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Dissertations / Theses on the topic 'Forensic mental health patients'
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Marth, Dean Markward Martha J. "A longitudinal study of differences in staff assaults by responses to residents in a forensic hospital." Diss., Columbia, Mo. : University of Missouri--Columbia, 2009. http://hdl.handle.net/10355/6134.
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Title from PDF of title page (University of Missouri--Columbia, viewed on Feb. 15, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. Martha Markward. Vita. Includes bibliographical references.
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Maparura, Loreen. "Challenges experienced by hospitalised forensic state patients regarding mental health services in Namibia." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/65578.
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For years, mental health has not been a priority in both developing and developed countries and this is seen in low budgets, if at all, allocated to various mental health sectors worldwide. Recent studies show that one in three countries has a budget dedicated to mental health. This is further compounded by a shortage of infrastructure and mental health staff. Consequently, this has a huge impact on forensic state patients (FSPs) who receive fragmented services from various stakeholders. Namibia has a shortage of mental health staff and only has one fully fledged centre offering mental health services. Whilst FSPs experience a wide array of challenges, there is a dearth of studies that particularly explore these challenges from a Namibian perspective. This user-led research sought to inform mental healthcare workers on these challenges. The goal of the study was to explore and describe the challenges experienced by hospitalised FSPs regarding mental health services in Namibia. The study utilised a qualitative approach and was applied in nature. It employed a collective case study design and utilised purposive sampling to intentionally select a sample of hospitalised FSPs. A sample of 12 participants was drawn from a population of 75 hospitalised FSPs at the Mental Health Care Centre of the Windhoek Central Hospital. The study?s findings show that participants faced challenges such as lack of access to mental health treatment prior to their admission, stigmatising attitudes, and lengthy stays in both holding institutions and at the forensic unit. The study proposes the training of all staff on the Patient Charter (Ministry of Health and Social Services, 2016) and the utilisation of a patient-centred approach to treatment of FSPs. It also proposes granting leave of absence to FSPs so as to prepare them for eventual discharge.Mini Dissertation (MSW)--University of Pretoria, 2017.
Social Work and Criminology
MSW
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Lawson, Malinda Marie. "Predicting Educational Attainment Based on Forensic Psychiatric Patients' Age at First Hospitalization." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6914.
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Education during recovery could impact a forensic psychiatric patient's community reintegration; however, individual education goals for patients can be difficult due to the lack of available parameters. The purpose of this study was to test whether age at first hospitalization is predictive of educational attainment among forensic psychiatric patients and to determine which ages of first hospitalization best predict 8 levels of educational attainment. Cattell's intelligence theory served as the theoretical framework for this study because mental illness requiring early hospitalization may affect education and learning. This quantitative, nonexperimental study involved a predictive design with data from the Canadian Institute for Health Information database. The sample of patients from 2011-2016 consisted of 16,639 diagnosed with schizophrenia or other psychotic disorder and 2,227 diagnosed with mood disorder. Multinomial logistic regression analysis indicated age at first hospitalization to be a predictor of educational attainment among both categories of diagnoses. Odds ratio analyses identified which ages of first hospitalization best predict 8 levels of educational attainment. Increased rates of education levels were indicated when age at first hospitalization increased. Patients were more likely to attain a high school diploma than drop out between 9th to 11th grade unless first hospitalized at age 14 or under. Based on the results from this study, completion of a general equivalency diploma or a life skills program may provide additional opportunities for independent living and employment, which can improve the lives of patients and those in the community. Therefore, this project can lead to social change by encouraging changes through the results and recommendations presented in a white paper.
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MacInnes, Marlene. "Examining the sequelae of childhood trauma in forensic mental health." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9879.
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Introduction The aims of this thesis were twofold. The first was to systematically review the literature, on the influence of childhood trauma on psychopathology, across a range of forensic settings. The second was to complete an empirical study that examined the relationship between childhood trauma and insecure attachment patterns and psychopathology, risk, and engagement in therapy, in a forensic population. Method For the first aim database searches and hand searches of journals assessed against predefined criteria, identified 13 papers that were eligible for review. For the research study, 64 participants from three forensic secure hospitals completed three self-report questionnaires as part of a retrospective cross-sectional design. Data was also obtained from hospital records and clinical staff. Results The systematic review identified ten studies that were rated to be of good quality, two that were rated to be of fair quality and one that was rated as weak. Results identified a relationship between childhood trauma and psychopathology, but it is difficult to generalise findings due to the heterogeneity of this population. The research study found both childhood trauma and insecure attachment significantly predicted psychopathology and risk. No associations with engagement in therapy were found, but methodological reasons for this outcome were considered. Conclusion The systematic review highlighted that research in the area of childhood trauma and psychopathology in forensic settings is at an early stage, as most studies are small and cross-sectional. It discussed the need to develop further research to improve psychological treatment and reduce recidivism. Recommendations were made in the research study to routinely assess for childhood trauma and consider attachment patterns. Limitations in the design of the study were also acknowledged.
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Austin, Jessica Ann. "Connection between psychosis, trauma and dissociation : an exploratory study involving patients in forensic mental health settings." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5824.
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Background: High levels of dissociation have been found in recent studies involving psychiatric inpatients. Proponents of the ‘dissociative psychoses’ have found that trauma-focused intervention strategies can improve outcomes of patients with major mental illness. Despite this, levels of dissociation have not been measured in forensic inpatients in Scotland. This study investigates levels of dissociative symptoms (DES-II) within a sample of male patients in secure forensic psychiatry settings in Scotland. It explores levels of psychosis (PANSS) and self-reported childhood trauma (CTQ), current PTSD symptoms (IES-R), levels of depression (BDI-II) and broad attachment style (RQ). Four groups were arbitrarily defined based on presence or absence of psychosis and childhood trauma. It was hypothesised that levels of dissociation would be predicted by presence of childhood trauma. Methods: A quantitative cross-sectional design was used in which 56 mentally disordered offenders were interviewed across three different secure hospitals in Scotland: The State Hospital – a maximum security psychiatric hospital, and two medium secure facilities. Attempts are made to clarify the relationship of dissociation with different types of childhood trauma and psychosis symptom clusters. By splitting the data into groups the study seeks to discern whether the groups differ significantly on dissociation scores in relation to the childhood experiences they reported and presence of psychosis they are experiencing. Results: Childhood traumatic experiences were frequent where median CTQ total score = 47.0 (IQR: 42-70.5). Physical neglect was reported by 58.9% of the sample closely followed by emotional neglect (55.4%). 46.4% of the sample reported physical abuse of significant levels, 44.6% reported being emotionally abused and almost a third reported being sexually abused (28.6%). DES-II (dissociation) scores were significantly associated with delusions and hallucinatory behaviour from PANSS. Emotional abuse and sexual abuse were significantly associated with dissociation scores. Mann Whitney tests revealed that dissociation was significantly higher in the groups which reported childhood trauma. Kruskal-Wallis results indicated no significant differences between groups within the data and dissociation scores. Conclusion: Patients with clinically significant levels of dissociative symptoms were identified. This indicates that dissociation is a key characteristic, warranting further consideration in this sample. Levels and severity of reported childhood trauma were higher than expected. The findings add weight and support to the importance of dissociation and trauma in formulations of male, mentally disordered offenders. Clinical implications of these findings are considered and further directions are discussed.
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Nunn, Katherine Louise. "Investigation into risk assessment and staff coping with patient perpetrated violence in inpatient forensic psychiatric settings." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33090.
