enhance the discussion between psychoanalysis and the institutions. Through the study of a clinical case of child\'s psychosis treated at APAE, it was possible to show the capabilities and limitations of psychoanalytical treatment. It finds that some maneuvers are possible, in one hand, in order to block The Other, and, in the other hand, to change the previous discourse through the analyst\'s discourse, even though those modifications don\'t change the institution\'s discourse. Finally, it points out limits to the treatment of The Other (i.e. psychosis\' treatment) when the APAE\'s current structures don\'t support these maneuvers.
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Rolph, Sheena Elizabeth. "The history of community care for people with learning difficulties in Norfolk, 1930-1980". [n.p.], 1999. http://library7.open.ac.uk/abstracts/page.php?thesisid=83.
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Cole, LaQuitta D. "California welfare and institutions code § 369.5 authorization of psychotropic medication to California's dependent children A policy analysis". Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527687.
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The purpose of this policy analysis is to critically review the Welfare and Institutions Code§ 369.5, which regulates the authorization of psychotropic medication to treat mental disorders among California's dependent children. While these medications have been proven effective forms of treatment, there is a growing concern about their life threatening side effects.
Research has concluded that children exposed to chronic child abuse and neglect often present with behaviors indicative of trauma. The Diagnostic and Statistical Manual of Mental Disorders 5th Edition has included criteria for Post-Traumatic Stress Disorder (P.T.S.D.) in children. However, the Welfare and Institutions Code§ 369.5 does not mandate psychiatrists and pediatricians to first rule out trauma prior to diagnosing foster children with one or more behavior, mood, or psychotic disorders.
Results support amending child welfare legislation and policies to reflect a shift toward trauma-focused services, thereby reducing the reliance on potentially dangerous pharmaceutical drugs.
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Secor, Andrew Phillip. "Predicting Spiritual and Religious Competence Based on Supervisor Practices and Institutional Attendance". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7744.
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Counseling students report a lack of competence in spiritual and religious integration (SRI). As such, counselor educators and supervisors (CES) and students want to understand how to develop SRI competence. Although past research highlighted SRI dialogue in training, the problem is that no clear understanding exists about the role of faculty supervisor SRI on perceived student competence. The supervision models used to inform the study included the integrated developmental model, discrimination model, and spirituality in supervision model (SACRED). The purpose of this study was to determine if master’s-level graduate counseling students’ perception of their faculty supervisors’ SRI practices predicted students perceived spiritual competence when considering attendance in faith-based and non-faith-based institutions accredited by the Council for Accreditation of Counseling and Related Education Programs (CACREP). A review of existing literature supported the use of a quantitative, cross-sectional design. An online survey was distributed to students (n=59) in master’s level CACREP counseling programs currently in field experience to measure perceived SRI in supervision and perceived SRI competence. A multiple linear regression revealed there was a statistically significant predictive relationship between supervisor SRI and perceived student competence as measured by the Spiritual and Religious Competence Assessment and the Spiritual Issues in Supervision Scale. These results inform CES about the importance of SRI and students’ ability to work with clients’ spiritual and religious beliefs. On this basis, it is recommended that supervisors focus on SRI in supervision. Future research should focus on additional factors related to SRI competence during counselor training.
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Bierman, Alex Elliot. "Institutional involvement and the mental health effects of perceived neighborhood disorder in old age the role of personal and divine control /". College Park, Md. : University of Maryland, 2007. http://hdl.handle.net/1903/6778.
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Thesis (Ph. D.) -- University of Maryland, College Park, 2007.Thesis research directed by: Sociology. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Dorigan, Juliana Hespanhol 1984. "Fóruns colegiados : espaços transversalizados na construção da atenção em saúde mental de Campinas". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312115.
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Orientador: Solange L'AbbateDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O município de Campinas constitui-se como referência nas políticas públicas de saúde mental por instaurar arranjos inovadores. Destaca-se a participação de profissionais como psiquiatras, psicólogos e terapeutas ocupacionais compondo equipes de Unidades Básicas de Saúde, seguindo a lógica de apoiadores matriciais em saúde mental. Este modo de organizar o processo de trabalho tem permitido a aproximação dos trabalhadores de saúde com as necessidades em saúde mental dos usuários que se apresentam na Atenção Primária à Saúde (APS), e, avançando no sentido de ampliar a compreensão do cuidado em saúde em geral. É conhecida a existência de fóruns de saúde mental em cada um dos distritos de saúde de Campinas, criados para construir e acompanhar os projetos de assistência em saúde mental que agrega profissionais da área - Centros de Saúde (CS), Centros de Apoio Psicossocial (CAPS) e serviços de referência. Considerando os princípios da Política Pública para a área de saúde mental, esta investigação pretende analisar o papel desses fóruns na formulação do modelo de atenção e implementação das práticas de cuidado ao usuário. Neste estudo foi realizada, no âmbito teórico da Análise Institucional, a denominada 'análise de papel', ou seja, o material empírico da análise constituiu-se de documentos, observações e entrevistas com apoiadores institucionais da saúde mental dos distritos de saúde de Campinas. Pretendeu-se com esta investigação construir informações sistematizadas sobre a forma como certos processos discutidos nestes fóruns repercutem na prática cotidiana dos profissionais, no atendimento ao usuário e na constituição de redes de cuidado
Abstract: Campinas is reference in public policy on mental health by introducing innovative arrangements. Emphasizes the participation of professionals such as psychiatrists, psychologists and occupational therapists composing teams of Basic Health Units, following the logic of supporter's matrix in mental health. This way of organizing the work process leads to the approximation of health workers with mental health needs of the users of the Primary Health Care and moving towards a broader understanding of health care in general. It is known that there are mental health's forums in each health district of Campinas created to construct and follow mental health's projects that is composed by professionals of Health Centers, Centers for Psychosocial Support and reference services. Considering the principles of Public Policy for the area of mental health, this research aims to examine the role of these forums in the formulation of the model care and the implementation of healthcare practices to the user. This study was performed in theorical field of Institutional Analysis, by the named 'role analysis', where the empirical analysis consists of documents, observations and interviews with mental health's institutional supporters of health districts of Campinas. This research was intended to build systematic information on how certain processes discussed in these forums reverberates in professional's daily practices, in customer service and networking care
Mestrado
Ciências Sociais em Saúde
Mestra em Saúde Coletiva
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Van, Wijk Evalina. "An investigation into patients perceptions of contributing factors towards their aggressive and violent behaviour after admission to a mental health facility". Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3530_1189064270.
