1,721,045 research outputs found
Registered psychiatric nurses’ practice with parents who have mental illness, their children and families, within general adult mental health services in Ireland
No full textThe overall aim of this study was to investigate Registered Psychiatric Nurses’ (RPN perceptions of their family focused practice (FFP) with parents who have mental illness, their children and families, in general adult mental health services in Ireland. The study sought to measure the extent of RPNs’ FFP in acute admission units and community settings and to establish how RPNs’ FFP compared with Australian RPNs’ FFP. It also sought to identify the significant predictors of RPNs’ FFP and to explore the scope and nature of high scoring RPNs’ FFP and factors that affected their capacity to engage in FFP. A mixed methods approach, using a sequential explanatory design, was employed to address the study aims. In Study One a clustered, random sampling approach was used to access 610 RPNs in 12 mental health services in Ireland (practicing within acute admission units and community mental health services). Data was elicited using the Family Focused Mental Health Practice Questionnaire (FFMHPQ) with a 57 percent response rate (n= 346). RPNs’ FFP was ranked on the basis of their responses on the questionnaire. RPNs were deemed to be high scoring if they obtained between five and seven on at least three of the six FFP behavioural subscales within the FFMHPQ. In Study Two, fourteen high scoring RPNs, from Study One participated in semi-structured interviews. Whilst the majority of RPNs in Study One were not family focused, and had lower mean scores than RPNs in Australia, a substantial minority were family focused. Most of the higher scorers were practicing within the community setting. The most important predictors of FFP were skill and knowledge, followed by RPN group (acute versus community setting) and confidence around parenting and children generally. Study Two suggested that high RPNS’ FFP WITH PARENTS AND THEIR FAMILIES iv scoring RPNs’ FFP was complex and multifaceted, comprising various family focused activities, principles and processes. Their capacity to engage in FFP was determined by certain enablers and barriers with other results focused on future potential developments in FFP. The findings have enhanced understanding of RPNs’ FFP with parents who have mental illness, their children and families, in the Irish context and internationally. The findings also represent a starting point for future research in this area within Ireland and elsewhere. On the basis of the results, various implications for RPNs’ education, practice and policy can be made. It is recommended that national policies be introduced to mandate the identification of service users’ parenting status by mental health professionals, including RPNs, on admission to mental health services, and to embed information and support regarding parenting into ongoing care. Furthermore, key enablers, including child and family focused education and time to engage in FFP, should be provided to RPNs, to facilitate the transfer of policy into practice. Future research is required to develop an in-depth understanding of RPNs’ FFP in different settings
Improving mental health of Koori men: a study of help seeking and mental health service response
No full textMental illness is widespread among Indigenous people in Australia and mental disorders are reported to be the leading cause of disease burden after cardiovascular disease. Indigenous males are affected by mental health problems at higher rates than their non-Indigenous counterparts. This is evident from the higher levels of psychological distress, higher hospitalisation rates and higher death rates due to mental and behavioural conditions among Indigenous men. However Indigenous men do not commonly receive treatment from mental health services. The literature highlights two important reasons. One is that they do not access mainstream mental health services in proportion to their need and the second is the suggestion that mental health services may be culturally inappropriate and inaccessible. This study sought to establish the qualitative factors that influence Indigenous male help seeking and aspects of the service setting that impede access. The specific objectives of this study were fourfold. The study sought to first examine the factors that influence Indigenous male help seeking for mental health problems. Second, the study aimed to identify the factors affecting utilisation of mental health services. Third, the study intended to determine the barriers and facilitators to care for Indigenous men with mental disorders and finally, it sought to identify strategies to improve access to and utilisation of mental health services by Indigenous men in Gippsland. The study was informed by the guidelines on values and ethics proposed by the National Health and Medical Research Council, the Decolonising Methodology of Linda Tuhiwai Smith as well as methods suggested by other authors who have worked in the field of Indigenous health. Within a Qualitative Description design,semi-structured interviews were utilised to obtain narratives from Koori men and carers and mental health professionals. A total of seventeen Koori were interviewed including men, carers, social and emotional wellbeing workers and a hospital liaison officer. In addition, 28 staff from the mental health services were interviewed individually or in focus groups. A total of thirteen themes emanated from the data. These have been categorised into three results chapters. The first results chapter relates to obstacles faced by Koori men in seeking help for a mental illness. This chapter covers the four themes of recognising a mental illness, disclosing one‟s mental illness, reluctance to contact a service, and