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    Community attitudes toward people with mental illness : the effects of time, location and demographic variables : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2003) Wakefield, Amber
    Deinstitutionalisation in New Zealand followed the worldwide trend of transferring mentally ill patients from psychiatric institutions into community-based care. The closure of psychiatric hospitals in favour of community care relied on positive and accepting attitudes of community members. At the time of the closure of Lake Alice psychiatric hospital in 1995, the remaining 12 chronically mentally ill patients were transferred into a community mental health facility in Wanganui. The present study investigated whether community attitudes towards mental illness change over time and if attitudes are influenced by geographical proximity to community mental health facilities. The study also investigated the influence of demographic variables, and prior contact, awareness and agreement with the community mental health facility on attitudes. Attitudes among the Wanganui community were measured by survey using the Opinions about Mental Illness scale (OMI, Cohen & Struening, 1959) and the Comfort in Interaction Scale (CI, Beckwith & Mathews, 1994). There were two samples used in the present study, one taken in 1995 comprising of one hundred and fifty seven respondents, and one taken in 1996 comprising of one hundred and forty-one respondents. Time was found to be a partially significant influence on attitudes among the respondents. Geographical proximity was not found to be significant. The results were consistent with the hypothesis that time, awareness of the community mental health facility, occupation and prior contact with people who have a mental illness produced a significant effect on attitudes toward people with mental illness among community members. Overall, attitudes as measured by the OMI and CI were positive and accepting of people with a mental illness.
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    Exploring the relationship between mental health professionals and family caregivers, who care for 18-30 year olds, diagnosed with a serious mental illness, in two district healthe board areas of NZ : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Rehabilitation at Massey University
    (Massey University, 2004) Nicholls, Elizabeth A
    Despite compelling evidence of benefits for mentally ill family members when there is a working relationship between mental health professionals (MHPs) and family caregivers (FCGs), international and New Zealand literature has continued to reveal that the relationship is fraught with difficulties. Although there have been a number of international studies exploring the relationship from the family caregiver perspective there have been few international studies and no New Zealand studies conducted that have explored the MHPs perspective of this relationship. Therefore the purpose of this research was to explore this relationship from the FCG's perspective and the MHP's perspective. In-depth interviews were conducted with six FCGs and seven MHPs, one of whom was also a FCG, from two North Island District Health Board areas. Four MHP themes and five FCG themes were identified which highlight a significant chasm that exists between the MHP's intention to build a relationship with the FCG, and the FCG's experience of the nature of this relationship. These findings are discussed and recommendations are made to bridge this chasm for the benefit of FCGs and MHPs, but ultimately the person with the mental illness.
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    Effects of relocating an inpatient programme for the "difficult-to-place" mentally ill, from a hospital to a community setting : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology, Massey University
    (Massey University, 1999) Daldy, Robert
    In order to effect final closure of Lake Alice Hospital, the need for a special inpatient facility for the ongoing treatment of a residual "long-stay" patient population was recognised. The Intensive Learning Centre (ILC) was developed to cater for this group, that were "difficult-to-place" by virtue of their unsuitability for existing trust and sheltered accommodation in the community. Consistent with the long-term plan, the programme was relocated from the hospital grounds to a community setting at Castle Cliff, Wanganui, continuing operation as Endeavour Lodge. The present research had three principal aims: to determine effects of relocation on the original ILC programme; to assess the functioning of the current Endeavour Lodge client group in order to extend findings from previous research; and to make a formal characterisation of the prevailing "Ward Atmosphere" or therapeutic milieu, in the new community location. A comparison of the two programmes was made on the basis of information gained from semi-structured staff interviews, and reviews of programme operating manuals and previous research. Client functioning was assessed with the use of two informant driven measures; the Rehabilitation Evaluation Hall and Baker (REHAB) and the Adaptive Behaviour Scale (ABS). Characterisation of the therapeutic milieu was made with the Ward Atmosphere Scale (WAS-R). It was found that relocation coincided with a loss of key personnel responsible for the development of the original ILC programme, who had experience and expertise in the use of "Behaviour Modification" techniques. Formal behavioural modification strategies that were an integral part of the original ILC prescription, appeared to have fallen into comparative disuse at the time of the current study. An initial significant improvement in general functioning was found between baseline and the 5- month follow-up. No other significant change in functioning was identified for either general functioning or maladaptive behaviour, between any of the subsequent follow-up periods. However, a descriptive supplemental analysis of mean group total scores, did identify meaningful and consistent trends of behaviour change over time. The implications of the findings, and recommendations for the programme and future research are discussed.