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Aggressive and violent behaviour in inpatient mental health facilities is found worldwide and is a frequent and serious clinical and nursing care problem. Despite the importance of international research findings and recommendations, it appears that patients perceptions of the possible contributing factors toward aggressive and violent behaviour in mental health facilities is an area of enquiry that has not been widely explored in South Africa in general, or in the Western Cape, in particular. It is against this background that this study endeavoured to investigate the external and situational contributing to patients aggressive and violent behaviour in mental health facilities in Cape Town, as seen from patients perspectives.
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Lima, Pedro Uriel Gonçalves. "AVALIAÇÃO DO SERVIÇO DE RESIDÊNCIA TERAPÊUTICA SOB A PERCEPÇÃO DE PROFISSIONAIS E USUÁRIOS". Pontifícia Universidade Católica de Goiás, 2016. http://localhost:8080/tede/handle/tede/3031.
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Previous issue date: 2016-03-11With the advent of the Psychiatric Reform and the enactment of Law 10.216 - 12 establishing a new vision for the treatment of people with mental illness, the implementation of Psychosocial and Therapeutic Residences Care Centers have been imposed as support for the new model of care for these patients. Through Satisfaction Assessment Scales Brazilian was aimed in this study to evaluate the degree of satisfaction of residents and staff of these homes, to reflect whether such dwellings or not brought benefits proposed by the Law. It was found that only 1.9% of the professionals they said very dissatisfied with the service, the majority, 62.7%, are satisfied with the work they do. With regard to residents, some data draw attention, such as 44.4% feel respected by professionals, 66.7% feel that professionals understand well your problems. After analyzing the verbal material collected in interviews of professionals and residents, it was possible to understand the dissatisfaction of professionals as to salary issues and incentives for training, and realize how much the occupant is received by the service.
Com o advento da Reforma Psiquiátrica e a promulgação da Lei 10.216-12 que instituiu uma nova concepção para o tratamento de pessoas com doenças mentais, a implantação dos Centros de Atenção Psicossocial e Residências Terapêuticas se impuseram como respaldo para o novo modelo de atendimento a estes pacientes. Por meio de Escalas Brasileiras de Avaliação da Satisfação objetivou-se neste estudo avaliar o grau de satisfação de moradores e funcionários dessas residências, para refletir se tais moradias trouxeram ou não benefícios propostos pela Lei. Foi constatado que apenas 1,9% dos profissionais se disseram muito insatisfeitos com o serviço, a maioria, 62,7%, estão satisfeitos com o trabalho que realizam. Com relação aos residentes, alguns dados chamam a atenção, tais como 44,4% se sentem respeitados pelos profissionais, 66,7% sentem que os profissionais compreendem muito bem seus problemas. Após analisar o material verbal coletado nas entrevistas dos profissionais e dos moradores, foi possível compreender as insatisfações dos profissionais quanto a questões salariais e incentivos à qualificação, além de perceber o quanto o morador é acolhido pelo serviço.
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Dragon, Paul Arthur. "Walk A Mile In My Shoes: The Social Construction Of Mental Illness Among State Administrators And Consumer-Advocates". ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/545.
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From 19th century insane asylums to state sponsored eugenic programs in the 20th century, the state has been an incongruous leader and provider of mental health policy and practice. Current practices that include such treatments as confinement, restraints, forced medication and electro-convulsive therapy continue to raise issues of social justice and humane treatment.
Since the 1970s a diverse group of consumers of mental health services from political and radical emancipatory movements to consumer and family initiatives have emerged to question, inform and influence federal and state policies and services. Today state administrators and consumer-advocates meet in formal settings in which they exchange ideas as they work to affect and develop mental health policy and practice. However, such exchanges have raised new questions regarding the relationship between these two groups and their ability, in light of past practices to effectively work together to develop mental health policy and practice.
The purpose of this study is to compare how state administrators and consumer-advocates perceive mental illness and how these perceptions impact policy and practice. Through a qualitative research study, the researcher compared and contrasted the perceptions of five consumer-advocates and five state administrators who are involved in major mental health policy in a rural state in order to consider how their perceptions of mental health affect policy and treatment.
This study shows an emerging relationship between state administrators and consumer-advocates but a relationship that lacks communication and trust as their discourse attempts to span the gap between their two symbolic universes. The focus of consumer-advocates on the importance of their role in battling pervasive stigma and the need for people with lived experience to be central in the mental health system can be seen as an effort to overcome a historical pattern of coercion and abuse of mental health patients by the state. The focus of state administrators to remain relevant in a mental health system in which consumer-advocates challenge the status quo can be seen as their effort to retain legitimacy as well as their historic control over the mental health system.
State administrators and consumer-advocates know that they exist in a new, shared world of mental health care and both groups agreed that the relationship between them needs to improve.
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Brunner, Maria Alice Cortez. "Prevalência da depressão pós-parto entre mulheres assistidas no ambulatório de pós-natal do Instituto Fernandes Figueira-Fiocruz". Instituto Fernandes Figueira, 2011. https://www.arca.fiocruz.br/handle/icict/8140.
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Previous issue date: 2011Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil
A depressão pós-parto (DPP) é uma das principais complicações do puerpério e representa um importante problema de Saúde Pública. Estimativas gerais sobre a magnitude da DPP sugerem uma prevalência entre 10 e 15%. Porém, essa parece ser a realidade de países desenvolvidos, e, em condições menos favoráveis, esses números podem ser significativamente maiores. No que tange às suas consequências, a DPP traz prejuízo não só para a mãe, mas também para o desenvolvimento cognitivo e emocional dos seus filhos, assim como para a relação com seu marido e familiares. O objetivo desse estudo foi estimar a prevalência da DPP nas mulheres cujo parto ocorreu no Instituto Fernandes Figueira – FIOCRUZ. Entre fevereiro e julho de 2011, 456 puérperas foram entrevistadas por volta de 6 a 8 semanas pós-parto durante sua consulta no Ambulatório de Pós-Natal. Dentre essas, 65% (n=336-IC95% 71,4-79,4) compareceram à primeira data marcada para sua consulta, 18% (n=94-IC95% 12,6-19,3) foram entrevistadas após busca ativa e novo agendamento de consulta, e 5% (n=26-IC95% 3,3-7,5) foram entrevistadas por telefone. A DPP foi investigada através da Edinburgh Postnatal Depression Scale (EPDS), sendo consideradas deprimidas aquelas que apresentaram escores maiores que onze. As informações sobre o histórico obstétrico e desfechos perinatais como anomalias congênitas, parto prematuro, crescimento intrauterino restrito e mortalidade perinatal foram pesquisadas no prontuário materno, enquanto as características socioeconômicas e demográficas foram avaliadas através de perguntas pré-codificadas. Ainda, instrumentos específicos foram utilizados para investigar antecedentes de abuso sexual, violência entre parceiros íntimos e abuso de álcool e drogas pelo casal. A prevalência geral da DPP nessa pesquisa foi de 24,8%. Contudo, a prevalência da DPP foi significativamente mais alta em alguns subgrupos, especialmente puérperas que compareceram ao Ambulatório de Pós-Natal após busca ativa e remarcação da sua consulta, aquelas com nenhum filho vivo ou com três ou mais filhos, mulheres com filhos apresentando anomalias congênitas na gestação índice, fumantes, na presença de consumo excessivo de álcool pelo casal, puérperas com antecedente de abuso sexual e aquelas vítimas de violência psicológica ou física pelos parceiros íntimos durante a gestação. A elevada prevalência da DPP no Ambulatório de Pós-natal do IFF detectada neste estudo mostra a importância do seu rastreio rotineiro na consulta pós-parto, principalmente nos subgrupos onde foi encontrado maior risco.Esse estudo destaca a importância da busca ativa das puérperas que faltam à consulta pós-natal, pois essas estão mais propensas a apresentarem o agravo. Uma rotina assistencial integrada e multidisciplinar à saúde materno-infantil ao longo do ciclo grávido –puerperal, favorecendo ações de prevenção, diagnóstico precoce e tratamento adequado. deve contemplar a saúde mental da mulher.
