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Item Mental health crisis intervention : a discourse analysis involving service users, families, nurses and the police : a thesis presented in fulfilment of requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand(Massey University, 2014) Wilson, Stacey CarolineThis research is a Foucault-influenced discourse analysis, which explores the field of Aotearoa New Zealand mental health crisis intervention, with the goal to challenge current practices. The study takes place in the context of changing access to mental health crisis services, following the implementation of the Mental Health Act (1992) and subsequent policy, regulation and practice development strategies. Analysis is centered in converging and competing discourses, strategies and technologies in the field. In order to develop a position to discuss a range of converging and competing discourses, perspectives were sought from 9 people who have accessed crisis services, 8 family members who have supported service users, 9 mental health nurses working in crisis services and 2 senior members of the New Zealand police. Analysis of the published research and grey literature took place in between interviews, data analysis and during the writing process. The overarching findings are that crisis intervention is affected by four predominant discursive constructions. These include mental disorder, risk management, expertise and uncertainty. The discursive constructs are influenced by three dominating biomedical, accountability and social development discourses, working together to produce power/knowledge of the people involved in crisis, whilst simultaneously subjugating a personal recovery discourse and the potential of uncertainty. Consequently, participants bear disproportionate amounts of responsibility during a mental health crisis in which they are held accountable for much of what occurs in the clinical and community setting. They have limited control over the decisions that affect care, and largely, the way services are delivered. In order to disrupt structural and systemic inequities, I argue that self-reflection is required to attend to the ways that the experiences of people involved in a mental health crisis affect and contribute to maintaining the status quo. Attending to the possible stages of resistance surrounding the dominating discourses allows the potential for building authentic relationships within crisis intervention. Foucault’s framework of ethical practice is utilised to counter conditional citizenship and redefine responsibilities in the field.Item Adding quality to the quilt : adolescent experiences of critical incident responses in secondary schools in Aotearoa New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Social Work at Massey University (Palmerston North campus), New Zealand(Massey University, 2008) Stewart, Kathryn JanetCritical incidents impact on populations that experience them. Within secondary schools in Aotearoa New Zealand, there is an expectation that a response is made to schools that experience such incidents. There is much conflicting international research as to the efficacy of these responses. The adult experts are making decisions that they believe are in the best possible interests of the young people; they are putting together a quilt that they believe will nurture young people. The expertise and knowledge of a major stakeholder – the young people involved in the critical incident response – has been for the most part, omitted from research. This particular study set out to gather data about young people’s experiences of critical incident responses, so that the quilt being provided has input from this group and so is able to better meet their needs. The study had four major facets. It incorporated reflections on my intrinsic involvement in this field of practice and was, therefore, heuristic. Secondly, qualitative research was utilised to explore with young people their stories about what happened for them at the time of an incident. Thirdly, it incorporated principles of participatory research as an acknowledgement that young people are central stakeholders in secondary schools and that their voice was one that needed to be heard in order that the best responses may be offered. Lastly, it was utilisation focused. It was designed so that the findings were not just written up and filed away but disseminated to those who make decisions at the school level and policy level. At the analysis stage, two major methods were used. Firstly, inductive analysis was used to identify the themes that emerged from the interviews with the young people. Triangulation was then used to consolidate these themes using the input from Collaborative Groups and a systematic review of the knowledge that I have gained over the time that I have been involved with young people in the critical incident response area. This analysis of the contribution from the young people resulted in several areas being highlighted. Firstly, participants asked that those responding to critical incidents considered the use of language and the power of words, Secondly, they believed that schools needed to act proactively and to have a plan and, in association with this, that they develop a culture that better cared for the needs of young people. Thirdly, the young people involved requested that the ‘right’ people responded at the time of an incident: the qualities of the ‘right’ people and the ‘wrong’ people were also identified. Next, the young people were well able to identify the positives that could ensue out of negative situations, and lastly, they expressed their wish that there be a place for their involvement at the time of a critical incident response.