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The present thesis was carried out in part fulfilment of the Doctorate in Clinical Psychology at the University of Edinburgh. It is presented in portfolio format, comprising of two individual papers although a total thesis abstract provides an overview of the entire thesis. The first paper is a systematic review of existing empirical research. It explores the predictive validity of risk assessment tools for imminent (short-term) violence and aggression in forensic psychiatric settings. The second paper is an empirical study exploring how frontline nursing staff both predict and emotionally cope with experiencing violence and aggression in a high-security setting. Paper one was prepared for Aggression and Violent Behavior and paper two for The International Journal of Forensic Mental Health; so, follow their respective author guidelines. Mental health, and forensic mental health nurses have been identified as being at particular risk of experiencing patient perpetrated violence and aggression (PPVA). There is relatively little research investigating how nursing staff predict and cope with more immediate, imminent inpatient violence and aggression, specifically within secure (forensic) settings. Negative outcomes of PPVA are widely accepted and demonstrated within empirical literature, including increased anxiety and stress for staff, fractures to the therapeutic relationship between patients and staff, and difficulties with staff retention and absenteeism for the organization. Due to the extensive negative outcomes associated with PPVA, a wealth of research has focused on developing the area of violence risk assessment. Despite this, there remains limited understanding regarding the utility of existing risk assessment tools for predicting and assessing violence risk over brief time frames (i.e. days to weeks). Therefore, a systematic review was conducted to explore the predictive validity of violence risk assessment tools for imminent, short-term risk in inpatient forensic psychiatric settings. Findings demonstrated that multiple tools had decent predictive validity, however quality scores were impacted by small sample sizes. The Dynamic Appraisal of Situational Aggression- Inpatient Version was the most effective tool with the highest mean quality score. The main limitations were the small number of studies assessing some of the included tools and the level of ambiguity between studies regarding the definition of imminent, short-term violence. Developing a shared understanding of what constitutes short-term risk and improving the number and quality of studies on the largely neglected tools, should therefore be research priorities. How nurses actually recognize and predict inpatient violence and aggression in forensic psychiatric settings, and how they emotionally cope with the aftermath, are poorly explored and understood processes. A social constructivist grounded theory approach was used to analyze the transcripts from 12 interviews with frontline nursing staff from an inpatient high-security setting. A model was constructed integrating nurses' beliefs and assumptions about subtypes of violence, their efforts to use observation skills in order to aid risk prediction, and their resultant emotional experiences following PPVA. Nurses emotional coping seemed to be affected by several factors relating to the culture of the organization and the accessibility of support. Seemingly, knowing the patient helped nurses to better identify underlying needs leading to violent behavior. This understanding helped nurses to implement targeted, needs-led interventions to address these unmet needs, and so reduce recurrent and cyclical violence. Recommendations are made to build upon, and utilize nursing skills in risk prediction and management, and to help better support the emotional impact of experiencing PPVA within forensic psychiatric settings.
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Engström, Lotta, and Pia Pettersson. "Förutsättningar och hinder för patientdelaktighet i psykiatrisk tvångsvård : en integrativ litteraturöversikt." Thesis, Luleå tekniska universitet, Institutionen för hälsa, lärande och teknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-83066.
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Abstrakt Trots att det i Sverige finns lagar som säger att patienten så långt det är möjligt ska vara delaktig i sin egen vård, så verkar inte det vara fallet. Inom den psykiatriska tvångsvården är det ofta en obalans mellan personalen och patientens makt, därav vikten av att arbeta mot patientens delaktighet. Syftet med den integrerade litteraturöversikten var att sammanställa kunskap om patientdelaktighet vid sluten psykiatrisk tvångsvård. Följande frågor besvarades: Vilka förutsättningar för delaktighet finns i den slutna psykiatriska tvångsvården? Vilka hinder för delaktighet finns i den psykiatriska tvångsvården? Metod Integrerad litteraturstudie. Sökningar gjordes i tre databaser utifrån tre sökblock. Det resulterade i sexton artiklar som svarade mot syftet, två kvantitativa, en mixad metod och tretton kvalitativa. Inklusions kriterier: peer-review, engelska och inte äldre än tio år. Detta resulterade i sexton artiklar. Artiklar lästes igenom både enskilt och tillsammans, därefter vidtog dataextraktion där enheter togs ut som svarade mot syftet. Resultat: Analysen resulterade i elva kategorier, varav attityd, engagemang, relation och tvångsvård var mest framträdande. Det som kom fram är att för att det ska kunna jobbas utifrån patient delaktighet krävs det att personalen har en öppen, engagerad och ärlig attityd. Detta gör det möjligt att bygga en god relation mellan patient och personal, vilket i sin tur kan leda till patientdelaktighet. Slutsats Vad behövs för patientdelaktighet beror på vilken attityd man har. Är man som personal öppen, engagerad och ärlig då kan man bygga en relation till patienten och lägga grunden för patientdelaktighet
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Nygren, Ebba, and Oona Palokangas. "Fysisk aktivitet kan leda till ökat välbefinnande hos patienter inom rättspsykiatrisk vård : En kvalitativ studie om hur personalen inom rättspsykiatrisk vård upplever användandet av fysisk aktivitet som hälsopromotiv insats." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-79528.
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I dagens samhälle finns ett stort behov av att förbättra den psykiska hälsan hos befolkningen. En liten del av personer med diagnostiserad psykisk ohälsa hamnar inom rättspsykiatrisk vård – personen har då begått ett brott under psykisk störning. Syftet med studien var att undersöka den rättspsykiatriska vårdpersonalens tankar om hur fysisk aktivitet används som hälsopromotiv insats i dagsläget, vad som kan förbättras och hur det kan främja patienternas hälsa. För att besvara syftet har kvalitativ forskning gjorts, med öppna brev som metod. De 15 personer som deltog i studien fick skriva sin berättelse utifrån meningen “Nu ska jag berätta hur vi kan använda fysisk aktivitet som hälsopromotiv insats för att förbättra hälsan hos patienterna… “. Data analyserades med hjälp av manifest innehållsanalys, som resulterade i tre underkategorier, samt en huvudkategori; “Ju högre grad patienterna har möjlighet att röra på sig, desto bättre för deras välbefinnande” med underkategorierna “Stillasittande vardag”, “Bredare utbud av aktiviteter” och “Ökat välbefinnande”. Resultatet visade att fysisk aktivitet som hälsofrämjande insats inte används i den utsträckning som det skulle kunna, som det ser ut idag, inom rättspsykiatrisk vård. Slutsatsen är att fler hälsopromotiva insatser i form av fysisk aktivitet behövs inom rättspsykiatrin, och att den troliga effekten skulle resultera både i förbättrad fysisk och psykisk hälsa hos patienterna.In today's society, there is a great need to improve the mental health of the population. A small proportion of people with diagnosed mental illness end up in forensic psychiatric inpatient care when they have committed a crime under a mental disorder. The purpose of the study was to investigate the forensic psychiatric care staff's thoughts on how physical activity is used as a health-promoting input in the current situation, what can be improved and how it can promote patients' health. To answer the question, qualitative research has been done with open letters as a research method. Fifteen forensic psychiatric care staff participated in the study, and were encouraged to write their story based on the sentence “Now I will tell you how we can use physical activity as a health promotion initiative to improve the health of the patients…”. The data was analyzed using manifest content analysis, which resulted in three subcategories as well as one main category; “The more patients are able to move, the better for their well-being” with the subcategories “Sedentary everyday life”, “Wider range of activities”, and “Increased well-being”. According to the results, health-promoting input in the forensic psychiatric care is not used in the extent it could be used. The conclusion is that more health-promoting interventions in the form of physical activity are needed in forensic psychiatric inpatient care, and it is presumed that increased physical activity would result in both improved mental health and physical health among the patients.
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Sutherland, Sophie. "Forensic mental health service users' narratives of recovery." Thesis, Staffordshire University, 2018. http://eprints.staffs.ac.uk/4904/.
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This thesis aims to explore the recovery experiences of forensic mental health service users. In doing so, it seeks to add to the small but growing field of literature exploring the application of recovery principles in forensic settings. Paper one is a review of the current literature, synthesising the recovery experiences and perceptions of forensic mental health service users. A total of 10 papers were included in the thematic review. Five themes were identified; hope; connecting with others; meaningful occupation, roles and identity; the powerful environment of the hospital; and coming to terms with the past and diagnosis. Paper two is an empirical paper which explores the recovery stories of five male participants who had been detained in a low secure forensic service and discharged into the community. A narrative analysis reveals the shared personal, community and dominant cultural recovery narratives. Counterstories were also identified. The findings are discussed in relation to the clinical implications, in particular how to work within a cultural narrative of openness about mental illness stories, but secrecy around offending narratives. Further research implications are also discussed. Paper three is an executive summary which seeks to provide an accessible summary of the empirical research paper. This provides an overview of the research, highlighting the key points and salient information in terms of clinical implications for service delivery in a forensic context.
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Mitchell, Carolyn Ruth. "Community forensic mental health teams : a Northern Ireland perspective." Thesis, University of Roehampton, 2015. https://pure.roehampton.ac.uk/portal/en/studentthesis/community-forensic-mental-health-teams-a-northern-ireland-perspective(df8a8d53-0384-46cf-a1c9-aad17dbfc4d4).html.