Postpartum depression (PPD) is one of the most common complications of childbearing and represents a considerable Public Health problem. It is estimated that the prevalence of postpartum depression varies between 10 and 15%. This prevalence seems to be the reality in developed countries, but, in unfavorable conditions, numbers can be significantly higher. The PPD not only brings prejudice to the mother, but can also cause impairment to the cognitive and emotional development of her children and to the relationship with her husband and family. The aim of this cross-sectional survey was to estimate the prevalence of postpartum depression (PPD) among women whose labour was assisted in the Fernandes Figueira Institute – FIOCRUZ. Between february and july 2011, 456 women in the postpartum period were interviewed. The interviews were carried out six to eight weeks after childbearing, during the postnatal appointment. Among them, 65% (n=336/CI95% 71,4-79,4) came to the first appointment in the outpatient department, 18% (n=94/CI95% 12,6-19,3) came only after being contacted by telephone to schedule a new appointment and 5% (n=26/CI95% 3,3-7,5) where interviewed by telephone. The PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), and women who scored above the cut-off of eleven were considered depressed. Information about some obstetrics characteristics, such as congenital abnormalities, premature labour, restricted intra-uterine growth and perinatal mortality, were searched from the maternal records, while the social-economic and demographic characteristics were evaluated through pre-codified questions. Moreover, specific instruments were used to search for history of child abuse, intimate partner violence and misuse of alcohol and drugs by the couple. The overall prevalence of DPP estimated in this research was 24,8% Prevalence was significantly higher in certain sub-groups, specially women who came to the postnatal appointment only after being searched by telephone, the ones with no child alive or with more than three children, mothers of children with congenital abnormalities in the last pregnancy, tobacco users, women with alcohol misuse by the couple history of sexual abuse and victims of psychological interpersonal violence or physical interpersonal violence (PIVP). The high prevalence of PPD in the postnatal outpatient department detected in this research outlines the importance of routine screening during the postnatal appointment, specially among the sub-groups in which a greater risk has been observed.. This research highlights the importance of continuous searching for the women who misses their appointment at the Postnatal Ambulatory, because they are prone to developing PPD. During pregnancy and postnatal period, an integrated multi-disciplinar routine assistance promoting prevention, diagnosis and adequate treatment shall attend women’s mental health.
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Jesus, Aidecivaldo Fernandes de 1962. "O processo de institucionalização de um serviço de saúde mental em um município de pequeno porte = o caso de Paraisópolis/MG". [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312117.
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Orientador: Solange L'AbbateTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O presente trabalho se propôs a investigar a Saúde Mental sob os vários ângulos possíveis no espaço de uma tese. Considerando a inserção técnica e política do autor na área, o trabalho pretendeu abordar a questão nos diferentes níveis vivenciados por ele e pela equipe de profissionais, na qual estava inserido. A fundamentação teórica básica deu-se com a utilização das ideias de Erwing Goffman, ao procurar entender o universo das equipes, especialmente através da obra "A Representação do Eu na Vida Cotidiana", além dos conceitos operacionais e o instrumental teórico-metodológico da Análise Institucional sistematizada por René Lourau. Com relação às políticas públicas foram analisadas algumas diretrizes propostas pelo Ministério da Saúde, pelas Secretarias Estaduais e, principalmente, pela esfera municipal. Tal estratégia não se deu a partir das portarias e/ou leis implantadas, mas sim da forma como estas são colocadas no cotidiano dos profissionais ou sua implantação nos serviços. Ao analisar os relatórios finais das Conferências Nacionais de Saúde Mental focalizado no tema "município de pequeno porte" pode-se assimilar, nos discursos dos atores presentes, o ponto de vista da Sociedade Civil em relação ao tratamento a ser dado aos portadores de transtornos mentais. A pesquisa teve origem numa encomenda feita ao pesquisador pelo gestor de saúde do município de Paraisópolis/MG. Este município, com cerca de 20 mil habitantes, assemelha-se a 79% dos municípios mineiros, que, para implantar um Centro de Atenção Psicossocial à Saúde no seu território, deveria estabelecer uma pactuação com outros municípios, o que não era pretendido pela prefeitura municipal. O caráter da encomenda feita ao autor foi a de assumir a coordenação do matriciamento entre os setores de Saúde Mental e Estratégia Saúde da Família, locais, além da assessoria à gestão de saúde para construção da rede de cuidados aos portadores de transtornos mentais e seus familiares. O objetivo principal do trabalho foi compreender as singularidades dessa proposta nesse município, tendo em vista à consolidação da atenção primária como estratégia de ação do serviço. Dado a relevância desse processo, optou-se por atribuir a essa forma de atuação um formato de pesquisa-intervenção, visando à elaboração de um doutorado em Saúde Coletiva. Para tanto, utilizou-se da Análise Institucional, a partir dos conceitos de instituição, implicação, analisador, transversalidade e restituição. A utilização de dois tipos de diários - o de pesquisa individual e o institucional coletivo - permitiu o resgate do processo de institucionalização da equipe de Saúde Mental, propiciando a apreciação de suas práticas cotidianas, tanto em relação á aspectos intersubjetivos, como à forma de prestar assistência aos usuários. Nesse processo, as implicações da equipe bem como as do autor da tese foram colocadas em análise. Ressalte-se que a leitura crítica dos documentos oficiais disponíveis a respeito da política de Saúde Mental vigente, permitiu o confronto das diretrizes das propostas formais com as práticas vivenciadas pelos profissionais, contribuindo para a compreensão do movimento dialético instituído/instituinte/institucionalização presente, de forma geral, nos serviços de saúde
Abstract: This study aimed to investigate the Mental Health under the various possible angles within a thesis. Considering the technical and political integration of the author in the area, the work aims to address the issue at different levels experienced by him and the team of professionals, which was inserted. The theoretical base was with the use of the ideas of Goffman Erwing, seeking to understand the universe of teams, especially through the work "The Presentation of Self in Everyday Life," in addition to the operational concepts and methodological and theoretical tools of Institutional Analysis systematized by René Lourau. With regard to public policies were analyzed some guidelines proposed by the Ministry of Health, the State Departments, and especially at the municipal level. This strategy did not come from the ordinances and / or laws in place, but the way they are put in everyday or professional services in its implementation. By analyzing the final reports of the National Conference on Mental Health focused on the theme "small city" can assimilate, in the speeches of the actors present, the view of civil society in relation to the treatment to be given to people with mental disorders . The research stemmed from an order made by the researcher to health administrator of the municipality of Paraisópolis / MG. This municipality, with about 20,000 inhabitants, is like 79% of the mining municipalities, which, to deploy a Psychosocial Care Center on Health in its territory, should establish a pact with other municipalities, which was not desired by the city. The character of the order was made to the author to assume the matricial coordination between sectors and Mental Health Family Health Strategy, local, beyond