alternate ways of coping. The second results chapter focuses on the mismatch between mainstream mental health services and includes the three themes, barriers to gaining entry into services, barriers to engagement with services and staffing problems in the services. The final results chapter relates to future directions and outlines six themes. The first two themes relate to improving help seeking among Indigenous men. They include improving mental health awareness among the Community and empowering men to talk about problems. The next four themes relate to rendering services more accessible. They include, building men‟s confidence in services, developing relationships with the Koori community, enhancing flexibility of services and strengthening the role of the Koori Mental Health Liaison Officer. The results are then discussed in relation to the literature on help seeking and available services. In this section, the unique experiences of Koori men with regard to help seeking and service utilisation together with implications for future research and interventions are discussed. Other co-incidental learnings from the study include the need to provide for a long time frame for research involving Koori men, the need to adopt a flexible approach to research and the need to engage cultural advisors who represent different sections of the Koori community. The distinctive aspects of this research are multiple. First, it provides the first in-depth exploration of help seeking among Indigenous men with mental health problems. Second, it sheds light on the various barriers to Indigenous men accessing mental health services. Third, it gives voice to Koori people to indicate how they expect mental health services to be culturally appropriate. Fourth, it provides the first report of dual perspectives of Koori men and carers as well as service providers in improving services. The best solutions for a difficult situation are usually those that include perspectives of all stakeholders. Finally, the research was carried out in a culturally appropriate way and in so doing the researcher has not only been able to identify real challenges and solutions but has also taken a step forward in improving the reputation of research among Indigenous men in Gippsland. Future research will have to determine the feasibility and usefulness of the interventions suggested
Dual diagnosis discourse and narratives in the State of Victoria, 1985-2012
No full textHealth services are more effective if they are coordinated around the person, family or community. Frequently they operate in silos determined by diagnosis. Many people with mental health problems also have problems with alcohol and other drug (AOD) use, and vice versa. The coexistence of such problems has been variously termed ‘dual diagnosis’, ‘co-occurring disorders’ or ‘comorbidity’. In recent decades attention has been drawn to the problem of fragmented services for people considered to have a ‘dual diagnosis’. A dual diagnosis discourse has developed around the proposition that there should be ‘no wrong door’ when people seek treatment or support. Services specialising in either mental health or drug and alcohol treatment should recognise assess and respond to co-occurring problems. Little research attention has been paid to the historical and cultural impediments to the ‘no wrong door’ approach. The thesis asks: Why did dual diagnosis discourse emerge? How did it evolve in the two specialist sectors? What are the implications for service users/consumers, services, professions and governments? How has the discourse played out in the context of an espoused vision of person-centred care, rather than care organised around disciplinary and service structures? The research, focusing on the State of Victoria since 1985, involved a qualitative exploration comprising six stages: a review of research literatures; collection and analysis of government policy documents; in-depth interviews with key informants, purposively selected to offer varied perspectives from the level of policy development and service leadership; feedback of findings to these informants for validation and further comment; synthesis of findings into papers for peer review; and final refinement of conclusions in the submitted thesis. I found that dual diagnosis discourse emerged in Victoria at a time of greater differentiation between services. Deinstitutionalisation was a part of this but further contributors were greater managerialism, the allocation of funds according to diagnosis, professional turf issues and a broadening of the scope of mental health and AOD strategies to encompass mild and moderate as well as severe conditions. ‘Capacity-building’ characterised the discourse and strategies through the 1990s and 2000s, entailing top down and bottom up change management that challenged over-specialisation and offered leadership, networks and a focus for achievement. The mental health and AOD sectors both made at best incremental progress towards a ‘no wrong door’ service culture. Still to be resolved are enduring therapeutic pessimism, particularly in the acute mental health sector, cultural clashes between sectors, and enduring social stigma. The thesis contributes to the body of qualitative research on the history and course of efforts to develop appropriate care for patients who are considered to have alcohol and drug problems and other mental health disorders. More broadly, the thesis illuminates the development and implications of a medical construct over time in a particular context. It adds to the evidence for improving quality control and interdisciplinary, intersectoral workforce development with a focus on patient strengths and recovery within an integrated health and social support system