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This is a study investigating, from the perspective of service users, the most effective treatment interventions for mentally-disordered offenders overseen by a community forensic mental health service (CFMHTs) in Northern Ireland. This study researches what works best with mentally-disordered offenders in the context of three psychological models in the field of offender rehabilitation, namely: McGuire’s (1995) ‘What Works’, Ward’s (2001) ‘Good Lives’, and Andrews and Bonta’s (1994) ‘Risk, Need, and Responsivity’ model. This study is unique in that the views of service users, that is, the patient, and the family of the patient, as well as professionals, were sought. Service user views were obtained through undertaking three separate studies involving qualitative and quantitative assessment. Study one involved focus groups with results evaluated by thematic analysis; study two involved administrating questionnaires developed from the focus groups to evaluate specific themes, whilst study three followed up specific issues with semi-structured interviews, the data again analysed by thematic analysis. In study one, service users identified ten key themes as important in the treatment and management of mentally-disordered offenders within the community. Study two explored the significance of the themes for the three service user groups. There were a number of significant differences between groups identified in study two in the areas of risk management and public perception and awareness. The differences are reflective of elements of the ‘Good Lives’ model, such as the importance of the therapeutic relationship. Study three undertook a more in-depth analysis of the questionnaire results, and endorsed the findings from studies one and two. Throughout the three studies the ten themes reinforced the importance of the ‘what works’ literature from the perspective of service users. The one theory, however, which services users appeared to endorse most strongly, is Tony Ward’s ‘Good Lives’ model and this is important for the future work of CFMHTs. The value placed by patients and families on the therapeutic relationship is one of the most significant findings to emerge from this research study and is reflective of the academic literature. The findings of each study have been discussed in relation to existing research in what works with mentally-disordered offenders. Recommendations for improvement in the treatment of this group are identified. The more important of these include: involving the patient’s family in their treatment and risk management; ensuring that a ‘step-down’ approach is adopted when patients move from security to community living; working to reduce stigma and Northern Irish cultural issues that adversely impact a patient’s rehabilitation, and the importance of a positive therapeutic relationship between professional, patient, and families. The research was limited by sample size and difficulty securing questionnaire responses from some professionals on time. Future research could increase the sample size by expanding numbers at a local level to other forensic teams in Northern Ireland. Furthermore, exploring re-offending data from the sample on a longitudinal basis would be informative. Overall, this study highlights the centrality of service users in determining what works best in the treatment and risk management of mentally-disordered offenders.
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Sallah, David K. "A study of outcomes measures in forensic mental health." Thesis, Aston University, 1999. http://publications.aston.ac.uk/10724/.
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Outcomes measures, which is the measurement of effectiveness of interventions and services has been propelled onto the health service agenda since the introduction of the internal market in the 1990s. It arose as a result of the escalating cost of inpatient care, the need to identify what interventions work and in what situations, and the desire for effective information by service users enabled by the consumerist agenda introduced by Working for Patients white paper. The research reported in this thesis is an assessment of the readiness of the forensic mental health service to measure outcomes of interventions. The research examines the type, prevalence and scope of use of outcomes measures, and further seeks a consensus of views of key stakeholders on the priority areas for future development. It discusses the theoretical basis for defining health and advocates the argument that the present focus on measuring effectiveness of care is misdirected without the input of users, particularly patients in their care, drawing together the views of the many stakeholders who have an interest in the provision of care in the service. The research further draws on the theory of structuration to demonstrate the degree to which a duality of action, which is necessary for the development, and use of outcomes measures is in place within the service. Consequently, it highlights some of the hurdles that need to be surmounted before effective measurement of health gain can be developed in the field of study. It concludes by advancing the view that outcomes research can enable practitioners to better understand the relationship between the illness of the patient and the efficacy of treatment. This understanding it is argued would contribute to improving dialogue between the health care practitioner and the patient.
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Warner, Samantha J. "Special stories : women patients, high security mental hospitals, and child sexual abuse." Thesis, Manchester Metropolitan University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267536.
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Baker, Stephanie. "Staff and service user experiences of forensic mental health services." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/90135/.
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This thesis consists of three chapters. Chapter one is a systematic review of the qualitative literature examining the experiences of clinicians working in mental health services with forensic service users (FSU). Following systematic searches and a process of quality assessment, a total of 14 articles were included and their findings were systematically compared. Staff members experienced both positive and negative emotional responses to their work, there are conflicting aspects to their role and additional challenges within the organisational context. Implications for clinical practice and further research are discussed. Chapter two uses Interpretative Phenomenological Analysis (IPA) to consider the experiences of FSUs diagnosed with Personality Disorder (PD) in Forensic Services and the meaning given to recovery within their accounts. The findings discuss the disempowered position of FSU participants and suggest that feeling safe within relationships in their environment is important for those with this diagnosis. There was evidence in their accounts of attempts to establish new identities but there also appeared to be multiple barriers to this. Chapter three offers a reflective account of the researcher’s experience of carrying out this study. It demonstrates the reflexive strategies used that allowed the competing subjective roles alongside that of ‘researcher’, to be examined and their influence on the research process explored.
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Rye, Owen. "Perspectives on recovery and recall to hospital in forensic mental health." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:3bd28a0b-26e6-42db-b692-d9709791068b.
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People who are mentally unwell and have committed a criminal offence are cared for by forensic mental health services. Their treatment is provided in secure hospitals so that any risks to the public are minimised. The complex nature of the mental health difficulties experienced by this clinical population means that they are typically treated in secure hospitals for several years, incurring high economic and personal costs. The need for meaningful approaches to treatment and management of these individuals is therefore paramount. The first paper systematically reviewed eighteen qualitative research papers that explored stakeholder perspectives on the personal recovery approach to care in forensic contexts. Principles of personal recovery were perceived to be meaningful and applicable in forensic contexts if adaptations were made to overcome inherent barriers such as restrictions due to risk management. Methodological quality of the reviewed studies was limited by shortcomings in the transparency of study procedures. The second paper explored the experiences of a significant subpopulation of forensic service users who were discharged to the community subject to conditions including ongoing monitoring, then recalled back to a secure hospital due to a relapse in their mental state or other indicators of increased risk. Using grounded theory, a theoretical model was developed of how these individuals make sense of being recalled. This was found to be a recursive process influenced by their perceptions of events before their recall, during the recall itself, and their subsequent experiences.
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Nowill, Joanna Elizabeth. "Shame, guilt and mental health problems." Thesis, University of Wolverhampton, 2009. http://hdl.handle.net/2436/113729.
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This thesis comprises three main sections: a literature review, research report and a critical appraisal of the research process. The literature reviewed is the current scientific literature relating to shame and guilt. The review attempts to clarify the conceptual confusion regarding shame and guilt and in particular attempts to delineate the distinctions between the two constructs whilst acknowleding the intricate and entwined relationship. The review also attempts to clarify the confusion regarding the role of guilt and its capacity to elicit both adaptive and maladaptive responses according to the way in which it is operationalised and conceptualised. The importance of the relationship between shame, guilt and mental health problems is presented with supporting empirical evidence. It is concluded that a new shame and guilt measure is required to show how shame and the maladaptive and adaptive aspects of guilt can be operationalised. It is hoped that this will enable future researchers to consider incorporating a profile approach to guilt in particular and that clinicians will consider the multiple and complex roles of shame and guilt in relation to psychological symptoms. The research report (Section 2) comprises two studies. Study 1 is the design, development and piloting of the new questionnaire assessing dispositional shame and guilt. The new measure is constructed and validity tested using an inductive approach. Study 2 is the use of the new measure with a forensic clinical sample and the relationship between guilt, shame and psychological symptoms is examined. It is hoped that this study will encourage researchers to locate future investigations within the clinical population. The final section is the researcher's critical appraisal of the research process based on her personal diary. This section is reflective and considers the impact of the research process on the researcher, the highs and lows of the research process and what changes the researcher might make.
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Jormfeldt, Henrika. "Dimensions of Health among Patients in Mental Health Services." Doctoral thesis, Lund University, Sweden, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-16873.
