Dissertations / Theses on the topic 'Prison mental health care'

Recent cross-sectional studies have confirmed that the prevalence of mental disorder in English prisons is high but they provide little insight into the fate of the mentally disordered in prison. This thesis concentrates on a longitudinal study of mental disorder in 569 unconvicted adult male remand prisoners received into Durham prison between 1 October 1995 and 30 April 1996. Subjects were interviewed at reception by psychiatric researchers and monitored throughout the remand period. The data collected was used to establish the prevalence of mental disorder and substance misuse at reception into prison, effectiveness of prison reception screening, number of mentally disordered subjects identified and referred for psychiatric assessmentn, ature of psychiatric interventions, and final disposal of all subjects. Additional research was undertaken at Durham to evaluate health care provision at this prison, and, in order to comment on the generalisability of the findings, health care facilities at other prisons in England and Wales were investigated. More than a quarter of subjects at Durham prison were suffering from mental disorder. Serious disorders were especially prevalent and one in twenty remands was acutely psychotic. Drug and alcohol misuse was the norm. More than half of our subjects received current substance abuse or dependence diagnoses. Prison reception screening failed to identify nearly 80% of subjects with mental disorder, including 75% of those with acute psychosis. The treatment needs of the majority of mentally disordered subjects were overlooked in prison. Just over one quarter of mentally disordered subjects were referred for a psychiatric assessment. Contact with psychiatric services was frequently hampered by the prison regime and the actions of the courts. This resulted in acutely psychotic prisoners being released without adequate treatment or follow-up. Help for prisoners with drug and alcohol related problems was minimal. Detoxification regimes were insufficiently prescribed leaving the majority of subjects addicted to opiates, benzodiazepines and alcohol at risk of serious withdrawal. Inadequate resources, a lack of suitably trained health care staff, low morale and staff sickness hampered the delivery of effective health care at Durham prison. However, staff attitudes, institutionalised practices and negative responses from prisoners also made a significant contribution. Further inquiry indicates that Durham. prison is not unique in these respects. Problems of a similar nature are endemic in the Prison Health Service. Indeed, when the history of this organisation is traced it is apparent that such difficulties have plagued it throughout its existence.

One consequence of the deinstitutionalisation of psychiatric care and increase in community care is the rising number of mentally ill people in prison populations where there are insufficient mental health professionals and services to address the treatment and rehabilitation needs of psychiatrically unwell prisoner patients. People with mental illness are over-represented in prison populations, and the provision of mental health services is a difficult task in an environment where discipline and safety take precedence over health treatment. This research investigated attitudes, perceptions, and experiences of prisoners, health professionals, and correctional staff in relation to mental illness and mental health service provison across eight prisons in Western Australia. The research aimed to gain a deeper understanding of experiences within prisons. Perceptions, attitudes and experiences of participants were explored using a mixed methods approach; both qualitative and quantitative methods were employed to gather information in a ‘two phase sequential design’ (QUAL/QUAN) (Creswell and Plano Clark 2007). The Phase One key informant interviews (n=17), and the key themes identified in the literature review, informed the development of the Phase Two quantitative survey questionnaires (n=168). These Phases acted as two different ways of exploring the research questions.One consequence of the deinstitutionalisation of psychiatric care and increase in community care is the rising number of mentally ill people in prison populations where there are insufficient mental health professionals and services to address the treatment and rehabilitation needs of psychiatrically unwell prisoner patients. People with mental illness are over-represented in prison populations, and the provision of mental health services is a difficult task in an environment where discipline and safety take precedence over health treatment. This research investigated attitudes, perceptions, and experiences of prisoners, health professionals, and correctional staff in relation to mental illness and mental health service provison across eight prisons in Western Australia. The research aimed to gain a deeper understanding of experiences within prisons. Perceptions, attitudes and experiences of participants were explored using a mixed methods approach; both qualitative and quantitative methods were employed to gather information in a ‘two phase sequential design’ (QUAL/QUAN) (Creswell and Plano Clark 2007). The Phase One key informant interviews (n=17), and the key themes identified in the literature review, informed the development of the Phase Two quantitative survey questionnaires (n=168). These Phases acted as two different ways of exploring the research questions.

Researchers have suggested that jails and prisons in the United States are becoming the new mental health clinics, contributing to the phenomenon of mass incarceration and costing upwards of $15 billion per year in public revenue. The problem is no conclusive evidence exists that treatment in these custodial environments is more effective than that provided by noncustodial programs; especially for substance users. Additionally, the continuing incarceration of people with mental health problems by the hundreds of thousands poses a difficult ethical dilemma regarding why this population does not receive noncustodial or hospital treatment instead. The study addressed the research question of whether there is a significant difference in individual patient treatment plan completions that points to differences in the effectiveness of custodial and noncustodial mental and substance use disorder treatment programs. The study was guided by self-determination theory. Archival data reported through the Statewide Maryland Automated Tracking System comparing the number of complete and incomplete treatment plans of 1 custodial (n = 940) and 1 noncustodial (n = 534) mental health treatment program in Maryland, were analyzed using a Pearson's chi-square test of independence .The analysis showed that while custodial treatment plans were more effective, both custodial and noncustodial had high failure rates, and custodial plan success may be limited to the period within custody. This study may impact social change by informing justice policy and lawmakers about the need for continued research to provide effective interventions for substance users that transcends custodial boundaries.

Mental health treatment in state prisons is revealed to be highly variable, under-funded, and systematically inadequate. Existing literature exposes this injustice but fails to provide a comprehensive proposal for reform. This paper attempts to fill that gap, outlining a cost-effective, evidence-based treatment proposal, directly addressing the deficits in care revealed through analysis of our current system. In addition, this paper provides historical overviews of the prison system and mental health treatment, utilizing theoretical perspectives to contextualize this proposal in the present state of affairs. Lastly, the evidence is provided to emphasize the potential economic and social benefits of improving mental health treatment in state prisons. Significant findings suggest a clear financial, legal, and moral incentive for states to address this issue, while the proposal provides a viable method of doing so.

Females are becoming a prominent population within America’s correctional facilities, which has led to incarcerated females increasingly becoming the popular subjects of more recent research. Along with the growing population of female inmates, the rates of sexual and physical victimization reported by incarcerated females is rapidly growing. The purpose of this project is to evaluate the pre-established correlation between mental health diagnoses, and the prior physical and/or sexual abuse of female inmates within the custody of correctional institutions, outline the current treatment process, and devise a revision of the treatment process in order to improve the future of mental health care for incarcerated females. First, a brief description of the increasing female inmate population, their significant mental health care needs, and the lack of effective mental health care they are actually receiving, followed by the issues that this poses to rehabilitation and the community will be provided. Second, an examination of the commonality of childhood physical and/or sexual abuse among the female offenders that have been diagnosed with mental illnesses will be conducted. Next, a discussion of the most common mental health diagnoses of incarcerated women, what they are said to be caused by, and how they are being treated behind bars will be directed. Finally, a conclusion covering the established relationship between physical and sexual abuse and adult mental illnesses, the issues that the lack of adequate mental health care for incarcerated females poses, and what can be done to change and improve the future will be presented.