advising the management of health to build the network of care for mental disorders and their families . The main objective of this study was to understand the uniqueness of this proposal in that district, with a view to the consolidation of primary care as an action strategy of the service. Given the relevance of this process, we chose to assign to this form of action a form of intervention research, aiming at the elaboration of a doctorate in Public Health. For this purpose, we used the Institutional Analysis, based on the concepts of institution, implication, analyzer, transversality and restitution. The use of two types of journals - individual and institutional research collective - has allowed the rescue of the institutionalization process of the Mental Health team, providing an appreciation of their daily practices, both in relationship to intersubjective aspects such as how to assist users. In this process, the implications of the team as well as the author of the thesis were placed under review. It should be noted that the critical reading of official documents available regarding the mental health policy in effect, allowed the comparison of the guidelines formal proposals with practices experienced by professionals, contributing to the understanding of the dialectical movement up / instituting / this institutionalization of overall, the health services
Doutorado
Saude Coletiva
Doutor em Saude Coletiva
41
Severo, Ana Kalliny de Sousa 1983. "A institucionalização da supervisão na reforma psiquiátrica brasileira : (re)produção de controles e desvios junto às equipes de saúde mental". [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313097.
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Orientador: Solange L'AbbateTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A supervisão tem se assegurado como um dos principais dispositivos de fortalecimento dos processos de mudanças almejados no modelo de Atenção Psicossocial. Esse dispositivo tem sido utilizado para qualificação dos serviços substitutivos e da rede de Atenção Psicossocial na Reforma Psiquiátrica brasileira, apesar de receber muitas críticas no sentido de apontar seu caráter reprodutor das relações de saber-poder hierarquizadas. Este trabalho buscou analisar a institucionalização da supervisão clínico-institucional no processo da Reforma Psiquiátrica brasileira, tendo como foco a experiência de supervisão no estado do Rio Grande do Norte. Para tanto, o referencial teórico-metodológico escolhido foi o da Análise Institucional, tanto na perspectiva da análise no papel como da socioanálise. A análise no papel foi utilizada para a investigação dos documentos e entrevistas em uma perspectiva sócio-histórica e a socioanálise em sua vertente socioclínica. Para a realização deste estudo, adotei quatro estratégias de pesquisa principais: análise de artigos que apresentavam a inserção da supervisão nas experiências reformistas dos anos 1980 e 1990; análise dos relatórios finais das Conferências Nacionais de Saúde Mental e dos editais de supervisão lançados pelo Ministério da Saúde; e intervenção desenvolvida durante um ano de supervisão clínico-institucional na rede de Atenção Psicossocial em um município do interior do Nordeste. O processo de intervenção desenvolvido fez parte de um desses projetos financiados, com edital lançado, e desenvolveu-se em doze encontros mensais com trabalhadores da rede de saúde e dos dispositivos intersetoriais. Na análise das experiências, percebemos que a supervisão nos princípios da Atenção Psicossocial sofreu mudanças tensionadas principalmente pelas transformações na constituição das equipes, da gestão, da rede e no cuidado comunitário. Na análise no papel dos relatórios da terceira e da quarta Conferência Nacional de Saúde Mental e dos editais do Ministério da Saúde existiram encomendas muito amplas relacionadas à supervisão, tais como a política de recursos humanos, de funcionamento de rede, de qualificação e de construção de Projetos Terapêuticos Singulares, que foram respondidas de maneira ainda insuficiente pelas políticas governamentais. Na intervenção realizada, as principais dificuldades encontradas foram a rotatividade dos profissionais do serviço, múltiplos vínculos de trabalho entre os servidores, mudanças na gestão do serviço e a relação pouco dialogada com a gestão municipal. Como movimento instituinte, assinalamos uma maior reflexão crítica acerca do percurso do profissional de saúde mental para adequação ao contexto da Atenção Psicossocial, ampliação do diálogo e ações interprofissionais, e fortalecimento da parceria entre o gestor municipal e a equipe do Centro de Atenção Psicossocial. Retomar a historicidade de um dispositivo permitiu compreender suas diferentes funções e os efeitos de retorno do instituído e de desconhecimento gerados pela paralisação e burocratização da Reforma Psiquiátrica, e a necessidade de retomar e fortalecer seu processo instituinte
Abstract: Supervision has assured itself as one of the main dispositive of improving the processes of changes desired in the psychosocial care model. This dispositive has been used for qualification of replacement services and from the psychosocial care system in the Brazilian psychiatric reform, despite receiving many criticisms towards pointing its reproductive character of hierarchical knowledge-power. This work aimed at analyzing the institutionalization of institutional clinical-supervision in the process of the Brazilian Psychiatric Reform in the state of Rio Grande do Norte. To this end, the theoretical and methodological support chosen was the institutional analysis, both from the perspective of analysis of the role and social analysis. The analysis of the role was used for investigation on documents and interviews in the sociohistorical perspective and in the social analysis in its social clinical perspective. In order to do this study, I applied four main strategies of research: analysis of articles that presented the insertion of the supervision in the reforming experiences in 1980s an 1990s; analysis of the final reports of the National Conferences on Mental Health and the supervision announcements released by the Ministry of Health; and intervention developed during a year of clinical-institutional supervision in network of psychosocial care in a country city of Brazilian northeast. The intervention process developed was part of one of theses funded projects with announcements released, and developed in twelve monthly meetings with Health system and intersectoral dispositives workers. In the analysis of experiments, we noticed that supervision on the principles of Psychosocial Care suffered changes influenced primarily by the transformation of teams, management, system and community care constitution. In analyzing the role of the reports of the third and fourth National Conferences of Mental Health and the announcements of the Ministry of Health there were many orders widely related to supervision, such as the human resources policy, the operation of the network, construction of qualification and Unique Therapeutic Project that were still inadequately answered by the government policies. In interventions, the main difficulties were the turnovers of service professionals, multiple bonds of work between servers, changes in the management of the service and and the little dialogic relationship with the municipal administration. As establishing movement, we noticed a deeper critical reflection on the course of the mental health professional to fit the context of psychosocial care, expansion of dialogue and joint actions, and strengthening the partnership between the city manager and staff of the Center for Psychosocial Care. Retaking the historicity of a dispositive allowed to understand their different roles and effects of return established and ignorance generated by paralysis and bureaucratization of the Psychiatric Reform, and the need to retake and strengthen their instituting proceedings
Doutorado
Ciências Sociais em Saúde
Doutora em Saúde Coletiva
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Otsuka, Ed. "O discurso da autonomia em saúde mental: construção, reprodução, institucionalização e criação". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/47/47134/tde-24072017-165615/.