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Empirical studies focusing on the subjective experience of health among patients in contact with the mental health services are rare and most questionnaires are based on a medical model that emphasizes objectively observed disease-oriented health indicators. In studies I and II perceptions of the concept of health among patients and nurses in mental health services were explored and described using a phenomenographic approach. The perceptions and description categories that emerged from these studies were transformed into a number of items forming a questionnaire intended to measure subjectively experienced health among patients in mental health services. In study III, a randomly selected sample was used to test the psychometric properties of the new Health Questionnaire. A factor analysis revealed three factors labelled Autonomy, Social Involvement and Comprehensibility. The purpose of study IV was to examine the construct validity of the Health Questionnaire. The hypothesis was that subjectively experienced health would be positively associated to self-esteem, empowerment and quality of life, and negatively associated to psychiatric symptoms, perceived stigmatization experiences and perceived attitudes of devaluation and discrimination. This hypothesis was mainly confirmed insofar that overall health was positively correlated to self-esteem, empowerment and quality of life and negatively correlated to symptoms, attitudes of devaluation and discrimination and rejection experiences. The results of this thesis show that health is more than just an absence of disease and support a focus on health promotion interventions in mental health care.Medicine doktorsexamen
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Cook, Andrea. "The use of restorative approaches in a forensic mental health setting." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12510/.
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Restorative justice is an intervention gaining worldwide recognition in criminal justice systems and other settings. There is a growing evidence base demonstrating positive outcomes in a number of domains, but to date there has been no research found focussed upon the use of restorative justice in a forensic mental health setting. This study used semi-structured interviews and grounded theory analysis to explore and develop a deeper understanding of the use of restorative approaches at an early stage of implementation in such a setting, looking at the experience of the intervention, issues particular to this setting and the implementation process. The aim was to attempt to understand the underpinning psychological processes associated with the intervention and to develop a theoretical model of the use of restorative justice in the setting. There were ten participants including restorative justice facilitators, patients and the patients’ staff victims. The final model highlights the role of containment and the necessity for facilitators to have a high level of skill when working with a complex, vulnerable and potentially dangerous client group. The findings are discussed in relation to theory and research with particular reference to the concept of containment. Restorative approaches are found to be congruent with models of mental health and offender recovery. Processing emotions, developing thinking and coherent narrative, and immediacy are found to be key components of the intervention. Clinical implications and limitations of the study are presented. Recommendations for further research to build upon these findings are made.
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Kirkham, Rosie. "Exploring the experiences of staff working in forensic mental health settings." Thesis, Lancaster University, 2017. http://eprints.lancs.ac.uk/89009/.
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Forensic mental health (FMH) is described as a complex and challenging specialism to work in. The experiences of staff working within FMH settings have important influences on the quality of care provided to patients. This thesis explored the experiences of both multidisciplinary staff and clinical psychologists. A meta-synthesis of international qualitative studies was conducted to explore the experiences of staff working in FMH settings. Sixteen papers were synthesised, revealing five themes: 1) The impact of safety; 2) Psychological and emotional impacts; 3) Trying to maintain control; 4) The double-edged sword of support; and 5) A special insight into humanity. The findings point to the importance of understanding how staff manage the impacts of working in FMH settings in order to develop effective support systems. Eight clinical psychologists were individually interviewed to explore their lived experiences of compassion satisfaction when working in UK forensic mental health settings. Five themes were identified using interpretative phenomenological analysis: 1) The magnitude of trust; 2) Adjusting expectations; 3) Being both lock and key; 4) Needing time and resources; and 5) Variety and complexity. The results highlighted important distinctions in how compassion satisfaction can be experienced by clinical psychologists in this specialty, and what may influence these experiences. A critical appraisal of the process of carrying out the research was conducted. Issues regarding ethical approval, recruitment, and methodology were discussed, in addition to the impact of the study on the researcher.
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Domingue, Jean-Laurent. "Exploring the Production of “Dangerous Persons” in Forensic Psychiatry: A Critical Ethnography of the Ontario Review Board (ORB)." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42688.
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Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two different mandates: criminal justice (public protection) and health care (public good). Nurses’ involvement at one of the systems’ points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and health care professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCRMD) represent significant threats to the safety of the public, and orders conditions aimed at keeping the community safe. The aim of this research project was to explore how psychiatric and public safety discourses construct the identity of persons UST or NCRMD during RB hearings, and nurses’ contribution to such identity construction. Critical ethnography methodology was employed, mobilizing three data sources: interviews with forensic psychiatric nurses, observations of RB hearings, and RB documentary artifacts. A poststructuralist lens was used to discern how RB culture produces truths about persons UST or NCRMD that sustain the hegemony of public safety and psychiatric discourses. The main finding was that the forensic psychiatric structure leverages therapeutic nursing interventions and documentation as evidence of deviancy, so that persons UST or NCRMD can be objectified and produced as dangerous, prior to socially rehabilitating them. Discursive structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering it coercive and punitive. Thus, a care-and-custody dichotomy is insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for research, practice, and education in forensic psychiatric nursing, nursing ethics, and other nursing specialties on the medico-legal borderland.
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Dowd, Jonathan Mark. "Forensic psychology perpectives of police mental health awareness training : an international study." Thesis, University of Newcastle Upon Tyne, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417519.
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Kalckreuth, Sophie, Friederike Trefflich, and Christine Rummel-Kluge. "Mental health related Internet use among psychiatric patients." Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-159186.
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Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.
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Berzins, Kathryn Mara. "Mental health service users’, carers’ and professionals’ perceptions of the named person provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/927/.
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Background: The Mental Health (Care and Treatment) (Scotland) Act 2003 reduced the role of the nearest relative, identified by a hierarchy of relationships, who previously could admit and discharge a patient as well as receive information about their care. This role is now reduced to one of receiving basic information only and the hierarchy for identification has been modernised. Service users may now nominate a named person with similar rights to service users to help protect their interests. This person cannot admit or discharge but is entitled to information and consultation about their care. If a patient has not appointed a named person, then the primary carer is appointed by default and, if there is no primary carer, the nearest relative assumes the position. Aims: To explore service users’, carers’ and professionals’ perceptions and experience of the named person provisions. Method: Twenty service users, ten carers, seven MHOs and nine professionals with influence on government policy were interviewed about their experiences. Interviews were carried out face-to-face (service users and some carers) and by telephone (carers, MHOs and policy influencers). The resulting transcripts were analysed using thematic analysis. Findings: The majority of all interviewees welcomed the introduction of the named person provisions because of the increased choice it gave service users. Service users often did not wish to nominate their nearest relative, many choosing to nominate a friend. Important factors in making a nomination were that the nominee knew the service user’s wishes and could be trusted to carry them out. Some service users chose not to nominate relatives to spare them responsibility. However, the provisions were not without their problems; uptake was perceived to be low and there were particular problems in relation to the level of understanding of the implications of a nomination by service users and of the lack of accessible information and support to increase this understanding. The imbalance of power in relationships between service users, carers and professionals was thought to impact on the autonomous choices of service users and carers. Further problems were identified with named persons appointed by default in relation to service user choice and confidentiality. Conclusion and recommendations: Although the choice is welcome to some service users, there appears to be a lack of full understanding of the role, and continued awareness-raising is required with service users, carers and professionals which should further be supported by accessible information for both service users and carers. There is currently a lack of support for carers in particular and it is recommended that this be addressed using carers’ services. It seems that many named persons are being appointed by default (itself an anomaly in Scots law) which threatens human rights, because of the lack of choice of the service user about who is involved in their care and their inability to prevent the sharing of confidential information with the default named person. The current lack of a right of service users to reject having a named person at all restricts choice and autonomy, and may further place unwanted responsibilities on carers and relatives which are difficult to remove. To ensure that service users’ rights are fully protected, the named person should become an optional nominated position and the default mechanisms removed.
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Sanschagrin, Kimberly A. Heilbrun Kirk. "The quality of forensic mental health assessments of juvenile offenders: an empirical investigation /." Philadelphia, Pa. : Drexel University, 2005. http://dspace.library.drexel.edu/handle/1860/658.
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Hussain, Shazia. "Men's experiences of engaging in psychological therapy in a forensic mental health setting." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8523/.