RESUMO: A população prisional é constituída por indivíduos geralmente sujeitos a alguma forma de exclusão social e que apresentam problemas de saúde física e mental mais frequentes do que na população em geral. A prevalência mais elevada de perturbações mentais e de suicídio nos reclusos, em relação à população civil, é consensual e está demonstrada em numerosos estudos internacionais. O abuso/dependência de substâncias, a depressão, as psicoses e a perturbação anti-social de personalidade são as perturbações mais comuns na população prisional. As perturbações mentais são importantes factores de risco de suicídio, de vitimização, de reincidência e de reentrada no sistema prisional. Assim sendo, o grupo de reclusos com perturbação mental constitui um grupo de risco relevante. A avaliação de necessidades de cuidados foi iniciada no Reino Unido como um método para o planeamento, medição dos resultados e financiamento dos cuidados de saúde. Para esta avaliação foram desenvolvidos instrumentos que avaliam as necessidades em diversos domínios (clínicos e sociais) para aplicação aos utentes, cuidadores e profissionais. Até aos anos noventa, a avaliação de necessidades no contexto prisional incidia especialmente nas necessidades de segurança dos serviços, segundo a perspectiva dos profissionais. Contudo, a partir do relatório Reed (1992), sobre a situação dos reclusos com perturbação mental, verificou-se uma abordagem mais abrangente, que incluía a avaliação das necessidades de cuidados dos reclusos. Embora as necessidades dos reclusos com perturbação mental pareçam ser similares às dos doentes psiquiátricos em geral, existem diferenças em determinados domínios como a comorbilidade do eixo II, o abuso de substâncias e o risco de violência. Por este motivo, as necessidades de cuidados de saúde mental dos reclusos são elevadas e frequentemente não se encontram satisfeitas. De forma a incluir estas especificidades foi desenvolvida a versão forense do Camberwell Assessment of Need (CAN), designada por CAN - Forensic Version (CANFOR). Actualmente existe um consenso generalizado entre as instituições internacionais do dever de proporcionar aos reclusos cuidados de saúde, de prevenção e de tratamento, equivalentes aos cuidados disponíveis para a população civil - o princípio da equivalência de cuidados. A presente investigação pretendeu caracterizar e avaliar as necessidades de cuidados dos reclusos acompanhados nos serviços de psiquiatria prisionais na área da Grande Lisboa (internamento no Serviço de Psiquiatria do Hospital Prisional de S. João de Deus (HPSJD) e consultas nos Estabelecimentos Prisionais (EP) de Caxias e de Tires). De modo a estabelecer uma comparação com sujeitos civis foi seleccionada uma amostra de conveniência de pacientes acompanhados num departamento de psiquiatria da mesma região, segundo um emparelhamento por sexo, escalão etário, e por diagnóstico, num período de 3 meses. Realizou-se um estudo de tipo observacional, transversal e comparativo. Aplicaram-se os seguintes instrumentos de avaliação: questionário específico, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning, CAN-R e CANFOR-R. No período do estudo (12 meses) foram assistidos 149 reclusos, dos quais, 35 (23,5%) não cumpriram os critérios de inclusão. A amostra final de reclusos (PRs) (n=114) foi constituída por 79 homens (69,3%) e 35 mulheres (30,7%), dos quais 77 eram condenados (67,5%) e 37 (32,5%) encontravam-se detidos preventivamente. A amostra final de participantes civis (PCs) foi constituída por 121 indivíduos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%).A amostra final de participantes civis (PCs) foi constituída por 121 indivíduos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%). Relativamente aos PRs, o diagnóstico mais frequente foi a Perturbação Anti-social da Personalidade (57,9%), seguida pela Depressão Major (56,1%). A maioria (53,5%) apresentava três ou mais categorias diagnósticas. Aproximadamente um terço dos PRs (30%) pontuou o nível elevado de risco de suicídio. A probabilidade deste risco aumentava, significativamente, nos portadores de Depressão Major, de um maior nível de psicopatologia e de uma condenação actual. Perto de metade dos PRs (47,4%) possuía duas ou mais condenações prévias e mais de metade estavam envolvidos em crimes contra pessoas (53,5%). A probabilidade de condenações múltiplas foi significativamente superior nos portadores de Perturbação Antisocial da Personalidade e nos reclusos com maior número de necessidades totais. Entre os PRs dos dois sexos, as principais diferenças significativas residiram na maior frequência de consumo de substâncias e no maior número de necessidades de cuidados nãosatisfeitas nos homens versus mulheres. A comparação entre os PRs, antes da detenção, e os PCs mostrou que os primeiros possuíam menor escolaridade, menos medicação psiquiátrica, mas mais emprego e mais consumos de substâncias ilícitas. A Perturbação Anti-social da Personalidade (OR=26,4; IC95%: 10,7-64,9), a Perturbação Pós-stress Traumático (OR=15,0; IC95%: 3,5-65,4), a Dependência/Abuso de Substâncias (OR=8,5; IC95%: 4,2-17,6) a Depressão Major (OR=2,6; IC95%: 1,5-4,4) e o Risco de Suicídio Elevado (OR=2,6; IC95%: 1,4-5,0) foram significativamente mais frequentes nos PRs versus PCs. Relativamente à avaliação de necessidades de cuidados, os PRs mostraram maior número de necessidades não-satisfeitas e maior necessidade de ajuda profissional, em relação aos PCs. Embora diversas necessidades não-satisfeitas possam resultar da condição de recluso, outras, em domínios da saúde física, da segurança do próprio e dos consumos tóxicos, poderão indicar que os PRs recebem um nível de cuidados inferior ao necessário, em comparação com os PCs. Os PRs apresentaram patologia mental, predominantemente não-psicótica e elevado risco de suicídio/auto-agressão, associado a depressão, necessidades de cuidados e uma pena de prisão. Possuíam, numa frequência elevada, características, consistentemente, associadas à reincidência criminal (personalidade anti-social, consumos tóxicos, condenações anteriores), pelo que se justifica um especial acompanhamento deste grupo, no período pré e pós-libertação. A comparação de necessidades de cuidados no contexto civil e prisional indica um maior nível de necessidades e um menor nível de cuidados recebidos pelos PRs, em relação aos PCs. O princípio da equivalência de cuidados poderá estar comprometido nos indivíduos reclusos com perturbação mental. A utilização do CANFOR foi fácil e poderá contribuir para um melhor planeamento, oferta e avaliação de resultados ao nível individual. Os PRs e PCs revelaram características clínicas e de necessidades muito diferentes entre si, pelo que, os reclusos com perturbação mental deverão ser assistidos em serviços de saúde mental preparados para abordar as suas especificidades.---------------ABSTRACT: The prison population is generally made up of individuals who are usually subject to some sort of social exclusion and who show physical and mental problems more frequently than the general population. Various international studies have found higher rates of mental disturbances and suicide within the prison population. The most common mental disturbances found are substance abuse or dependency, depression, psychosis, and anti-social personality disturbance. Such mental disturbances are important factors in suicide, victimization, delinquency recurrence, and the risk of reentry into prison. As a result, prison inmates with mental disturbances are a relevant at risk group. Assessment of needs of care first started in the United Kingdom as a method of care planning, results measuring and finance health care. The method involved the development of certain measuring instruments to be used by patients, caregivers and professionals in order to evaluate needs in various domains (clinical and social). Until the nineties, the assessment of needs of care in a prison context focused mainly on the service’s security needs. However, after the Reed (1992) report on mentally disturbed inmates, a much wider approach was considered, which included evaluation of the inmate’s needs of care. However similar mentally disturbed prison inmates’ needs may appear to those of other psychiatric patients, there are some differences in particular domains, namely, co-morbidity of Axis II, substance abuse and the risk of violence. For this reason, inmates’ mental health care needs are high and very often not met. In order to include these specificities, a forensic version of the Camberwell assessment of need (CAN,) designated CAN – Forensic version (CANFOR) was developed. There is now generalized consensus among international institutions of the duty under the equivalent health care principle to provide inmates with preventative health care and treatment, that are equivalent to the care available to the civil population. This investigation aims to characterize and assess the health care provision of prison inmates admitted to Lisbon’s Psychiatric Prison ward - the Psychiatric Ward of São João de Deus Hospital (HPSJD) - and inmates in the Caxias and Tires Prison Establishments (EP) undertaking outpatient treatment. In order to establish a comparison between prison and civilian patients, a convenience sample was selected from civilian patients being treated in a psychiatric ward in the same geographical area. This sample was paired by gender, age group and diagnosis during a three month period. The study was observational, transversal and comparative. The following measuring instruments were used: a purpose-built questionnaire, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning Scale, CAN-R and CANFOR-R. During the research period (12 months), 149 inmates received care, of whom 35 (23.5%) did not comply with the prerequisite criteria of this study. The final sample of inmates (PRs) (n=114) comprised 79 men (69.3%) and 35 (30.7%) women, of whom 77 (67.5%) were convicted prisoners and 37 (32.5%) were in preventive custody. The final sample for Civilian Participants (PCs) was made up of 121 individuals, of whom 76 (62.8%) were men and 45 (37.2%) were women. The most common diagnosis among the PRs was Anti-Social Personality Disorder (57.9%), followed by Major Depression (56.1%). More than half of the subjects in the sample (53.5%) showed three or more diagnostic categories. Approximately one third (30%) of the PRs showed a high level of suicide risk. The probability of this risk was significantly higher among Major Depression patients, those showing a higher level of psychopathology and those with a current conviction. Almost half of the PRs (47.4%) had been given two or more prior convictions and more than half (53.5%) were involved in crimes against people. The probability of multiple convictions was significantly higher among inmates with Anti-Social Personality Disorder and in those with more total needs. With regard to gender, the main significant difference among the PRs was that men were found to have a higher frequency of substance use and a greater number of unsatisfied caring needs than women. Comparison between the PRs prior to detention and PCs revealed that the former held lower educational qualifications and received less psychiatric medication, but had higher levels of employment and showed greater consumption of illicit substances. In addition Anti-Social Personality Disorder (OR=26.4; IC 95%: 10.7-64.9), Post-Stress Traumatic Disturbance (OR=15.0; IC 95%: 3.5-65.4), Substance Dependency/Abuse (OR=8.5; IC 95%: 4.2-17.6), Major Depression (OR=2.6; IC 95%: 1.5-4.4), and High Suicide Risk (OR=2.6; IC 95%: 1.4-5.0) were significantly more frequent amongst PRs than PCs. The results for needs assessment revealed that the PRs showed higher levels of unmet needs and a greater need for professional help in comparison with the PCs. Although various unmet needs may result from the inmate’s condition, other needs - in particular those regarding physical health, personal security and toxic substance use - suggest that the care given to PRs may be inadequate in comparison with that given to PCs. This implies that the principle of equivalent health care for PRs with mental illnesses may not be upheld. Furthermore, the mental morbidity results of the PRs indicated that they suffer predominantly from non-psychotic and high suicide/self inflicted aggression risk associated with depression, caring needs and a prison sentence. They also often showed characteristics that are consistently associated with criminal recidivism (Anti-social Personality, use of toxic substances, prior convictions). This result justifies that there should be special follow-up for this group in the pre- and after release period. The use of CANFOR proved to be simple and the application delay was acceptable. No difficulties were encountered in the understanding of its categories by its users. As a result, itcould contribute towards better planning, supply and assessment of results at an individual level. Given that the PRs and PCs revealed different clinical and needs characteristics, it is recommended that inmates with mental disturbances should be assisted in mental health services that are adequately prepared to address their specificities.