Gippsland Mental Health Vacation School: development and investigation of the impact of a targeted short-term intervention to address mental health workforce shortages in Gippsland, Victoria, Australia
No full textThe mal-distribution of health practitioners across urban and rural areas in Australia, Canada and the USA is well documented. Despite disparities across all health disciplines, research and policy addressing rural disadvantage have principally focused upon the medical profession. There is limited rural allied health workforce research and even less into the mental health professions. Emerging strong evidence from medicine to redress the urban-rural imbalance suggests that the probability of rural practice post-registration increases through: selection of students from rural backgrounds and/or having rural practice intent, and exposure of pre-registration students to rural life and practice through a mix of rural health training modules and extended clinical placements. Even though evidence regarding rural background may be generalizable to nursing, there is scant evidence that any of the above factors pertain to either allied health or mental health practitioners. Furthermore, evidence regarding the efficacy of interventions designed to address rural mental health workforce shortages is lacking. Therefore, the three primary aims of the thesis were: 1) identify mental health workforce recruitment and retention issues and solutions in rural Gippsland; 2) investigate the impact of one strategy: a brief mental health workforce recruitment intervention that addresses recruitment challenges in Gippsland; 3) examine how to establish a sustainable recruitment intervention for the sector. Three separate data collections were carried out to achieve each of these research aims: 1. Qualitative data was collected from 24 senior personnel from Gippsland mental health services. Thematic analysis identified issues and solutions to mental health workforce challenges in Gippsland. 2. Quantitative and qualitative data were collected from 76 students who attended five Gippsland Mental Health Vacation Schools from 2010 to 2014. Multivariate statistics and content analysis explored the immediate and longer term impact of the Vacation School experience upon students’ interest in and attitudes towards living and working in a rural setting. 3. 18 students and 9 regional mental health service staff who participated in Vacation Schools contributed as ‘experts’ in a three-stage Delphi Study, designed to inform the long term sustainability of the intervention. Findings from Research Aim 1 led to the development and implementation of the Gippsland Mental Health Vacation School. This brief and inexpensive intervention addresses: a) the lack of training for mental health professionals in Gippsland; and b) the limited regional pool of potential mental health workers. Findings from Research Aim 2 indicate that this annual 5 day program positively impacted upon students’ interest in and attitudes towards both rural living and rural mental health work. These immediate positive changes weakened in the six months following the program; however, the level of interest in rural work diminished less compared to the decline in interest in rural life. This weakening of interest was then used to inform a Delphi study undertaken in pursuit of Research Aim 3. The findings of which suggested: 1) that Vacation School student engagement could be maintained through the use of social media to promote employment opportunities to participants in the months following the program; and 2) transitioning to a blended learning approach to delivery of the program. The findings of the thesis have important implications for mental health workforce policy, specifically the promotion of rural practice and collaborative development of tailored strategies to address local rural practitioner shortages
Experiences and outcomes of prevention and early intervention programs for young people of parents with a mental illness
No full textParental mental illness has the potential to affect children adversely. Children who have a parent with a mental illness may experience various psychosocial challenges and have a higher risk, than other children, of developing a mental illness themselves. At the same time, some young people are resilient in the face of adverse situations arising from their parent’s illness, especially when appropriate supports and interventions are provided. Although there are several interventions available to support young people of parents with a mental illness, research regarding their efficacy and effectiveness is limited. In addition, and critical to the main objective of this thesis, much of the previous work in this area, including intervention development and evaluation, lacks the young person’s point of view. There is a gap in previous research regarding how positive outcomes for young people whose parent has a mental illness might be promoted and sustained. Moreover, to the best of my knowledge, no research has specifically examined the needs and desires of children of parents with a mental illness regarding their preferred interventions and supports. It is important to elicit the views of young people from these families because young people have the capacity to contribute to the matters that directly affect them and I would argue, have the right to be engaged in the matters that concern them. The overall aim of this thesis was to investigate how different interventions impact young people living in families affected by parental mental illness, from the perspective of the young people themselves. Accordingly, four studies were conducted using a mixed method research design. The first study examined the impact of a DVD intervention called Family Focus for children whose parent has an affective disorder. The second study examined the impact of a booklet called When Your Parent Has a Mental Illness on