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Background: The Multifactor Offender Readiness Model (MORM) acknowledges the importance of gender-sensitive interventions in enhancing engagement in the rehabilitation of offenders. However, to date, little attention has been paid to the role of gender identity in psychological therapy. Even though men in forensic settings are likely to endorse hypermasculine attitudes, such as promoting aggression and restricting emotional expression, which run counter to therapeutic ideals. Methodology: Nine men residing in medium-secure forensic mental health hospitals were interviewed. Interpretative Phenomenological Analysis (IPA) was used to obtain first-person accounts of the men’s lived experiences to gain an insight into the subjective meanings they attached to their experiences of psychological therapy. Results: An analysis of the individual transcripts highlighted the men’s journey over the course of therapy, marked by an internal struggle against the external pressures. Three superordinate themes were identified: ‘shifting self’, ‘relationship with other’ and ‘therapeutic journey’, alongside their subsequent sub-themes. Discussion: A gradual, non-linear process of change was evident in the men’s narratives, who at the various phases of psychological therapy were faced with the challenge of questioning and redefining their identity. This involved lowering their guard, learning to become comfortable with vulnerability and face their past in the presence of a supportive ‘other’, in order to move towards building a new or better future for themselves.
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Walsh, Sean. "Performance-Based Assessment of Oral Dependency within a Forensic Inpatient Mental Health Population." University of Toledo / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1480456507489641.
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Alford, Max. "Impulsivity in forensic populations." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33164.
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Purpose: The systematic review summarised the research investigating potential risk factors for impulsive behaviours in forensic populations. The empirical study examined the predictive utility of clinician rated, self-report and behavioural measures of impulsivity in detecting violence and antisocial behaviour in forensic mental health inpatient settings. Method: The review is comprised of 9 studies identified through electronic database searches using a structured search strategy and predetermined inclusion criteria. The empirical study employed a cross-sectional design using retrospective and prospective statistical analysis. Forty-three participants were recruited from secure forensic mental health inpatient settings across Scotland and data collected from clinician rated, self-report and behavioural measures of impulsivity. Results: The review found original evidence to suggest that traumatic brain injury, substance and alcohol misuse, trauma and sleep as possible predictors of impulsive behaviour in forensic populations. The empirical study found a relatively consistent relationship between impulsive behaviour and violent or antisocial behaviour in a sample of forensic mental health inpatients. Conclusions: The systematic review identified a limited number of risk factors thought to influence impulsive behaviour in forensic populations. The review highlights the need for future research with improved methodological design to further explore contributory factors for increased levels of impulsivity. Findings from the empirical study reveal clinician rating of impulsive behaviour to be the most sensitive in predicting future incidents of violent and antisocial behaviour, which may be supplemented by the addition of a self-report measure.
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Cole, Samantha. "Management of clients who self-harm in UK secure forensic units." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/15030/.
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Little evidence exists in the literature for how to manage clients who self-harm within low, medium and high secure forensic wards, despite the identified high rates of self-harm within these services. This study sought to investigate the management practices used with clients who self-harm in low, medium and high secure forensic wards, how helpful staff consider these practices and what understanding staff have of the reasons for which clients self-harm. A Delphi survey methodology was employed across three rounds using a multidisciplinary cohort of forensic ward staff, across low, medium and high wards. Physical management strategies were reported as most frequently employed to manage self-harm. Relational approaches to managing self-harm showed the highest rate of consensus for their helpfulness in practice. Consensus was reached across numerous domains explaining reasons for self-harm, including as a ‘communication of distressing feelings’. Statements indicating a negative view of self-harm such as ‘to manipulate staff and gain attention’ received consensus of disagreement. Psychological models and approaches used by clinical and forensic psychologists in the cohort were identified, and helpful elements of these models were identified, including ‘positive focus of approach’ and ‘emphasis on relational working’.
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Woods, Phil. "The Behavioural Status Index (BSI) : descriptive studies within a forensic context." Thesis, Anglia Ruskin University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.300347.
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Holloway, Katharine Rose. "Mental health review tribunals : the release of restricted patients." Thesis, University of Cambridge, 2000. https://www.repository.cam.ac.uk/handle/1810/251739.
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This thesis is concerned with the operation of the mental health review tribunal system and presents an empirical investigation of tribunal decision-making in restricted cases. Tribunals were first introduced in the Mental Health Act 1959 to safeguard patients from unjustified detention in hospital. In recent years mental health and social policy have become focused on issues of public safety. In the Executive Summary of a White Paper issued in 1998, the Government stated that public protection was, and would remain, its "first priority at all times". Given that the first priority of a tribunal to safeguard patients, it is important to consider how effectively tribunals are fulfilling their fundamental role in the current climate of heightened concern for public safety. Of especial concern is the operation of tribunals in restricted cases where public safety is of particular relevance. Previous research sheds little light on the issue, largely because the projects of any substantial research value are now considerably out of date. A new project, the subject of this thesis, was therefore devised to address this gap in knowledge. Focusing solely on the Trent region the project comprised three parts. First, a retrospective file study of hearings was conducted to explore the factors predictive of tribunal outcome. Five factors were found to predict the decision to discharge and four the decision to recommend transfer. The factor of greatest influence was the written opinion of the responsible medical officer. Second, a questionnaire survey of tribunal members was designed to explore how members used the evidence and applied the discharge criteria when making their decisions. The medical evidence, particularly that of the medical member, was reportedly of most assistance to the members. The evidence of the Home Secretary and the social worker were rarely of assistance to members. Questionnaire responses also indicated that a number of patients had not been discharged in spite of majority (or unanimous) agreement that they had satisfied the discharge criteria. The third study, observational in nature, yielded qualitative data that helped to guide and interpret the quantitative findings. Of note was the negative effect of a heavy caseload on the quality of tribunal decision-making.
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Knott, Jonathan Charles. "Management of mental health patients in the emergency department /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002656.
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Hanif, Ayshah. "Therapists' experiences of therapy endings with mental health patients." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8546/.
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Volume I has three chapters. Chapter one presents a systematic meta-synthesis which reviews fourteen qualitative research articles about mental health professionals’ experiences of patient suicide. The analysis illustrates an underlying sense of bereavement, fear and transformation. Chapter two presents an empirical research paper which explores psychotherapists’ experiences of therapy endings. The analysis suggests therapists and patients can have an intimate professional relationship which can be differentially affecting for both after the therapy ends. Chapter three is a public dissemination document which gives an accessible overview of chapters one and two. Volume II contains five clinical practice reports. The first report details the case of a woman experiencing Anxiety, Depression and suicidal ideation; formulated from two psychological models. The second report presents a service evaluation assessing non attendance rates of psychological services assessment appointments and ways of improving engagement in adult secondary community mental health teams (CMHT’s). The third report presents a psychological consultancy led case of a woman with challenging behaviour. The fifth report details a single-case experimental design of a woman with a mild learning difficulty and re-current stress induced vomiting. The fifth presents an abstract of an oral presentation about a woman experiencing low mood and binge eating.
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Stocking, Corrine Ann. "Transgender Patients' Experiences of Discrimination at Mental Health Clinics." PDXScholar, 2016. http://pdxscholar.library.pdx.edu/open_access_etds/2993.
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The transgender population is makes up about 0.3% of the U.S. population (Gates 2011). The term transgender is both an identity and an umbrella term used to describe people who do not adhere to traditional gender norms (Institute of Medicine 2011). Transgender people experience many barriers to services, negative health outcomes, and discrimination (Fredrikson-Goldsen et al. 2013; Institute of Medicine 2011; Eliason et al. 2009; Hendricks & Testa 2012). Mental health clinics are an important site for understanding transgender peoples' experiences due to being a gatekeeper for other medical services and their role in helping transpeople with issues surrounding coming out, victimization, and discrimination (Grant et al. 2011; Youth Suicide Prevention Program 2011). The mental health field has a contested relationship with the transgender population due to a history of pathologizing gender variance, barriers to accessing services, and insensitivity from mental health providers (American Psychiatric Association 2013; Eliason et al. 2009). I conducted secondary data analysis using the National Transgender Discrimination Survey (2008) in order to understand the relationships between gender non-conforming identities, others' perception of one's gender identity, and discrimination at mental health clinics. Results suggest that there is an association between gender identity, others' perception of one's gender identity, and discrimination. This association depends on which gender identity, the degree to which an individual identifies with each term, and the type of discrimination. Logistic regression results reveal that identity and others' perception are not significant predictors for experiencing discrimination. Rather, income and race are significant predictors for experiencing discrimination at metal health clinics.
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van, Wormer Rupert Talmage. "Risk Factors for Homelessness Among Community Mental Health Patients with Severe Mental Illness." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/653.