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Neste trabalho busca-se explicitar como o discurso de promoção de autonomia se instaura e se reproduz entre os diversos atores do campo da saúde mental, especialmente os trabalhadores da saúde mental, que mais o proferem como forma de embasar sua atuação. Para tal tarefa, explora-se o modo como a noção de autonomia é sustentada institucionalmente e como ela atinge de forma incisiva os usuários de serviços de saúde mental, sobre os quais recaem as ações e as práticas institucionais. Ao longo do percurso da pesquisa, considera-se que a psicanálise, que pensa o homem como sujeito do grupo e do vínculo, consiste no mais adequado aporte teórico para discutir os processos que envolvem a temática, por implicar as dimensões da subjetividade, do social, do grupal e do institucional. Avalia-se ser fundamental compreender como a autonomia do sujeito é condicionada desde sua constituição, que ocorre na relação com o outro e o mundo, definindo sua realidade intrapsíquica e intersubjetiva. A partir da obra de Kaës e do conceito de alianças inconscientes, discute-se como o sujeito se constitui, sendo a relação entre mundo interno e externo indissociável. As alianças exercem a função de intermediário. Assim, para compreender como o sujeito se insere no mundo, verifica-se o imperativo dos contratos e pactos, mais especialmente o contrato narcísico e o pacto denegativo, por um processo de economia psíquica que visa garantir sua sobrevivência e a convivência possível para cada sujeito. É por meio dessas modalidades de alianças inconscientes, que o sujeito busca a autopreservação e a perpetuação do grupo, da instituição e da espécie. Com a referência da autora Piera Aulagnier, empreende-se uma imersão nos processos de constituição do sujeito, que se define como tal, condicionado ao vínculo com a mãe, representante primeira do mundo, que lhe apresenta suas possibilidades de representação sobre ele. Assim, as possibilidades de subjetivação, de construção de identidade e de agir do sujeito são limitadas e delimitadas pelo que a realidade, anterior a ele, lhe concede. O intuito do estudo aqui apresentado consiste na promoção de uma discussão que possa trazer possibilidades de análise e de ruptura dos discursos instituídos e alienadamente reproduzidos. Por meio da elaboração dos processos psíquicos envolvidos na trama institucional, é possível se pensar na superação de tal quadro por cada sujeito que se insere nessa realidade. Considerando que a busca pelo saber, pelo novo, é inerente a todo sujeito, discute-se o processo de criação que consiste na tensão entre o estabelecido e seu diferente, e que pode surgir, ao se estabelecer a dialética entre ambos, superando o estado dilemático que impõe uma paralisação nessa relação. Assim, a problemática da autonomia desloca-se para a de criaçãoIn the present work, we aim to explicit how the discourse of autonomy promotion is established and reproduced by several actors in the mental health field, especially the workers, who utter it most of the time as a way to support their actions. In order to do so, we have analysed how the notion of autonomy is sustained by institutions and how it sharply reaches the users of mental health services, upon whom institutional actions and practices fall. Throughout the research, we have considered that the type of psychoanalysis that interpret an individual as a part of a group consists in the most appropriate theoretical framework to discuss the processes that encompass the theme, as it considers the dimensions of subjectivity, society, groups and institutions. We think it is fundamental to understand how the autonomy of the subject has been shaped since his constitution, which occurs in the relationship with the other and the world, thus defining his intrapsychic and intersubjective reality. Based on René Kaës\'s work and the concept of unconscious alliances, we have discussed the way by which the subject is built, considering the relationship between external and internal worlds inseparable. The alliances play the role of intermediary. In order to understand how the subject enters the world, we stress the importance of the imperative of contracts and pacts, especially the narcissist contract and the denegativo pact, by means of a process of psychic economy that is aimed at guaranteeing each subject possible ways of survival and interactions. By means of these types of unconscious alliances, the subject seeks self-preservation and the perpetuation of the group, the institution and the species. Based on Piera Aulagnier, we have immersed ourselves in the processes of the constitution of the subject, which is determined by the relationship with the mother, the first representative of the world, who presents him his possibilities of representation of the world. So, his possibilities of subjectivation, identity building and action are limited and shaped by all the aspects that the reality, which comes before the subject, gives to him. The aim of this work consists in stimulating a discussion that may bring possibilities of analysis and ruptures as well of the discourses that are established and reproduced in an alienated way. By elaborating the psychic processes that are involved in the institutional framework, it is possible to identify the possibility that each subject who participates in this reality has to overcome this context. Considering that the search for knowledge and innovation is inherent in every subject, we have discussed the process of creation that consists in a tension between the established situation and different scenarios, which may arise when there is a dialectical tie between them, thus overcoming the dilematic state that imposes a stoppage on this relationship. In other words, the question of autonomy gives way to that of creation
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Highland, Samuel Vladimir. "Adoptive Identity: Emerging Adult International Adoptees’ Narrative Coherence Following Early Institutional Care". Antioch University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1607043824349026.