A qualitative study of the experiences and observations of 4 art therapists and 2 program directors who facilitated Camp Suzanne, a week-long art-based therapeutic program for incarcerated mothers and their children in a federal prison in California. Research on psychotherapy, art therapy, and family therapy in prison environments, with a focus on parent-child dyads, Attachment Theory, and various techniques for creating sustainable therapy with separated family units, including tele-mental health and evidence-based military protocols, informed the interviews. The research participants were interviewed individually and created art regarding the subjects of Attachment Theory with incarcerated-mother-child dyads and longevity considerations for the program. Emergent themes in the data included the impact of art-making on attachment and a variety of observable attachment styles, as well as obstacles to both attachment and longevity of Camp Suzanne. Some of the obstacles addressed include systemic challenges, continuity of care, location concerns, external support (for facilitators and for incarcerated-mother-child dyads), as well as preparatory support (psychoeducation). Various implications of these obstacles are discussed.

This quantitative and qualitative study investigates the type and quality of health care and conditions of imprisonment that prevailed in some South African prisons in the late 1980s. It was inspired by political activists who were incarcerated, yet despite, or because of, the harsh conditions in prison persisted with their struggle for human rights. Appeals for the improvement of prison conditions which they submitted to the authorities are unique primary source documents. By implication, this survey adds value to their cause, for several issues examined in it had already been raised while they were in prison. With most information on prisons restricted until 1992, there was no body of literature on South African prison health care to review. Instead, Chapter 1 outlines the historical background of imprisonment in South Africa and key penal legislation. It also deals with events like the Biko affair which, in the recent past, affected the medical profession, the response of professional organisations to these events, and the national and international repercussions. Chapter 2 on the methodology describes the study design, data collection process and the limitations of the survey. Numerous attempts to interview District Surgeons and visit prisons were fruitless, consequently reducing the intended scope of the primary research. Because these external limitations affected the study design, they are discussed under methodology. A semi-structured questionnaire was developed to collect information about health care while imprisoned during the States of Emergency ( 1986-1990). Interviews based on this questionnaire were conducted with 123 ex-detainees from the Eastern and Western Cape. The results of the study are presented in Chapter 3, both quantitative, in the breakdowns of the data relating to each of the 14 questions, and qualitative, in the tables which reflect individual experiences and comments. The significance of these results is examined in the discussion in Chapter 4, backed by other supportive evidence. It begins by sketching general conditions of imprisonment, using unsolicited information from the interviewees, and proceeds to discuss health care services as they pertained during the study period. Many points of discussion also draw on the seven Case Reports and the report on North End Prison, Port Elizabeth, which have been added as an appendix to that chapter. The research indicates a disregard for the well-being of and failure to provide adequate health care for individuals at the mercy of detaining authorities. This situation was compounded by collusion among the forces of law and order and District Surgeons, and a scant response by academics and professional organisations to problems associated with imprisonment, isolation and torture. In the conclusion, Chapter 5, strategies for improving prison health care are explored. They are based on current national and international literature, policy and practice. The main proposals for reform are then summarised in the recommendations in Chapter 6. These range from revising legislation so as to accord with the constitutional rights of prisoners to addressing the training and attitudes of personnel, establishing health care standards and auditing mechanisms, and creating a more open prison system.