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The purpose of this study was to identify risk factors associated with homelessness, assess the relationship between housing status and consumption of costly publicly funded resources, to identify characteristics associated with service retention, and to evaluate whether length of treatment is associated with better outcomes. The target population was homeless and formerly homeless adults with SMI enrolled in community mental health services at the Downtown Emergency Service Center SAGE mental health program located in Seattle. The sample consisted of 380 SAGE patients who had continuous enrollment in 2005. These patients formed the cohort for the study. Agency records for these patients were reviewed for a 3-year period (2005-2007). The study utilized a non-experimental retrospective cohort study design. Multiple logistic regression, hierarchical multiple regression, two-way repeated measures ANOVA, and Cochran's Q test were used to analyze the data. Homelessness was associated with African American race, substance use, lower income, and younger age. Patients who were homeless spent more time in jail and required more mental health staff time compared with patients with stable housing. Patients with schizophrenia were more likely to retain services and African American patients were less likely to retain services. Overall, patients who remained enrolled in services from Year 1 to Year 3 had improved housing stability, fewer days of incarceration, and required less staff support. The overrepresentation of African Americans among patients who experienced homelessness suggests that racism could be a factor contributing to homelessness for this racial group. Further research is needed to assess the relationship between race and homelessness.
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Swart, Barbour Tania. "The therapeutic alliance as a component of risk management and assessment in forensic mental health." Thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28370.
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Background: Few forensic mental health facilities in South Africa use formal risk assessment instruments to monitor risk and recovery of forensic state patients. The study set out to examine the usefulness of the therapeutic alliance as a proxy measure of violent recidivism in a forensic state facility. The study proposed that the nature and strength of the therapeutic alliance is associated with risk of violence in a forensic population and that attachment security is a relevant factor in this relationship. Additional related factors were studied including demographic and contextual data and their influence on the alliance and risk.
Design and method: A quantitative research method was used to sample both inpatients and outpatients (n=131) using a naturalistic, cross-sectional research design. Statistical analyses focussed on regression modelling and addressed mainly the statistical associations between ratings of the different variables. Various psychometric tests were administered and scored and entered into a database. It was hypothesised that a strong (positive) therapeutic relationship measured with the Dual- role Relationship Inventory-Revised (DRI-R) questionnaire is associated with low risk for violence using the Historical, Clinical, Risk Management (HCR-20) scale.
Findings: Essentially there was a direct association between the therapeutic alliance and violent recidivism, that is, men with a strong therapeutic alliance have lower risk for violent behaviour. Key practitioner type was considered to be highly influential in establishing positive alliances and as a mediator of potential violent recidivism. An insecure attachment style was dominant in the study sample and insecure states of mind partially influenced current therapeutic alliances with an associated increased vulnerability for violence. Positive psychotic symptoms remained a high-risk factor for violence and criminal histories and antisocial behaviour may continue to present a risk for recidivism in the absence of psychosis.
Conclusion: Violent recidivism can be adequately monitored by the DRI-R. Affiliation and control are not mutually exclusive in forensic mental health care. Addressing attachment deficits prevalent in this population may be useful in informing both risk and recovery. Symptom reduction remains an important aim in treatment and risk management. Ratings of the alliance by practitioners and how it concurs with risk is an area for further research.
Key words: Therapeutic alliance, dual-role relationship, risk assessment, violence, attachment, state patients, recovery
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Sturidsson, Knut. "Measures in forensic psychiatry : risk monitoring and structured outcome assessment /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-262-0/.
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Cutshall, Jessica. "Psychoeducational Mental Health Counseling Video Intervention: Patients’ Attitudes, Knowledge, and Conversations with Provider about Mental Health Counseling." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586883515772007.
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Ellis, Kate. "An exploration of the relationships between inpatients and clinical psychologists in forensic mental health services." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12509/.
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Recent studies with offenders have identified a growing distrust in psychologists and that this may be due to the changing role of clinical psychologists working within these settings. In addition to the traditional role of alleviating psychological distress, psychologists in these settings also have the additional role of providing expert risk assessment. Clinical psychologists working in forensic mental health settings (FMHS) are also tasked with this ‘dual role’. To date, there is no research exploring the impact of this dual role in FMHS. Semi-structured interviews were carried out with eight inpatients in two medium secure units. A grounded theory analysis produced a model of how trust was built and relationships developed. Despite the ‘dual role’ held in these settings, with an approach that is transparent, open, collaborative, and patient-centred; service users are able to build trusting relationships. Furthermore, they report making positive therapeutic gains. Where ‘coercive’ experiences were described, this appeared to be a representation of more distant times, with recent experiences being described as more satisfactory. Clinical psychologists also seem to be placed in a position of ‘mediator’ amongst the wider care team. Further research is required to explore these findings and whether they apply in other secure settings.
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Bruwer, Marise. "Characteristics of domestic homicide perpetrated by persons with severe mental illness - a forensic psychiatry observation population-based study." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27454.
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Background: Domestic homicide (killing of a person aged 16 or older by a family member or a current or former partner) accounts for 50% - 70% of homicides perpetrated by offenders with mental illness. Despite these statistics, surprisingly little is currently known about the characteristics of domestic homicides perpetrated by those with severe mental illness. To the best of our knowledge, domestic homicide in the context of severe mental illness has not been researched in South Africa. Objective: To investigate domestic homicides by offenders with severe mental illness referred to the Forensic Mental Health Service at Valkenberg Hospital for forensic psychiatric observation. Methods: A five-year retrospective folder review was conducted to obtain data on the characteristics of offenders and victims, as well as the circumstances surrounding the homicide. Results: The majority of the offenders in our sample were young (mean age of 31), single, unemployed males who were known to mental health care services. Substance use disorders and non-adherence to medication were common. Psychotic disorders were the most prevalent diagnoses. The majority of victims were male and a significant minority of the domestic homicides were parricides (28.6%). The incident took place at the victim's residence or the victim and perpetrator's shared residence in most cases. Stabbing was the most common method used. Almost half of the perpetrators were psychotic when the incident took place and 60% of these were first episode psychoses. In spite of the high prevalence of substance use disorders (66.7%), only 23.8% of the sample reported that they were intoxicated when they committed the offence. Conclusions: The majority of our sample was known to mental health care services. This implies that there were potential missed opportunities to prevent these lethal assaults. Our research identified treatment adherence, comorbid substance use disorders and aggressive treatment of first episode psychosis as a possible focus of future interventions in order to prevent domestic homicides due to mental illness.
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Pangrazzi, Elizabeth. "The Rural Provider's Perspective| Conversations With Patients About Mental Health." Thesis, Union Institute and University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10624346.
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The rural primary care provider is likely to treat patients with mental health issues in rural populations due to lack of mental health providers, comorbidity and multimorbidity of patient illness, and stigma associated with seeking mental health services. The very nature of rural primary care allows for patients to be comfortable with their PCP and therefore, rely on the strong foundational relationship they have in entrusting them with their mental health concerns. Being a primary care provider in a rural setting offers both rewards and challenges unique to the rural culture.
The main goal of the study was to explore what might enhance, diminish, or otherwise give meaning to the rural primary care provider’s experience of engaging in discussions about mental health issues with their patients. This was achieved through identifying themes in response to two primary research questions. The primary research questions were: (a) How do rural primary care providers engage in conversations about mental health issues with their patients?; and (b) What are factors of being in a rural setting that affect and/or influence the primary care provider in having these conversations?
Data from ten participants across the three rural primary care clinics was analyzed using the qualitative method of thematic analysis to identify embedded themes. Five themes were revealed: (a) The relationship between the patient and the rural primary care provider allows for the conversation about mental health issues; (b) Rural primary care providers routinely provide mental health services; (c) Rural primary care providers experience challenges treating complex mental health issues; (d) Rural primary care providers navigate barriers in rural communities; and (e) There are benefits and drawbacks of rural living.
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Ferens, Christine L. "Treatment of Patients with a Mental Illness in Emergency Services." Thesis, Capella University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10936352.