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Bastos, Helivalda Pedroza. "Saúde e educação: reflexões sobre o processo de medicalização". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/47/47134/tde-25022014-164505/.
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Esta pesquisa tem por objetivo estudar o processo de medicalização e patologização da educação através de entrevistas com psicólogos da rede pública de saúde e coordenadores pedagógicos de escolas públicas focalizando a intervenção desses profissionais nas dificuldades apresentadas no processo ensino-aprendizagem. Medicalização e Patologização entendidas como um processo ideológico que transforma problemas sociais em doenças de indivíduos. Trabalhamos com a região norte do município de São Paulo. Os psicólogos entrevistados atuam em Unidades Básicas de Saúde e os coordenadores pedagógicos em escolas públicas de ensino infantil, fundamental e médio. O método utilizado foi o qualitativo, sendo as entrevistas conduzidas de acordo com o preconizado por José Bleger. A análise desenvolvida utiliza o referencial teórico de Grupos Operativos, tal qual formulado por Enrique Pichon-Rivière. Os resultados apresentados desvelam as dificuldades enfrentadas pelos profissionais no cotidiano de trabalho, principalmente no que tange à estrutura e dinâmica institucional e à formação acadêmica. Como consequência identificam-se processos de medicalização e patologização da educação. Aponta-se para a necessidade de revisão das políticas públicas e melhor instrumentalização teórica e técnica dos profissionais. Indica existir um pacto denegativo entre as instituições que garante a preservação da ordem estabelecida, evitando a crise que toda mudança carrega e, com isso, impedindo a transformaçãoThis research aims to study the process of medicalization and pathologizing of education through interviews with psychologists in public health and coordinators of public schools focusing on the intervention of such professionals in the difficulties encountered in the teaching-learning process. Medicalization and pathologizing understood as an ideological process that transforms social problems in diseases of individuals. We work with the north region of the city of São Paulo. Psychologists interviewed worked in Basic Health Units and coordinators in public schools kindergarten, elementary and secondary. The method used was qualitative interviews were conducted in accordance with the recommendations by José Bleger. The analysis uses the theoretical Operational Group, as it formulated by Enrique Pichon-Rivière. The results presented reveal the difficulties faced by professionals in daily work, especially with regard to the structure and dynamics of institutional and academic. Consequently it identifies processes medicalization and pathologizing of education. Points to the need for revision of public policies and better exploitation of theoretical and technical professionals. Indicates there is a pact between denegativo institutions that guarantees the preservation of the established order, avoiding the crisis that all change loads and thereby preventing the transformation
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Elias, Marisa Aparecida. "Equilibristas na corda bamba: o trabalho e a saúde de docentes do ensino superior privado em Uberlândia/MG". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/59/59137/tde-12122014-104307/.
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Esta tese teve por objeto de estudo o trabalho de docentes de Instituições de Ensino Superior Privado. O objetivo foi investigar a relação entre as condições de trabalho e os problemas de saúde relatados, em especial os relacionados à saúde mental. Foram objetivos específicos: identificar os modos de enfrentamento, objetivos e subjetivos, utilizados por aqueles trabalhadores para lidar com o cotidiano no trabalho e descrever como a precarização da educação interfere no trabalho docente universitário. A pesquisa fundamentada no referencial teórico metodológico do materialismo histórico dialético fez uso de entrevistas gravadas como principal técnica de coleta de dados. Foram realizadas cinco entrevistas com docentes que atuam em Instituições de Ensino Superior Privado há pelo menos cinco anos. Os resultados mostraram que os docentes estão submetidos a condições precárias e intensificadas de trabalho. O tipo de contrato de trabalho e a instabilidade profissional submetem os profissionais a situações desestabilizadoras do psiquismo, tornando-os submissos a atividades desgastantes e vulneráveis à alienação em relação a estas mesmas condições. A preservação da idealização da atividade de educador é um facilitador da alienação que prende o profissional a esta representação do trabalho como missão e não atividade profissional. Esta contradição, além de submeter a condições fisicamente desgastantes, também submete a pressão psicológica potencialmente causadora de adoecimento. Dentre os mecanismos de enfrentamento utilizados por eles, destaca-se a negação do sofrimento e a banalização do adoecimento. Os professores estão submetidos a situações potencialmente estressoras na atividade laboral, que se refletem em afecções psicossomáticas generalizadas. Conclui-se que a forma como o trabalho se encontra organizado, a pressão exercida por meio da cobrança de metas, a sobrecarga de trabalho, os diferentes vínculos empregatícios que se sobrepõe e a tendência a mercantilização da educação do ensino descaracterizam a função do educador e proporciona desgaste, mal estar e adoecimento a estes profissionais.The present thesis examines the work performed by the teachers of the Private Institutions of Higher Education. The objective was to investigate the relationship between workplace conditions and reported health problems, in particular those related to mental health. Specifically: to identify both subjective and objective coping mechanisms for handling the day-to-day difficulties encountered by those workers, and also to describe how the increasing precariousness in the educational system interferes with the job of a university lecturer. The research has as its foundational principles the theoretical methodology of historical dialectical materialism, and the data is collected in the form of recorded interviews. Five interviews were conducted with instructors who have taught at Private Institutions of Higher Education for at least five years. The results demonstrate that the instructors are subjected to precarious and intense work conditions. The type of employment contract and professional instability subject those professionals to destabilizing psychic situations, resulting in a tacit submission to fatiguing activities and rendering them vulnerable to alienation as a result of these conditions. The continued idealization of the activity of an educator also facilitates this alienation, as it enforces a view of the work as a calling and not as a profession. This contradiction, in addition to subjecting workers to physically exhausting conditions, also applies psychological pressure which can cause mental illness. Among the coping mechanisms used by these instructors, particularly salient are the denial of suffering and the banalization of illness. They are subjected to potentially stressful situations of during work, which are reflected in generalized psychosomatic conditions. It is concluded that that manner in which work is organized, the pressure exerted through meeting targets, overwork, the existence of different locations of work, all in an environment of the commercialization of education, serve to demean the function of an educator and creates exhaustion, malaise and illness in these professionals.
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Borges, Fernanda de Barros Machado. "O clube dos saberes no hospital: análise institucional de uma intervenção". Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/47/47134/tde-16122009-153458/.