This thesis represents a sociological exploration of Her Majesty’s Prison Service, male prisoners’ mental health, and the provision of National Health Service mental healthcare in a prison setting. This qualitative social science study is conducted in one prison establishment. The work is characterised as a policy and practice orientated exploratory case study. The study implements an inductive approach to the datum–theory relationship, a constructionist ontological position, and an interpretivist epistemological orientation. Semi-structured interviews are conducted in a male category B prison with healthcare centre staff (e.g. registered general nurse, registered mental health nurse, health care assistant, plus varied administration and clinical management staff), the secondary mental health team (psychologist, psychiatrist, community psychiatric nurse), prison governors, prison psychologists, primary-level mental health service users/prisoners, and secondary-level mental health service users/prisoners. The subject of place is salient when deliberating the mental health of prisoners as a social group. The prison setting can fashion or exacerbate mental illness. In comparison to the general population, the prevalence of mental distress experienced by the prison population is exceedingly high. In order to consider issues that concern the mental health of prisoners (i.e. aetiology, prevalence, severity, interventions, and outcomes), the prison setting as a communal and procedural place requires attention. Therefore, this medical sociology study devotes attention to social and institutional arrangements that permeate the prison locale. As examples, these include prisoner–staff relations and prison regimes. The prison environment is not conducive to good mental health, and is not often a useful catalyst for mental healthcare for myriad reasons. Notably, the custodial treatment setting is important here. The provision of mental healthcare and the pursuit of good mental health in the prison milieu are challenging. Thus, the prison-based exceedingly complex three-way relationship between culture, mental health, and mental healthcare is addressed. As, if one wishes to provide appropriate healthcare in a prison, one also has to understand something about those for whom the healthcare exists. Knowledge of the specific patient group is important. Therefore, prison healthcare ought to be increasingly fashioned (i.e. commissioned, provided, managed, and practiced) in accordance with the prison social environment, the institutional set-up, and the specific health requirements of patients/prisoners. The proposition is that context is crucial to the provision of wholly apt prison mental healthcare. Study data are analysed thematically. Resultant themes include: the nature of clinician–patient/prisoner rapport; the working environment of the healthcare setting; the notions of healthcare provision and receipt in a custodial setting; patients’/prisoners’ perspectives regarding prison mental health; aspects concerning prison existence and mental healthcare users’ experiences; prison staff mental health knowledge, roles, and responsibilities; prison service and healthcare services collaborative working. The penal milieu in relation to an extensive variety of issues impacts mental health and mental healthcare. These range from the overarching ethos of imprisonment right through to individual interactions in the setting. To précis, mental healthcare provision and receipt experiences and environments are important for clinicians and patients/prisoners alike.

Background: Research predominantly from high income countries suggests that depression and anxiety are highly prevalent among prison inmates. With limited available research from low and middle income countries, this study aimed to estimate the prevalence of possible anxiety and depression among Malawian inmates and identify factors associated with these conditions. Methods: This cross-sectional study was conducted at Thyolo prison situated in the southernmost region in Malawi, from February to March 2018. A total of 378 male prison inmates were interviewed face-to-face using a general questionnaire examining sociodemographic characteristics, prisoners’ previous and current involvement with the prison services, and self-reported mental health problems. Validated screening instruments were used, including the Center for Epidemiologic Studies Depression scale (CES-D) to measure depression; while the Beck Anxiety Inventory (BAI) was used to measure symptoms of anxiety. Multiple logistic regression analyses were conducted to determine the association between anxiety, depression and related variables. Results: The prevalence of possible anxiety disorder and depressive disorder was 62.7% and 72.5% respectively. After adjusting for the effects of the other variables in the model, a multiple logistic regression found that anxiety was significantly associated with no support (AOR 1.65 95% CI: 1.02-2.66) and a previous mental disorder diagnosis prior to imprisonment (AOR 2.07 95% CI: 1.05-4.07); while depression was significantly associated with no support (AOR 5.19 95% CI: 2.66-10.14), and having two or more traumatic events (AOR4.30 95% CI 1.65-11.23). However, being divorced (AOR 0.12, 95% CI: 0.04-0.35) was found to be a protective factor for depression. In addition to this, no support (AOR 2.24 95% CI: 1.36-3.69) and a previous mental disorder diagnosis prior to imprisonment (AOR 2.10 95% CI: 1.05-4.22) were significantly associated with comorbid depression and anxiety. Conclusion: This study provided valuable insights into the prevalence and risk factors associated with possible depression and anxiety among prison inmates in Malawi. Therefore, regular screening of prison inmates for early detection and treatment of mental disorders would be beneficial to improve the quality of life of prison inmates.

The purpose of the descriptive, quantitative study was to examine recidivism rates of mentally ill incarcerated individuals. With data provided by the Florida Department of Corrections, the current study sought to describe recidivism rates of mentally ill offenders who, within three years of release, returned to prison. The use of descriptive statistics provided information through means, modes, and frequencies, which led to incorporating logistic regression to provide further details concerning recidivism. The sample consisted initially of more than 120,000 offenders released, and narrowed to more than 20,000 released with a mental health diagnosis in the studied time frame, 2005 to 2008. The study consisted of 11 categorical and individual diagnoses while incorporating analyses of demographics, crimes committed, educational level, past incarcerations, and other variables in relation to mental health diagnoses. The results identified those with a mental health diagnosis were more apt to return to prison within the three-year time frame than those with no diagnosis. Specifically, those with a Schizophrenia diagnosis had a higher recidivism rate than the other diagnoses studied. Other variables found positive for recidivism were age, gender, and prior prison arrest record.

This research explored correction officers’ perceptions and attitudes in relation to inmates with mental health issues. In a qualitative fashion, semi-structured interviews were conducted with five correction officers in Southern California (N = 5) during the Winter 2018 Quarter. Using thematic analysis, this study identified six major themes from the interview data: mental health has remained a prominent issue within the prison population; correction officers were fairly knowledgeable about mental health; correction officers perceived themselves as having to play a limited role in the rehabilitation of inmates with mental health problems; constant prompts in daily activities and medication management were two challenges encountered by correction officers in their interaction with inmates; correction officers’ progressive preparedness to serve mentally challenged inmates; and correction officers reported a need for more support and higher level of care within the prison system. Implications for the criminal justice system were discussed. Keywords: mental health, correction officers, inmates, preparedness, lack of support

The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings. The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health? Using a case study approach, this study drew upon qualitative methods to examine and identify the factors throughout the system, organizational, professional, and clinic levels that support CCO efforts to facilitate the integration of primary care and mental health. Fourteen primary interviews were conducted with executive and senior staff. In addition, eleven secondary interviews from a NIDA funded project as well as twenty-four key CCO documents from three CCOs were also included in this study. The RMIC was successful in differentiating extent of CCO integration of primary care and mental health. Findings demonstrate that normative and functional enablers of integration were most prevalent at the system and organization level for integrating mental health into primary care for these three CCOs. However, there was variation in CCO involvement in the development of functional and normative enablers of integration at the professional and clinic levels. Normative and functional enablers of integration were limited at all of the RMIC levels for integrating primary care into community mental health settings across all three CCOs. The Patient-Centered Primary Care Home model provided CCOs with an opportunity to develop functional and normative enablers of integration for integrating mental health in primary care settings. The lack of a fully developed model for integrating primary care services in community mental health settings serves as a barrier for reverse integration. An additional barrier is the instability of community mental health as compared to primary care; contributing factors include historically low wages and increased administrative burden. System wide conversations about where people are best served (i.e., primary care or community mental health) has yet to occur; yet these conversations may be critical for facilitating cross-collaboration and referral processes. Finally, work is needed to create and validate measures of integration for both primary care and community mental health settings. Overall findings confirm that integrating primary care and mental health is complex but that organizations can play an important role by ensuring the development of normative and functional enablers of integration at all levels of the system.