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The purpose of this action research study was to examine the effects of the stigma of mental illness towards individuals with mental illness on services provided by medical professionals, specifically, registered nurses who work in an emergency department (ED). There have been numerous studies on how attitudes towards mental illness can be present in health care professionals; however, none that focused specifically on the attitudes of ED nurses. Nurses working in the ED are often the first health care professional a patient with mental illness sees and their attitude can influence the rest of the ED visit. The Opening Minds Scale for Health Care Workers (Modgill, Patten, Knaak, Kassam, & Szeto, 2014. “Opening Minds Stigma Scale for Health Care Providers (OMS-HC): Examination of Psychometric Properties and Responsiveness”) and the Caring Nurse Patient Interaction Short Form (Cossette, Cote, Pepin, Ricard, & D’Aoust, 2006. “A Dimensional Structure of Nurse-Patient Interactions from a Caring Perspective: Refinement of the Caring Nurse-Patient Interaction Scale (CNPI-Short Scale)”) were used to measure attitude towards stigma and the perception of the care a nurse gives a patient. Thirty-four nurses from two emergency departments participated in the research with the expectation of there being high levels of stigma which would in turn affect the care given to the patients with mental illness. Descriptive statistics, multiple regression and ANOVA were used to find low to moderate levels of stigma of mental illness, and these nurses had a perception of providing excellent care to their patients. This is in contrast to other studies finding moderate to high levels of stigma in general among health care professionals. This information can be useful in exploring and then using any policies and procedures present in the research sites for the benefit of other emergency departments. Additional research is planned to further review these sites and other emergency departments within the hospital network to ascertain if these results hold true, and if so, identify the dynamics involved.
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Karger, Graeme. "Staff perceptions of Positive Behavioural Support in a secure forensic adult mental health setting." Thesis, Cardiff University, 2016. http://orca.cf.ac.uk/95815/.
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Background: The application of Positive Behavioural Support (PBS) has been widespread across educational and learning disability settings, typically in supporting individuals who exhibit challenging behaviour. Following espousal in various national policy and guidance, PBS is now being applied in the area of secure forensic adult mental health. To date, very little is known about the application of PBS in this area. This study aims to understand how staff within a secure forensic adult mental health setting perceive the application of PBS. Method: Using semi-structured interviews, 11 multi-disciplinary staff members were interviewed regarding their perceptions of PBS. The data was collected and subject to a qualitative thematic analysis. Results: Five themes were identified from the data relating to staff perceptions of PBS, these were: 'The functions', 'Appraising a new approach', 'Collaborative challenges', 'Staff variables' and 'Organisational issues'. Conclusion: PBS translates to a forensic mental health setting and is generally appraised positively by staff. There are however a number of issues that are perceived to impact the delivery of PBS, many of these are consistent with existing PBS literature, however a number arise from the unique nature of providing an approach underpinned by social role valorisation in a context of containment and disempowerment.
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Wilkinson, H. "Staff empathy and burnout in forensic mental health services : the impact of psychological formulation." Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3003382/.
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Doyle, Patrick. "Social climate and staff based interventions in forensic mental health settings : a research portfolio." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/26016.
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Aims: The aims of this thesis were focused on the social climate of inpatient forensic mental health settings. Firstly, the study reviewed the literature of qualitative studies of staff and patient experiences of social climate. Secondly, the utility of a case study methodology to examine innovations to practice in forensic mental health settings are discussed. Thirdly, a longitudinal case study aimed to examine the impact of a Mentalization based treatment (MBT) training and case consultation intervention on the functioning of a low secure ward. Method: A systematic review and qualitative synthesis of social climate in forensic mental health settings was completed using the ‘best-fit’ framework approach. Secondly, a critical analysis of case study methodology was presented based on key decision points. A longitudinal ward case study with staff (n=37) and patient (n=7) participants examined the impact of staff MBT training and MBT based case consultation sessions. MBT based case consultation sessions ran on the ward over an eight month period. Data was collected through a range of methods including questionnaires, semi-structured interviews, ward observations and routinely reported data. The case study data was tested through a pattern matching approach with reference to rival explanations. Results: The systematic review identified 20 papers that met the inclusion criteria. The framework synthesis identified 22 themes related to social climate, which were organised in a conceptual model. Ten themes were seen to represent the experience of social climate. Consideration of the applicability of the case study method to forensic settings found the method to be feasible and acceptable to staff though a limitation is that outcomes are tentative and open to rival explanations. Positive impacts of the training and case consultation intervention included an increase in enthusiasm for working with patients with a personality disorder diagnosis and evidence of some increased team cohesion. The main rival explanation identified was the impact of changes to the composition of the staff and patient group. Conclusions: The systematic review findings highlight that current quantitative measures of social climate may not fully represent the construct. The conceptual model developed allows for generation of potential interventions to improve social climate. In the case study, staff reported positive perspectives of both MBT training and the case consultation sessions. The intervention did not appear to impact on patient motivation, though patients reported positive changes in staff behaviour. The case study method was seen as applicable to forensic mental health settings and provided interpretable data useful for analytical generalisations, and clinically in considering innovations to practice.
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Burdock, Matthew. "Burnout in secure forensic mental health services for young people : a mixed methods approach." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/402565/.
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Occupational burnout is highly prevalent in mental health services and has a deleterious effect upon the psychological wellbeing of staff. Few studies have explored burnout in inpatient settings; those that have do not address the possible systemic impact. This study aimed to explore burnout and emotional reactions to behaviour that challenges in a secure forensic mental health service for young people; a specialised environment in which severe and frequent incidences of aggression and violence occur. Following a systematic review of burnout literature pertaining to inpatient mental health services, an empirical study was conducted using a convergent parallel mixed method design. Forty three staff members were recruited to the quantitative strand and ten were recruited to the qualitative strand. Emotional Reactions to Challenging Behaviour Scale (ERCBS) and Maslach Burnout Inventory (MBI) instruments were used. A significant moderate positive correlation was found between emotional exhaustion and negative emotional reactions to behaviour that challenges. This relationship was mediated by general self-efficacy, which buffered the effect of emotional exhaustion on negative responses to behaviour that challenges; responses found to be detrimental to the relational environment. ‘Young People Blame Themselves’ was explored as a relational barrier and maintaining factor in occupational burnout. In ‘You Want Someone You Recognise’ and ‘We Lack That Consistency’ a high ratio of agency staff and a lack of operational consistency were identified as occupational stressors. Emotional exhaustion is associated with negative emotional reaction to challenging behaviour. Interventions should be targeted towards developing staff self-efficacy, through the use of reflective practice and ecological changes that enhance team-working and feelings of safety on the ward. When on the ward, staff should be mindful of young people’s predisposition towards attribution bias. Future studies need to give greater consideration to systemic outcomes associated with burnout.
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Hunter, Stephanie Victoria Elizabeth. "Exploring metacognition in the narratives of therapeutic ruptures with staff within forensic mental health." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6718/.
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Introduction: It has been argued that a capacity for metacognition in relation to others could be a key underpinning quality required in a mental health worker to develop positive therapeutic relationships. It is likely that forensic mental health staff are exposed to difficult and potentially threatening situations as a result of their patients’ complex backgrounds and risk. Aims: The study aimed to pilot and develop a methodology to explore and code metacognition and causal attributions in the context of staff reflecting on their experiences of resolved and unresolved therapeutic ruptures. In addition the study sought to explore associations between metacognition and measures of ward atmosphere and staff burnout. Methods: Twenty members of staff working within a medium secure forensic mental health service volunteered to participate in the study. Participants were asked to recall two experiences where there had been a rupture in the therapeutic relationship, one where the situation had been resolved, and one where it was unresolved. Participants also completed the Ward Atmosphere Scale (WAS) and the Maslach Burnout Inventory (MBI). Interviews were transcribed and coded using the Metacognitive Assessment Scale (MAS) and the Leeds Attributional Coding System (LACS). Results: Analysis of the MAS found that participants had significantly lower levels of metacognition for the unresolved situation than the resolved situation. Positive correlations were found between overall MAS scores and three of the WAS subscales. The majority of attributions made were where the patient was the Agent/Cause and the staff-member/speaker was the Target. Discussion & Conclusion: We were able to identify changes in metacognition across different experiences of ruptures in the therapeutic relationship. These findings have implications regarding the suggestion of further research on a larger scale with improved methodology. These studies may prove useful in developing methods to enhance staff metacognition in response to therapeutic ruptures.
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Cordingley, Kevin John. "How do occupational therapists practising in forensic mental health know? : a practice epistemology perspective." Thesis, Brunel University, 2015. http://bura.brunel.ac.uk/handle/2438/12205.