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O objetivo desta pesquisa é analisar, a partir do referencial da Análise Institucional, a experiência do Clube dos Saberes (CS), um dispositivo que fez parte de uma intervenção institucional, num hospital psiquiátrico privado da cidade de São Paulo, entre os anos 2001 e 2005. O Hospital é uma instituição biforme, com uma organização hierárquica-piramidal e características manicomiais. O CS é uma rede de relacionamentos formada pela troca de saberes e de experiências entre as pessoas de um coletivo, que se organiza democraticamente e visa tanto o crescimento pessoal e individual quanto do próprio coletivo. Ele é proposto ao Hospital como possibilidade de superação da crise enfrentada através da inoculação de uma nova cultura de tratamento, de novas formas relacionamento, de novos modos de funcionamento e organização. A pesquisa envolveu, num primeiro momento, a reconstituição da história dessa experiência a partir da memória da pesquisadora-participante e de registros escritos e, num segundo momento, a seleção de trechos dessa história que possuíam a qualidade de analisador. A análise mostrou que apesar do CS representar uma esperança de mudança e de superação da crise do hospital, ele sofreu resistências por parte da equipe e enfrentou diversos obstáculos: participação pouco expressiva dos trabalhadores do hospital no desenvolvimento do CS; apreensão distorcida ou limitada do projeto; baixa efetividade das parcerias firmadas; persistência e recrudescimento das características manicomiais do hospital; predomínio da organização sobre a clínica e maior atenção à saúde financeira do hospital do que à saúde de seus agentes (pacientes e trabalhadores). Por fim, consideramos que o desenvolvimento do CS foi significativamente prejudicado pela falta de espaços de análise da instituição e de sua alienação.The object of this research is to analyze, using institutional analysis as a reference, the experience of the Clube dos Saberes, ( Club of knowledge ) or CS, the instrument of an institutional intervention in a private psychiatric hospital in the city of São Paulo between the years of 2001 and 2005. The hospital is a two pronged institution, which has a hierarchicalpyramidal organization with characteristics of an asylum. The CS is a network of relationships formed by the exchange of knowledge and experiences between a collective, that organizes democratically and aims for a personal and individual growth as well as the growth of the collective. This instrument is offered to the hospital as a possibility of overcoming a crisis through the inoculation of a new culture of treatment, of new forms of relationship, of new ways of functioning and organization. The research involved, at first, rebuilding the history of this experience through the memory of the participant-researcher, and through written records, later there was the selection of passages of this history that had the quality of analyzer. The analysis showed that although of the CS represented a hope of change and a chance of overcoming the crisis in the hospital, it suffered resistance from the part of the team and it faced several obstacles: a participation of small significance from the staff in the development of the CS; limited or distorted apprehension of the project; low effectiveness of the established partnerships; the persistence and aggravation of the characteristics of the hospital as an asylum; The predominance of the organization in detriment of the clinic and a greater attention to the financial health of the hospital then the health of its agents ( staff and patients ). In conclusion we find that the development of the CS was significantly hindered by the lack of a space for an institutional analysis and its own alienation.
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Azevedo, Luciana Fernandes de Medeiros. "Nervos: rede de discursos e pr?ticas de cuidado na aten??o b?sica no munic?pio de Natal/RN". Universidade Federal do Rio Grande do Norte, 2010. http://repositorio.ufrn.br:8080/jspui/handle/123456789/17387.
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Previous issue date: 2010-06-07The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter
A aten??o b?sica e uma de suas principais estrat?gias, a Estrat?gia Sa?de da Fam?lia (ESF), se configuram como a porta de entrada para o Sistema ?nico de Sa?de (SUS). Dessa maneira, boa parte dos problemas de sa?de incidentes e prevalentes na popula??o dscrita deve ser resolvida nesse n?vel de aten??o, incluindo o sofrimento psicol?gico e a denominada queixa de nervoso. Nervos e nervoso denotam uma complexidade que nem sempre ? bem compreendida pelos trabalhadores de sa?de, de maneira que o cuidado a esse tipo de problema geralmente ? inadequado. O objetivo geral desse trabalho ? analisar a rede de discursos e de cuidados no atendimento ao sofrimento psicol?gico que se expressa como nervos, no cotidiano da aten??o b?sica do SUS. Mais especificamente, identificar os princ?pios e diretrizes da aten??o b?sica em sa?de mental; investigar o posicionamento dos trabalhadores de sa?de diante do sofrimento psicol?gico e das queixas de nervos, e analisar as diferentes a??es e pr?ticas de cuidado realizados nas diferentes Unidades de Sa?de diante de queixas como nervos. A perspectiva te?rico-metodol?gica adotada no trabalho foi a Etnografia Institucional. Essa abordagem busca compreender e analisar as rela??es institucionais em determinado contexto considerando as influ?ncias socioestruturais e as rela??es de poder, bem como as pr?ticas e os discursos cotidianos. Foram realizadas entrevistas com trabalhadores de sa?de, conversas informais e observa??es em seis Unidades de Sa?de com equipes da ESF de diferentes distritos sanit?rios do munic?pio de Natal/RN. Constatou-se o alto ?ndice de queixas de nervos, sendo que o encaminhamento a psic?logos e psiquiatras e a prescri??o de psicotr?picos s?o a forma mais comum de interven??o. Em geral, h? uma falta de conhecimento especializado sobre o tema da sa?de mental, bem como aus?ncia de discuss?es sobre as pol?ticas de sa?de mental. De um lado, as condi??es de trabalho e a falta de apoio institucional dificultam a realiza??o de a??es de preven??o de doen?as e promo??o ? sa?de. Por outro, h? diferentes pr?ticas em andamento tais como reuni?es de hipertensos e idosos, caminhadas, visitas, rodas de conversas e terapia comunit?ria embora nem todas visem o cuidado espec?fico ao sofrimento psicol?gico. O apoio matricial, estrat?gia metodol?gica de supervis?o e acompanhamento de casos de sa?de mental, vem sendo implantado por psic?logos em algumas Unidades de Sa?de do munic?pio, por?m ainda n?o est? totalmente implantado na rede. As pr?ticas de cuidado aos problemas de nervos dependem principalmente do envolvimento do trabalhador com as diretrizes da ESF e das pol?ticas de sa?de mental, al?m do apoio sistem?tico, quando dispon?vel, de outro profissional que funciona como apoiador matricial
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Hayne, Shelby. "An Analysis and Critique of Mental Health Treatment in American State Prisons and Proposal for Improved Care". Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/scripps_theses/1256.
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Mental health treatment in state prisons is revealed to be highly variable, under-funded, and systematically inadequate. Existing literature exposes this injustice but fails to provide a comprehensive proposal for reform. This paper attempts to fill that gap, outlining a cost-effective, evidence-based treatment proposal, directly addressing the deficits in care revealed through analysis of our current system. In addition, this paper provides historical overviews of the prison system and mental health treatment, utilizing theoretical perspectives to contextualize this proposal in the present state of affairs. Lastly, the evidence is provided to emphasize the potential economic and social benefits of improving mental health treatment in state prisons. Significant findings suggest a clear financial, legal, and moral incentive for states to address this issue, while the proposal provides a viable method of doing so.