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    Two year follow-up of long-stay chronically mentally ill inpatients transferred to the community : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology, Massey University
    (Massey University, 1995) Huzziff, Robyn
    The present study was undertaken to evaluate the affect of transferring long-stay chronically mentally ill clients from Lake Alice Hospital to community placements. Thirty chronically mentally ill clients were followed over two years in the community. Follow-up assessments were completed at 12, 18, and 24 months to assess clients' community adjustment. Community adjustment was conceptualised to include measures of general adaptive functioning, maladaptive behaviour, inpatient readmission, client satisfaction, subjective well-being, and levels of distress. The results showed that clients' general adaptive functioning and deviant behaviour remained stable from the hospital baseline assessment into the community follow-up phases. With respect to client characteristics, clients who exhibited more maladaptive behaviour were found to be significantly more likely to be readmitted to a psychiatric unit or hospital, and older clients were more likely to be socially isolated and exhibit poorer levels of adaptive functioning. Many clients remained socially isolated from family and friends, suggesting that if community support were withdrawn neglect may occur. Clients were significantly more satisfied with community than hospital services at 12 months follow-up and clients were found to be globally satisfied with community services. Nevertheless, up to 10% of client's showed poor community adjustment, with frequent readmissions to a psychiatric hospital, poor adaptive functioning, and high levels of maladaptive behaviour and distress. The implications of the findings for chronically mentally ill clients and service providers are discussed, with several recommendations for future research.
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    Evaluation of an inpatient programme aimed at preparing "hard-to-place" chronically mentally ill for the community : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1995) Hall, Marie
    With the continued policy of deinstitutionalising psychiatric inpatients, Lake Alice Hospital developed the Intensive Learning Centre (ILC) in an attempt to prepare their "hard-to-place" clients for successful community placement. The present research evaluated the ILC programme's ability to meet its' stated objectives, and compared the 15 ILC clients to a group of 26 clients who had been transferred to community placements 18 months earlier. Informant driven measures of adaptive and maladaptive behaviours were used to evaluate the effectiveness of the ILC programme, and to compare both subject groups on levels of functioning. The findings indicated a short-term (5 month) improvement in the general functioning levels of the ILC clients, but this improvement was not sustained at the 10 month follow-up. The ILC and community groups displayed similar levels in areas such as independent functioning, economic and domestic activity, violence, self-injury and verbal aggression. The community group demonstrated higher levels of functioning in areas such as social activity, self-care, community skills, antisocial behaviour, withdrawal and inappropriate behaviours. The implications and recommendations of these findings for the staff, clients and treatment programme are discussed.
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    A qualitative exploration of environmental and relational factors affecting service user involvement from the perspective of community mental health nurses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Palmerston North Campus, New Zealand
    (Massey University, 2012) Brown, Vicky Keryn
    Mental health policy and clinical guidelines require service user involvement principles within clinical practice and service provision, yet few national studies exist to examine Mental Health Nurse’s (MHNs) viewpoints about its implementation. This qualitative research project asks the question ‘What are the environmental and relational factors which affect service user involvement in community mental health team settings from the perspectives of community MHNs?’ The research aims were: (1) Explore how the practice environment supports service user involvement; (2) Explore how they include, or not, service users in the provision of care; and, (3) To discuss how the group of community MHNs recognise and describe service user involvement. Central ethics approval was gained and eight community MHNs in two District Health Board’s (DHBs) with over 5 years experience were interviewed. Participant’s discussion was audio taped, transcribed and then analysed utilising a thematic analysis approach. From this analysis, two predominant themes arose. Theme one highlights the ‘relationship dynamics of practice’ through exploration of concepts of historical changes; conflicting relationships, influential attitudes and powerlessness. Theme two explores ‘strength based approaches’ from the participants perspectives and includes recovery; inclusive practices; challenging stigma and beliefs towards service user involvement. Mutual agreement about the benefits of service user involvement was identified. However, changes to funding, hierarchical mental health organisations, nurses’ education, stigmatising attitudes and lack of nursing identity have impacted on the implementation and support of service user involvement. Recommendations for further research and suggestions for nursing practice are offered through building nursing capacity, capability, quality and strengthening the profession.