Although not typically considered formal mental health care professionals, clergy are regularly contacted as a resource by people with mental illness. Little is known about the clergy's role in this capacity. The aim of this research is to explore the experiences and perspectives of Canadian ministers of the United Church in response to mental health issues using simple qualitative description. Three female and nine male urban ministers of the United Church of Canada were recruited to participate in semi-structured interviews. Interviews were audio recorded, transcribed, and analyzed by hand for relevant themes. Themes within the following three main topics emerged: how ministers served people with mental illness, ministers' experiences working alongside formal mental health care professionals, and remaining challenges and facilitators. Ministers reported providing various support services for people with mental illness. While ministers reported little direct collaboration, they reported regularly referring people with suspected mental illness to formal mental health care professionals. Finally, ministers cited an innate trustworthiness in their profession and their community as facilitators, while remaining challenges included limitations in terms of financial resources, time, trust between themselves and formal mental health care professionals, and trust between ministers and their colleagues. The findings of this research indicate that collaborative relationships should be encouraged between formal mental health care professionals and ministers of the United Church to better serve people with mental illness.
N'étant généralement pas considérés comme des professionnels de la santé mentale, les membres du clergé sont régulièrement sollicités comme personnes ressources par des personnes atteintes de maladie mentale. On en connaît peu sur le rôle du clergé dans le domaine de la santé mentale. Le but de cette recherche est d'explorer les expériences et points de vue de pasteurs de l'Église Unie du Canada en réponse aux problèmes de la santé mentale à l'aide de la description qualitative simple. Trois femmes et neuf hommes pasteurs urbains de l'Église Unie du Canada ont été recrutés pour participer à des entrevues semi-structurées. Les entrevues ont été enregistrées, transcrites et analysées. Trois grands thèmes ont émergé : la façon dont les pasteurs mettent leurs services au profit des personnes atteintes de maladie mentale, l'expérience des pasteurs à travailler conjointement avec les professionnels des soins de santé mentale, et les défis restants et les mesures facilitant la prise en charge de ces personnes. Les pasteurs ont déclaré fournir divers services de soutien aux personnes atteintes de maladie mentale. Bien que les pasteurs aient signalé peu de collaboration directe des professionnels des soins de la santé mentale, ils ont déclaré leur diriger régulièrement des personnes soupçonnées d'être atteintes d'une maladie mentale. Finalement, les pasteurs ont déclaré avoir une confiance innée en leur profession et en leur communauté comme intervenants facilitateurs, bien que de nombreux défis se posent au niveau des ressources financières, du temps, de la confiance entre pasteurs et professionnels des soins de la santé mentale, ainsi que de la confiance entre les pasteurs et leurs collègues. Les résultats de cette recherche indiquent que les relations de collaboration entre les professionnels des soins de la santé mentale et les pasteurs de l'Église Unie devraient être encouragées pour mieux servir les personnes atteintes de maladie mentale.

This thesis explores equity issues in the mental health field in Britain by initially developing a conceptual structure to define equity in mental health and then analysing data from three national psychiatric morbidity surveys to measure inequalities and inequities in both mental health and in the use of services. Standard methods are used for measuring income-related and social class-related inequalities with reference to many indicators of mental health which represent 'normative' or 'felt' needs for services. Inequity in the use of mental health services is also examined by relating use of services to needs. Analyses of income-related inequalities and equity are carried out with reference to the general population using data from the Psychiatric Morbidity Survey 2000 and with reference to the minority ethnic groups in Britain using data from the survey of Ethnic Minority Psychiatric Illness Rates in the Community 2000. Changes in social class-related inequalities and equity for the general population between 1993 and 2000 are examined using data from the Psychiatric Morbidity Surveys for those two years, in order to see if the policy and practice changes that took place since the beginning of the 1990s in the health and social care sectors had exerted any impact on equity in mental health. The three mental health surveys being cross-sectional do not permit the study of causal pathways between income and mental health. Therefore, in order to understand the links between living standards, health and health care utilisation patterns further, data from a longitudinal study, the British Household Panel Survey on general health are examined using robust theoretical and empirical models. The assumption is that many of the factors associated with general health are also associated with mental health and much of the model that links income, health and health care utilisation behaviour is likely to be relevant for mental health as well.

This study aimed to determine if the Department of Behavioral and Mental Health at a local school district is improving the academic outcomes of the students it provides services to. The purpose was to evaluate its effectiveness in order to improve and expand services. This is important since schools have become a primary setting to address the mental health needs of children and youth. The research design consisted of a quantitative, one-group pretest-posttest as students’ outcomes were assessed before and after treatment. The data was analyzed using a paired samples t-test. The findings from this study demonstrated no statistical significance in students’ grades and attendance, thereby demonstrating the need for further research on this topic.

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1997.
Source: Masters Abstracts International, Volume: 45-06, page: 2943. Abstract precedes thesis as 1 preliminary leaf. Typescript. Includes bibliographical references (leaves 66-67).

Mental health concerns are presented in primary care settings regularly, yet a majority of these issues go undetected or are misdiagnosed by primary care physicians (PCPs). This may be due to a lack of mental health training for PCPs during their medical education. Over time, medical school curricula have evolved to include mental health training in order to bridge this gap in the healthcare system and to more readily identify patients in need of mental health services. The current study investigated AMA-accredited medical school curricula from universities across the US and US territories (N = 170) who train physicians in primary care, family medicine, or other generalist tracks. Data on mental health training were collected from the public websites of each school. Results showed that most universities indicated at least some type of required mental health training (85.3%), which were either didactic or experiential in nature. Although this result appears encouraging, further examination reveals that this training was most often limited to only one 4-week psychology-related course and a 6-week psychiatry rotation. Overall, many universities indicated at least one required course (N = 95), and most universities reported a required psychiatry rotation (N = 135). Moreover, only 12.9% of the sample reported having at least both didactic and experiential training required. The implications of this are varied. First, PCPs often have only a short amount of time with their patients, reducing their ability to fully assess both medical and mental health. A lack of exposure to mental health needs may lead to missed opportunities for intervention and improvement in patient health. Second, it is important for mental health professionals to work closely with PCPs in primary healthcare settings in order to improve rates for detection and treatment of mental health problems. In addition to improved patient outcomes, having mental health professionals integrate within primary healthcare can serve to decrease the stigma associated with seeking mental health treatment, as well as reduce long-term healthcare costs. This can also increase access to care for those individuals who are unable to see a mental healthcare provider, especially in rural areas. Finally, overall health may improve in relation to better mental healthcare, since medical and mental health have been consistently shown to significantly influence one another.