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Pagnano, João Renato Ciabattari. "O hospital psiquiátrico como analisador da Saúde Mental de um município de médio porte do interior do Estado de São Paulo". Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/153958.
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Nosso objetivo nesta pesquisa de mestrado foi problematizar, a partir da Análise Institucional, enquanto lugar teórico-metodológico de investigação, as práticas e os discursos dos atores institucionais que trabalham na organização Saúde Mental, tais como se apresentam nos modos de funcionamento institucional de três hospitais psiquiátricos existentes em uma cidade de médio porte localizada no interior do Estado de São Paulo. Realizamos uma série de visitas de observação participante nesses três estabelecimentos, com a utilização de um diário de campo e entrevistas semi-dirigidas com membros da equipe dirigente e com psicólogos que atuam nesses locais, visando captar o plano do discurso institucional e as contradições existentes na organização Saúde Mental. Como mediação e pano de fundo para nossos objetivos, por meio de uma revisão bibliográfica, examinamos o processo histórico que engendrou a atual sociedade disciplinar enquanto um projeto do Estado de normalização social, que possibilitou o aparecimento dos Hospitais Psiquiátricos. Procuramos estudar os discursos e as práticas institucionais presentes nesses locais, bem como detectar quais são seus possíveis efeitos em termos éticos e de produção de subjetividade. A escolha da Análise Institucional como referencial teórico-metodológico, revelou-se muito útil para pensar a organização Saúde Mental, por permitir considerar o campo social, bem como a transversalidade dos momentos instituintes. A Análise Institucional subsidiou a construção analítica dessa investigação e a utilização de seus conceitos nos permitiu, ao estudar o plano latente desses estabelecimentos institucionais, captar as linhas de transformações que podem escapar aos jogos de poder sobrecodificadores praticados no campo da Saúde Mental. O Hospital Psiquiátrico como analisador indica que os atravessamentos de ordem reguladora, de disciplina e de controle costumam superar o projeto oficial dos estabelecimentos da organização Saúde Mental. Detectamos que os problemas dessa organização necessitam serem contextualizados no plano institucional e sócio-político, para não permanecermos em considerações funcionalistas que apenas mascaram a realidade do poder e da política, reduzindo os problemas às questões unicamente de ordem psicológica individuais.
Our objective in this master's research was to problematize, from the Institutional Analysis as a theoretical and methodological place of investigation, the practices and discourses of the institutional actors that work in the Mental Health organization, such as they are presented in the institutional modes of functioning of three psychiatric hospitals existing in a medium-sized city located in the interior of the State of São Paulo. We conducted a series of participant observation visits in these three establishments, using a field diary and semi-directed interviews with members of the management team and with psychologists who work in these places, in order to capture the institutional discourse plan and the contradictions existing in the organization Mental Health. As a mediation and background to our objectives, through a bibliographical review, we examine the historical process that engendered the current disciplinary society as a project of the State of social normalization, which made possible the appearance of the Psychiatric Hospitals. We seek to study the discourses and institutional practices present in these places, as well as to detect their possible effects in ethical terms and the production of subjectivity. The choice of the Institutional Analysis as a theoretical-methodological framework proved to be very useful for thinking about the Mental Health organization, since it allows to consider the social field, as well as the transversality of the instituting moments. The Institutional Analysis subsidized the analytical construction of this investigation and the use of its concepts allowed us, when studying the latent plan of these institutional establishments, to capture the lines of transformations that can escape the overcoding power plays practiced in the field of Mental Health. The Psychiatric Hospital as an analyzer indicates that the crossings of regulatory, discipline and control tend to overcome the official project of the establishments of the organization Mental Health. We have detected that the problems of this organization need to be contextualized in the institutional and socio-political levels, so that we do not remain in functionalist considerations that only mask the reality of power and politics, reducing the problems to the only questions of individual psychological order.
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Fialová, Lydie. "Remnants of humanity : psychiatry and post-socialism in the Czech Republic, 1989-2010". Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/28684.
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This thesis explores the roles that medicine, human rights discourse, and the arts play in the project to improve the lives of patients suffering from severe forms of mental illness in the context of the post-socialist transformation of the Czech Republic. It is a study of the ways in which social solidarity and social exclusion intersect in the spaces of mental illness in a particular historical setting, and how the responsibility for care is negotiated between families, communities, the medical profession, and the state. The first part of the thesis focuses on the proposed reform of care for patients with severe mental illness that was put forward in the two decades after 1989. I examine the origins and aims of the attempted institutional change – the ‘humanization of psychiatry’ – in the context of the influential Charter 77 movement which demanded respect for the rights of those who are unable to claim them for themselves. I also trace how the re-establishment of a civil society that owed much to the concept of ‘apolitical politics’ and the process of the reintegration of Czech Republic into the European community impacted the attempted reforms. More than twenty years after the revolution, Czech Psychiatry still does not comply with international standards of care and, as I show, despite the explicit disclaimer with the totalitarian past and great hopes for change, there is in fact a clear continuation of many of the practices, ideas, interactions, as well as forms of governance of the preceding decades. These historical legacies, in combination with other factors, such as ideological disagreements within the psychiatric profession, a lack of political interest in this area, and a strong focus on other economic priorities have all contributed to the failure to improve mental health care. The second part of the thesis offers a complementary perspective on these processes – a view from ‘inside’ of the institutions that provide psychiatric care. The origins of institutional care in Central Europe date back to late nineteenth century, when large hospitals were built within parks as self-sufficient complexes surrounded by walls, outside of large cities. My research took place in two contrasting institutions: one a highly specialised clinical and research center for treatment of acute conditions, and the other a hospital for treatment of chronic conditions originally devoted to those with ‘incurable’ conditions. I show how the notion of ‘curability’ is a crucial factor in both the experience of the patients and the social responses to their conditions. In this part I also explore some epistemological issues in psychiatry, including knowledge, practices, and ideology, in the context of a strong scientific materialism where – unlike in many parts of the world – the tradition of psychoanalysis has been absent. Specifically, I examine the role of neurobiological paradigm in various interpretations of psychotic experience, its affect on patient’s self-understanding, and its role in the externalization of agency and responsibility. Finally I address the phenomenon of using ‘unclaimed bodies’ of psychiatric patients for anatomical teaching and research, and interpret this practice through notions of liminality, impurity, and sacrifice. I conclude the thesis by examining the ethical dimension of psychiatric care in the light of the writings by Emmanuel Lévinas.