young people. The third study identified children’s experiences of a peer support program, Kookaburra Kids Camp, and the outcomes of this type of intervention. The final study in the thesis was somewhat different and examined young people’s general perspectives of intervention programs and informal supports. This final study sought to identify what supports young people wanted, from whom, how they wanted it and why these supports were important to them. A mixed method research design was employed across all studies (Chapters 5 and 7, Studies 1, 2, 3 and 4). The first three studies employed three questionnaires administered at two different times: pre and post the intervention (DVD, peer support and booklet; Chapter 5, Studies 1, 2, 3). These questionnaires included two outcome measures (Chapter 5): the Children’s Knowledge Scale of Mental Illness and the General Help-Seeking Questionnaire. An intervention satisfaction questionnaire was also administered, post intervention. Paired-sample t-tests were used to identify changes on these questionnaires after youth engaged with the intervention (Chapter 5, Studies 1, 2 and 3) and frequency statistics using mean (M) descriptors were used on the intervention satisfaction questionnaire (Chapter 5, Studies 1, 2 and 3). In each study, individual semi-structured telephone interviews were employed two to four weeks after children accessed the intervention. Interview transcripts were analysed using thematic content analysis, a systematic means of describing and organising phenomena (Chapters 5 and 7, Studies 1, 2, 3 and 4). In the first study that examined the utility of a DVD intervention (Section 5.1) 29 children aged between 8 and 12 years participated. Post DVD, the children’s knowledge of mental illness improved. However, no change in the children’s help-seeking behaviours was found. According to interview data, the DVD challenged young people’s misconceptions about mental illness. Most children preferred watching the DVD with a parent. The second study (Section 5.2) examined the impact of a psycho-educational booklet. Nine participants aged between 12 and 15 completed questionnaires, and five of these participants took part in individual follow-up interviews. No change was recorded on the Knowledge Scale. Interview data suggested that after reading the booklet, young people were able to initiate conversations about their experiences with their parent. They described using the booklet to inform these conversations. In the third study (Section 5.3), which examined the impact of a peer support program, approximately 69 participants, aged between 8 and 12 years old, completed pre and post questionnaires, and 18 of these same participants engaged in telephone interviews to describe their experiences of the intervention. Mental health knowledge was improved after the program. Additionally, the children were more likely to use an anonymous telephone helpline after attending the program. Children indicated that the program provided a place of respite from caring for their parent with a mental illness and an opportunity to connect with peers. It also promoted a positive change in their perception of their parent’s mental illness. The fourth and final study of this thesis is different from the previous three studies (Chapter 7). The main objective of this study was to present young people’s expressed preferences for supports (for example, informal supports such as talking to peers or parents) and relatively more formal interventions (i.e. developed programs). To achieve this aim, a mixed method research design was employed, including a questionnaire we constructed ourselves followed by individual semi-structured telephone interviews. One hundred and seventy-five participants aged between 13 and 17 completed the online questionnaire, and six participated in individual telephone interviews. The youths identified a need for psycho-education and confidential support, and a preference for accessing information from health care professionals. However, the nature of this support, how it was accessed, from whom and why it was important varied greatly, suggesting that one intervention type may not suit all young people. Across the four studies, ‘talking with parents about parental mental illness’, ‘confidential and anonymous support’, ‘connection with peers’ and ‘information about parental mental illness’ were young people’s preferred supports. In addition, another overall finding of the thesis was that while young people want information about parental mental illness, they also want the opportunity to discuss their parent’s illness and that this conversation is one that is interactive and ongoing with their parent. This involved receiving different types of information about mental illness that was also delivered in different ways, such as through a DVD or booklet or presented to a group of peers. This thesis is the first large body of research explicitly examining young people’s experiences and perceptions of interventions. There are limitations in the various studies around the context of where the studies are positioned and in the use of the various questionnaires employed. Hence, notwithstanding the positive contributions of this thesis, the findings presented here can only be said to be moving towards understanding youths’ views of support, rather than being absolute or definite about their needs and intervention supports. Further participatory research is required to further substantiate and explore what interventions works, with whom, when and arguably more importantly, why. The thesis builds on previous literature regarding intervention programs and provides recommendations, based on young people’s reports, for the ways in which children of parents with a mental illness may be supported
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
- …