Thailand faces increasing mental health problems, however mental health services are limited. In particular, mental health services provided in communities across the country are not clearly structured. Research in regard to community mental health care is rare. The purpose of this study was to explore mental health care management in two primary care units (PCUs) in Thailand in order to understand the ways they operate within Thai communities. The specific objectives were to identify mental health care practices and roles of health providers, models of care and influences on mental health care practices in the two PCUs as case studies. An ethnographic approach using participant observation, semi-structured interview, quantitative questionnaire and document analysis was used in gathering data. The participants were seven nurses and three public health workers practising in the PCUs. Findings enhanced understanding in the context of two PCUs located in communities of the Northern and Central Thailand. Both were local health centres providing a wide range of health services based on the principles of primary health care (PHC). The PCUs were operated without mental health specialists, however nurses were the main resource in providing mental health care in terms of primary and secondary prevention. Primary prevention was provided through counselling sessions, drug prevention activities and seniors clubs. In addition, the health providers conducted activities of mental health promotion towards particular risk groups after assessing risks. They also gave support to mental health and normal cases that had possible mental health problems. Secondary prevention was provided in home visits, primarily in giving injections. The health providers played four main roles as educator, consultant, agent and manager in primary and secondary prevention. There was no single model of mental health care practice provided in the PCUs. Information derived from the present study showed a variety of models underpinning care practices. The nursing process was clearly adopted, as well as integrated care, community participation, collaboration and consultation, and using standard guidelines. Personal knowledge and interest in mental health were mentioned as an important factor in practising mental health care. Environmental factors such as adhering to policy, being family-oriented, being mindful of economic factors, using Buddhist Principles to guide interactions, guarding against occupational risks, maintaining a teamwork approach and the lack of specialists appeared to be factors influencing mental health care. This study contributes to the body of knowledge of community mental health care management in Thailand. The findings suggest implications for practices, education, and policy making to improve quality of care.

Background: Integrated Care Pathways (ICPs) are prearranged processes of care which are being increasingly used to deliver mental health services. The literature reveals difficulties in their development and implementation, and a lack of empirical evidence to support their use. Aims: The aim of this research was to investigate how an ICP has been used to manage mental health care in one selected mental health Trust in England. Methods: A case study approach was adopted with several units of analysis. The views of healthcare professionals using semi structured interviews; the experiences of service users and carers using focus groups; contrasting hospital episode and performance statistics with a comparison Trust and documentary analysis of the ICP. Findings & Discussion: Of the healthcare professions, only nurses used the ICP. No professionals used the ICP to support clinical decision making and risk management. However, just over two-thirds (67.2%) of the interventions described in the pathway were delivered. There was no statistically significant difference when comparing performance indicators for an equivalent episode of care between the ICP Trust and non ICP Trust. Service user and carers' experiences revealed that peopled did not feel that their care was individualised to them, although amongst them they had different perceptions of the care process. Conclusions: Mental health ICPs need to reflect the relationships between stakeholders, variability of illness and individual ways of living if they are to provide a framework for managing care in the future that accords with the needs of people using mental health services.

Background: The mental health of prisoners is of growing global health importance as prison populations increase exponentially. Though additional risks of mental disorder and poor mental wellbeing of prisoners are now better understood, women, especially those in low and middle income countries, and in regions outside North America and Europe are underrepresented in prison mental health studies. There is strong evidence of associations between religion and spirituality (RS) and mental health in the general population in North America and Europe. This thesis aims to measure and explain any associations between RS and depression and mental wellbeing among female prisoners in Chile. Methods: An explanatory sequential mixed methods approach comprised an initial quantitative study linked to a subsequent qualitative study. In the quantitative phase, 94 randomly sampled female prisoners in Chile participated in a pooled two-stage cross-sectional survey which collected data on background, mental health and RS variables. Mental wellbeing was measured using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Self-report depression data were collected and 40 prisoners were also administered the Mini International Neuropsychiatric Interview (MINI). RS variables included: affiliation, personal importance, involvement (frequency of attending services), benefits and beliefs. The design of the qualitative phase was informed by quantitative study findings. Six prisoners who had participated in the cross-sectional survey attended one of two focus groups. Individual in-depth interviews were conducted with 3 prison chaplains and 2 health professionals from the prison health centre. Topic guides for focus groups and interviews were used to facilitate discussions on the mental health and RS of female prisoners and to elicit views on selected findings from the quantitative study. Logistical regression techniques were used to statistically test the hypothesis of no association between RS and depression and mental wellbeing. Audio-recorded qualitative data were transcribed in Spanish and analysed thematically in English. Results: Of the 94 women, 11 (11.7%) reported a current professional diagnosis of depression, while major depression was confirmed in 13 (32.5%) of the 40 women assessed using the MINI. The women had a median WEMWBS score of 55 (IQR 43-61) out of 70. Religiosity was high among the sample with 86 (91.5%) women affiliated to mainstream Christianity and 69 (73.4%) who considered RS to be personally very important. In a sample of 40 women, frequency of attendance at RS services was significantly higher in prison than during the year prior to incarceration (Wilcoxon Sign Ranks Test Z=3.1; p < 0.002). No significant associations were found between depression and mental wellbeing, and the key RS variables. However, 61 (89.7%) women believed there was a connection between their mental health and spirituality. The qualitative data revealed differences within and between participant groups in understandings of mental health and RS terminology and concepts. Themes emerged around the prison determinants of mental health and the mental health effects of the female gender. Prisoners identified RS variables that influenced mental health which had not been measured in the survey. Explanations were found for the divergent survey results of the association between RS and mental health. The data showed how RS shapes prisoners' help-seeking behaviour and attitudes to mental health care. Conclusion: The association between RS and mental health among prisoners in Chile remains unclear but may differ from established patterns reported in non-prisoner populations. This a challenging area of study with an additional layer of complexity present in prison populations where there are high levels of religiosity and spirituality. Larger studies are needed to confirm the quantitative findings, while qualitative findings should lead to raised awareness of RS in the development of prison mental health strategies in accordance with the needs of a given population.

The mental and emotional well-being of mental health care professionals can be jeopardized by burnout, a syndrome similar to depression and other affective disorders in its symptomology and effects. A questionnaire designed to assess mental health and burnout was developed using various assessment tools from the mental health care community to obtain information about health habits, stressors, coping skills, personal history, and length of service. Forty-seven workers at a public mental health facility responded to the questionnaire. The results of this study suggest that approximately 20% of mental health care-givers are experiencing high degrees of burnout and mental disease. Neither personal history or long-term service appears to contribute to the burnout. Workers new to the field seem to be at greatest jeopardy. Control coping mechanisms were found to be more effective than escape coping mechanisms in combating stress and mental illness.