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My research explored the knowledge of occupational therapists practising in forensic mental health. There is no ‘gold standard’ evidence in this practice area but other forms of evidence, including experience and “intuition”, are used in practice. My research aimed to identify the knowledge formed from and used in this practice area. My research design used qualitative methodology that was informed by American pragmatist, social constructivist and post-modern theory. In particular, I used grounded theory and situational analysis to generate and to analyse the data. The practitioners were three occupational therapists working in various forensic services in one London based NHS trust. My data was generated longitudinally over eight to twelve months, where the practitioners participated in email and face-to-face interviews. The critical incident technique and the critical decision method enabled practitioners to describe and explain their knowledge about one patient with whom they were working over the interviews. The practitioners also reflected upon participating in the research. My findings demonstrated that the practitioners’ knowledge was created from practice through the interaction of three categories. First, steps of practice were structures through which knowledge was generated about the service user. Second were rules for practice where expectations had to be met. Unpredictable situations and knowledge gaps prevented meeting expectations, so new knowledge was created from practice to meet them. The third category was a blend of the practitioners’ personal and professional experiences and emotions. Practitioners created a connection with service users in order to build a therapeutic relationship, alongside creating a nuanced narrative with their service users, which helped to build empathy. In conclusion, the practitioners in my research used various forms of knowledge in practice. My thesis contributes to existing scholarship by supporting a practice epistemology approach. Thus knowledge for occupational therapy in forensic mental health is created from practice.
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Wilkinson, Catherine Elizabeth. "An exploration of service users' experiences of a low secure forensic mental health service." Thesis, University of Leeds, 2008. http://etheses.whiterose.ac.uk/428/.
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This is an exploratory study of the experiences of service users in forensic mental health settings, including how service users make sense of these experiences and their link to identity. Current research into forensic mental health services is very limited (Coffey,2006). Research has focussed on describing specific events but has not explored how service users have experienced their environment, relationships, and treatment. The information that has been gathered has focused on medium and high secure settings with very little research having been conducted in low secure setting settings. There was therefore a need for further research to inform clinicians and influence their practice so as to reduce psychological distress and risky behaviour, and to work towards recovery and reintegration into the community. Semi-structured interviews were conducted with six service users from a low secure forensic mental health service to explore experience. These accounts were analysed using Interpretative Phenomenological Analysis (Smith, 1995) to create themes that reflected experiences, understanding of these experiences and identity. Individual cases and group themes have been presented. Service users described a range of experiences such as feeling vulnerable, experiencing life as having been interrupted and valuing positive experiences with other people. Their understanding of these experiences fell into four categories: biological, psychosocial stress, behavioural and experience as being senseless. Participants used a range of ways from each category to make sense of their experience and these were sometimes contradictory. There was also a theme of participants trying to make sense of other people's thinking. Each participant had a combination of ways of understanding that was individual to them. Participants evaluated their character, ability and affiliation to help define their identity. These evaluations had an interpersonal aspect. The findings of the study have been discussed in relation to research from settings with different levels of security. They have also been discussed in relation to social psychological frameworks such as Symbolic Interaction (Blummer, 1938,1969), Social Representation Theory (Moscovici, 1973) and Social Identity Theory (Tajfel and Turner, 1986) to help understand meanings and how identity is shaped by experience. Clinical implications have been discussed. These include increasing opportunities for meaningful activities and relationships, and working with service users to help them to find ways of coping with their internal experiences, to feel empowered and take an active role in their recovery, and to build positive identities.
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Dickinson, Philip Geoffrey. "Patients diagnosed with non-epileptic seizures: their perspective and experience." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=96809.
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Patients that suffer from psychogenic non-epileptic seizures are confronted with many obstacles in seeking effective treatment for their illness. Underlying many of these obstacles is the divergence between the medical model and the patient's perception of their illness. The objective of this qualitative study is to elucidate, through semi-structured interviews, the subjective illness and treatment experience of these patients, in order to answer the research question: How do non-epileptic seizure patients make sense of their illness experience? This may allow a better understanding of the impediments to proper care that the patients encounter. The results showed that the participants that implicitly incorporated epilepsy as an illness prototype demonstrated less effective treatment expectations and imposed greater life constraints on themselves, than the participant that utilized anxiety attacks as an illness prototype. The participants that defined an explanatory model with a psychosocial basis for illness onset were receptive and demanding of psychotherapeutic intervention. The importance of early diagnosis and improved diagnostic strategies is emphasized. Two overarching interconnected themes that emerged, loss of control and an inability to communicate appeared to characterize the underlying internal struggle that permeated the illness and treatment experience of the study participants.Les patients qui souffrent de crises non épileptiques psychogènes doivent faire face à de nombreux obstacles dans la recherche d'un traitement efficace de leur maladie. L'origine de beaucoup de ces obstacles est la divergence entre le modèle médical et la perception du patient de sa maladie. L'objectif de cette étude qualitative est d'élucider, au moyen d'entrevues semi-structurées, l'expérience subjective de la maladie et du traitement de ces patients, afin de répondre à la question de recherche : Comment les patients non épileptiques donnent-ils un sens à leur expérience de la maladie? Cela peut permettre une meilleure compréhension des obstacles aux soins appropriés que rencontrent les patients. Les résultats ont démontré que les participants qui ont implicitement accepté l'épilepsie comme prototype de la maladie s'attendent à des traitements moins efficaces et s'imposent des contraintes de vie plus sévère que les participants qui ont accepté les crises d'angoisse comme prototype de la maladie. Les participants qui ont défini un modèle explicatif avec une base psychologique dès les débuts de la maladie ont été plus réceptifs et enclins à demander l'intervention psychothérapeutique. L'importance d'un diagnostic précoce et de l'amélioration des stratégies de diagnostic ressort de l'étude. Les deux grands thèmes qui ont émergé de l'étude : la perte de contrôle et l'incapacité à communiquer la détresse caractérisent l'apparent conflit interne sous-jacent et relié qui imprégnerait l'expérience de la maladie et le traitement des participants à l'étude.
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Cancino, Ramon Samera. "Health services utilization of adult dual eligible patients with mental health illness, 2011." Thesis, Boston University, 2014. https://hdl.handle.net/2144/21129.
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Thesis (M.S.H.P.)BACKGROUND: Dual eligible (DE) patients qualify for Medicare and Medicaid. There are approximately nine million DE patients in the United States, and healthcare costs for this population totaled 319.5 billion dollars in 2011. Behavioral health illness (BHI) is a risk factor for increased healthcare service utilization. The healthcare utilization of adult DE patients <65 years of age with BHI has been studied sparsely. This study sought to describe the adult DE patient population <65 years of age at an urban academic safety net health center and compare hospital and emergency department (ED) utilization of those with and without BHI. METHODS: The study was a secondary analysis of hospital administrative data. Inclusion criteria were patients with Medicare and Medicaid between ages 18 and 65 years, who utilized Boston Medical Center between 1/1/2011 and 1/1/2012. The independent variable was diagnosis of BHI, and the dependent variables were hospital admission and ED utilization. Chi-square and Wilcoxon rank-sum tests were used for descriptive statistics on categorical and continuous variables, respectively. Greedy propensity-score matching without replacement with a caliper distance of half of a standard deviation was used to control for confounding factors. Rate ratios (RR) and confidence intervals (CI) were determined after matching and after adjusting for those variables that remained significantly different after matching. RESULTS: Pre-propensity-score matched data showed significant differences in age, sex, race/ethnicity, marital status, education, employment, physical comorbidities, and Charlson Comorbidity Index score. Post-propensity-score matched analysis found significant differences in sex, Hispanic race, and other education and employment status. As compared to those patients without BHI, patients with BHI had RR 2.07 (CI: 1.81- 2.38) (p<.0001) of hospital admission and a RR 1.61 (CI:1.46-1.77) (p<.0001) of ED utilization. After adjustment, RR for hospital admission and ED utilization remained significantly different and even increased slightly, RR 2.14 (CI: 1.87-2.46) (p<.0001) and RR 1.64 (CI:1.49-1.81) (p<.0001), respectively. CONCLUSION: As compared to DE patients without BHI, those with BHI had significantly more hospital admission and ED utilization, even after controlling for confounding factors. Results suggest interventions for decreasing healthcare services utilization in this population should focus on those DE patients with mental health illness.
2031-01-01
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Lander, Tammy D. Heilbrun Kirk. "The content and quality of forensic mental health assessment : validation of a principles-based approach /." Philadelphia, Pa. : Drexel University, 2006. http://dspace.library.drexel.edu/handle/1860/745.
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