Research has indicated that offering support and services for people who experience mental health problems and their families is a complex and contested area. Despite the controversies surrounding therapeutic interventions with families, it has now been recognised that relatives and other supporters of people with mental health problems should be included in their care. Whole- family interventions and partnership working with carers and families is now central to secondary care UK mental health policies and clinical practice guidelines. However, for many families/ carers this remains an aspiration rather than a reality. The way in which we successfully developed family focused mental health practice, as well as specialist family interventions (FI) for people who have been given a diagnosis of psychosis, has therefore aroused considerable interest. The Somerset Partnership NHS Foundation Trust has adopted a Strategy to Enhance Working Partnerships with Carers and Families, developed best practice guidance and has established two complementary workforce development projects - the development of specialist family intervention services and the widespread training of mental health staff to create a ‘triangle of care’ with service users and their families. This has resulted in widespread adoption of systemically informed, ‘whole-family’ practice. In response to the widespread difficulties experienced following other staff- training initiatives we developed specialist family interventions (FI) services by means of an innovative one-year course delivered in partnership with Plymouth University. This training initiative has been widely acknowledged for its novel integration of psycho-educational and systemic approaches and the effective in-situ, multi-disciplinary service development model. An advantage of this approach is that by the end of the course a local FI Service has been established and staff experience fewer difficulties in applying their new skills than people trained in other programmes. We then ensure the continued development of clinical skills by means of a service structure that emphasises on-going supervision. Regular audits of the service and in-depth research studies clearly indicate that the service is effective and highly valued by users. Our ‘cognitive-interactional’ approach, which integrates systemic therapy with psychosocial interventions (individual- and family-CBT) within a collaborative therapeutic relationship, enables us to meet the needs of families in a flexible, tailored manner. The FI teams are able to deliver early interventions for people with first episode psychosis, as well as meeting the NICE guidelines for people with longstanding symptoms. Recognising that many families do not require formal family interventions/ therapy, we also have been designing ‘stepped-care’ family intervention services. We have developed, and extensively evaluated, short training packages to enhance working partnerships with families throughout our mental health services. We have used this three-day package to train a range of community and inpatient teams. We have also encouraged family- inclusive practice with the establishment of a trustwide steering group, practice guidelines and the establishment of ‘family liaison’ posts to facilitate family meetings on inpatient units, as part of the assessment process. Both training initiatives explicitly focus on developing systemic thinking, by integrating CBT and systemic therapy. The involvement of families/ carers in the design and delivery of both training initiatives is also crucial.

Liaison mental health services provide mental health care, including assessment, interventions and sign posting to further specialist care, for those who present with mental health needs in non-mental health settings. Liaison mental health services in the United Kingdom most frequently exist within, but are not limited to general hospital provision. The commissioning of these services is however inconsistent, having developed in an ad hoc manner, and the evidence base for an appropriate structure remains limited. This thesis reports an extensive literature review which identifies that to date there has been no published detailed exploration of the experiences of service users of liaison mental health care. Only recently has research been published which tentatively identifies the ability of liaison mental health services to reduce costs to general hospitals of mental health presentations and co-morbidity. The empirical element of this programme of research is a study of the experiences of service users of a liaison mental health service, offered within a general hospital setting. The service users have experiences of both inpatient and emergency department care. The study utilises a secondary data analysis methodology to provide an in depth interpretation of these experiences. Data were analysed using a grounded theory constant comparative method. A core category of ‘negotiating and navigating the system’ emerged as service users’ experienced psychological distress as they attempted to manage their own resources and expectations as a personal safety net. It is only when this personal strategy fails to alleviate their symptoms that they attempt to find help from professional services within the general hospital. Gaining access to assessment by the liaison mental health service requires the service user to negotiate a complex system of care. This experience is represented in the study utilising a conceptual map of their journey, using the analogy of a road to explore the enablers and barriers to an effective experience of liaison mental health care. A model of liaison mental health care is required that ensures provision of educational support for non-mental health professionals within the general hospital setting. This education needs to acknowledge that those who are having their first experience of a mental health issue often do not know where else to seek help, other than the emergency department, because it represents the ‘front door’ of health care. The adoption of a comprehensive model of liaison mental health care is a priority for all general hospital settings in order to achieve improved service user experience, cost efficiency and integrated health care provision.

Mental health is recognised as a global burden of disease and amongst the leading contributors to disability, with common mental health affecting one in six adults. The impact of these conditions on individuals and the economy are significant. Primary care is the first point of contact and general practitioners, as public health gatekeepers are of key importance in the recognition and management of these. It is suggested that general practitioners find consultations challenging, though it is not clear what these difficulties are. The aim of this thesis was to investigate what, if any, problems general practitioners experience with regards to the common mental health consultation. A scoping study and survey provided information on general practitioners’understanding of common mental health and its management. Another survey investigated the perceptions, beliefs and understanding of the general public in relation to common mental health and its management. A theory of planned behaviour study looked at factors that influenced general practitioners’ prescribing and referral behaviours. And finally, a triangulation study examined the findings from the programme of research with other key professionals who are also part of the pathway of care - primary care counsellors and clinical psychologists. Results of this thesis suggest that general practitioners do experience difficulties with the management of common mental health. Challenges were shown to be associated with the general practitioner’s role as the patient’s advocate, lack of knowledge and education, confidence, personal experience, patient expectation and management systems. Results also showed General practitioners’ and lay persons’ understanding of common mental health in everyday practice was different to that in public policy. General practitioner treatment management was shown to be in conflict with clinical guidelines. Furthermore, prescribing and referral behaviours were shown to be influenced by their attitude, significant others and whether they possessed adequate skills or knowledge.

This research addressed the social othering and positioning of mental health consumers in Australian society. Using a critical lens, the study explored the accounts of nurses caring for mental health consumers in intensive care. Interpretations of the accounts of interactions between nurses and consumers in this context brought focus to the ways in which nurses exercise legitimated power and privilege. It is hoped that the research will prompt critical reflection on the inherent structural power inequities in healthcare facilities and that political awareness of oppression and disenfranchisement of mental health consumers can be fostered among nurses as a professional group.

Indian Punjabis constitute a large proportion of the immigrant population in the Lower Mainland of BC. By 2031, it is anticipated that South Asians will be the largest visibility minority group in Canada (Statistics Canada, 2005). As a result, the mental health needs of this population may soon have a large impact on mental health providers. The present study investigated how Punjabi immigrant women constructed the meaning of mental health through the following research questions: 1) How do Punjabi immigrant women define concepts related to mental health and illness?; 2) How are mental health services accessed and utilized by the participants?; 3) In what ways do the existing mental health services meet or fail to meet the needs of the participants?; 4) How can these services be made more culturally accessible?; and 5) How is mental health defined by prominent mental health organizations? Drawing from feminist post-colonial theory and utilizing a critical qualitative approach, the first segment of this study was a narrative analysis of qualitative interviews that enabled an understanding of the participants’ views of mental health and experiences accessing mental health services and; the second segment of the study critically analyzed documents pertaining to the meaning of mental health as defined by three prominent mental health organizations. The results of this study suggested that the participants’ conceptions of mental health shared some similarities with Western models. The meanings that the participants constructed for various concepts, and their underlying metaphors, however, differed from Western models of mental health. Further, cultural conventions and perceptions often affected how participants’ viewed mental health issues and the type of help they sought. Recommendations, limitations and challenges, and future directions are discussed. As critical research, the results of this study contribute to the ongoing development of a culturally responsive approach to health care provision.

Excerpt: Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project.

Despite the existence of effective treatments, mental health care disparities exist in the availability, accessibility, and quality of services for racial and ethnic minority groups. People living with serious mental complaints often resist engaging in treatments and experience high rates of dropout; poor engagement can lead to worse clinical outcomes. Addressing the complex mental health care needs of racial and ethnic minorities warrants considering evidence-based strategies to help reduce disparities. This systematic review sought to provide an analysis of published literature about the barriers and effective strategies in identifying and treating minority patients with mental health disorders. The practice-focused question of this systematic review was: What are the barriers and effective strategies to identification and treatment of mental health disorders among minority populations. This project was guided by PRISMA and SQUIRE guidelines and Fineout-Overholt and Melnyk’s appraisal form, comprising 11 studies published between 2014 and 2019, identified through Thoreau, Cochrane, CINAHL with Medline, EBSCO, and ProQuest, SAMHSA and PubMed databases. The systematic review results recommend intervention strategies such as integrated/collaborative care, workforce diversity, providers in minority neighborhoods, improving providers’ cultural skills, and stigma reduction to help reduce mental health care disparities. These findings are significant to lowering the gap in practice and can be used by the entire health care system to improve mental health care, thereby leading to a positive social change. Implementing these strategies would benefit patients, families, their communities, and the entire health care delivery system.

This thesis explores the potential for soul-making in the prison violence-prevention program known as GRIP—an acronym for Guiding Rage into Power. The author utilizes hermeneutic methodology to explore the meaning and evolution of the concept of soul-making within the literature of depth psychology. Using heuristic methodology, the author then analyzes what he perceived to be a profound demonstration of soul-making among the members of the GRIP prison group he cofacilitated. The findings indicate that by combining a downward move into the underworld of emotional woundedness and psychopathology with a vertical orientation that includes contact with ego-transcendent archetypal energies, the inmates participating in the GRIP program had an opportunity for deep healing and genuine soul-making.

Infants who experience multiple risk factors, such as preterm birth, developmental delay, and low socioeconomic status, are at greater risk for mental health problems. Mental health interventions for infants typically target infants from high-risk groups, and there is strong evidence that some intervention programs for infants can prevent long-term negative outcomes and promote long-term positive outcomes. Despite emerging research and federal initiatives promoting early intervention, minimal research has examined community-based mental health services during infancy. Improving the effectiveness and efficiency of routine care requires close examination of current practices. The current study characterized current usual care practices in infant mental health through a survey of mental health providers. Provider, practice, and client characteristics, provider use of intervention strategies and intervention programs, and provider attitudes toward and knowledge of evidence-based practices are described. Study findings are discussed in the context of previous usual care research. Implications and directions for future research are discussed.

Understanding differences in resource use between patient groups is required for decision- making in clinical practice and health care policy. The overall aim of this research project was to show whether patient-specific resource use of inpatient mental health care can be inferred from patient characteristics. This aim was subdivided into four objectives, namely 1) to analyse the association between patient characteristics and length of stay, 2) to synthesise current scientific knowledge considering the association between patient characteristics and per diem resource use, 3) to analyse differences in per diem staff time use between patient groups and 4) to analyse patient-specific determinants of total per diem hospital costs. A systematic review was carried out to synthesise the current knowledge. Data of consecutively sampled patients were used to analyse the association between length and intensity of care and patient and service characteristics. A work time study was used to measure differences in staff time use. Eight potential cost drivers were identified on the basis of previous studies. Strong and significant effects on length and intensity of care were found in both patient and service characteristics. It was neither possible to reliably predict length of stay nor to reliably predict the intensity of care. Idiosyncrasies of inpatient mental health care might have hindered the identification of patient groups that are homogenous in terms of resource use. Decision makers in clinical practice and health policy should be aware of potential differences in resource use between apparently similar patients.

Rationale: International research has demonstrated that in order to retain a skilled and healthy cadre of willing health-workers there is a need to monitor and develop strategies to mitigate adverse impact of this work and improve the quality and effectiveness of client and patient mental health care. Aims: (i) Monitor and evaluate Thailand’s national HIV mental health and psychosocial care program. (ii) Measure the impact of HIV mental and psychological care on health care providers. (iii) Examine the relationship between occupation-related psychological morbidity and the recruitment, training, clinical supervision and work-practices of HIV mental health service providers. (iv) Develop, implement and evaluate a training curriculum that addresses the demands of the HIV client population in Thailand. Method: In Study 1, 826 government hospitals, 1000 government health centres, and 1135 non-government organisations and private providers participated in: semi-structured, key informant interviews; focussed group discussions; and criterion-referenced appraisals of health policy and service delivery. Study 2, a small exploratory, qualitative study, utilised a schema of five key stressors commonly associated with HIV care to analyse responses gained from HIV counsellors and employed semi-structured interviews and focussed discussion groups. Study 3, a cross-sectional study, explored the relationship between training, work practices, Locus of Control of Behaviour and the self-reporting of signs and symptoms of psychological distress. 803 HIV counsellors completed a series of questionnaires including the Thai version of the General Health Questionnaire (GHQ-28), the Locus of Control of Behaviour Questionnaire and the Thai HIV Counsellors Survey (THCS). Study 4 involved the development, delivery and evaluation of a series of short courses designed to train 79 health workers to provide HIV counselling. The training was evaluated by pre and post knowledge examinations and anonymous evaluations. Results: Study 1 found that policy and legislation failed to adequately guide the practitioner in a number of key areas including: testing and counselling of minors; testing without informed consent; confidentiality of medical records and disclosure of HIV status; and “duty of care” in terms of threatened suicide or harm to others. Furthermore, it was found that epidemiological data had not been adequately considered in terms of providing specific psychological support services, and developing counselling curriculum, and that the conduct of Thai based psychological and operations research had been limited. Whilst there was good national coverage of HIV testing counselling services, psychological services to address HIV issues across the disease continuum were limited and frequently provided by individuals without adequate training. There does not appear to be any systematic mechanism for monitoring and evaluating HIV mental health and psychosocial care. This study also revealed that Thailand is limited in its ability to provide adequate HIV field-experienced, trained mental health care personnel who can teach in the necessary languages that would enable sharing of the Thai health sector experience within the region. Study 2: The respondents identified a number of workplace stressors including: fear of contagion; client-professional boundary issues; difficulties with being identified as working in the sphere of a highly stigmatised disease; the experience of multiple losses, in a context of perceived inadequate training; role expansion; and perceived lack of recognition and reward. Participants also identified a number of work and socio-cultural influences which were perceived to mitigate the impact of the work. Study 3: Failure to take up counselling duties after training was primarily associated with counsellors having too many competing non-counselling duties (31.2%; n=108), and being deployed to other workplaces in a non-counselling capacity (22.8%,n=79). Over 81% (n=441) of respondents who indicated that they were continuing to work as counsellors reported signs and symptoms of psychological disturbance on the GHQ-28 screening at a level that warranted further mental health assessment. There was a significant positive correlation between GHQ-28 “caseness” and Locus of Control of Behaviour scores (r =.118; p<.001). Decisions to leave counselling were positively associated with self reported psychological disturbance (r =.324; p<.001) and the perception that their work was not helpful to clients (r =.108; p<.001). Study 4: The results clearly showed that the curriculum, and method of training resulted in both perceived and measured change in knowledge and skills and were reported to have resulted in improvements in the trainees’ perceived self confidence to meet the demands of their clients. Conclusion: The studies identified the many challenges inherent in providing effective HIV counselling, mental health and psychosocial services in Thailand. This research suggests that delivering HIV psychosocial care services in Thailand has potentially an adverse impact on: the health and well being of care providers; the quality of care received by clients and patients; and ultimately on the ability of the health system to retain its skilled personnel.

The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasises the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting engage in specific activities. The observations of this study determined that nurses' time is accounted for 31.65% in direct care, 51.63% in indirect care and 16.71% in service related activities.