A critical narrative analysis of shared decision-making in acute, inpatient mental health care

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients? care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

A critical analysis of Child and Adolescent Mental Health Services policy in England, 2000‐2015

Policy in Child and Adolescent Mental Health (CAMH) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health, and CAMHS are constituted in 15 policy documents, 9 pre‐2010, and 6 post 2010. We trace how these constructions have changed over time, and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socioeconomic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities, to a view that children’s mental health must be addressed early to prevent future socio‐economic burden. We consider the implications CAMHS policies for the relationship between children, families, mental health services and the state. The paper concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health.

Standardisation of a mental skills scale in South Africa and the United Kingdom

The contemporary science of sport and exercise psychology requires the standardisation of mental skills questionnaires to facilitate accurate assessment of and intervention for individuals and groups in various health and sport related contexts. The study presents international research findings regarding the standardisation of a Mental Skills Scale with a sample of university students (N=420) from South Africa (n=211) and the United Kingdom (n=209) respectively. Although further international and national standardisation in both English and other languages is recommended, factor and reliability analyses indicated satisfactory validity and reliability of the current English version of the scale.

Are mental health services getting better at responding to abuse, assault and neglect?

Objective To determine whether staff responses to abuse disclosures had improved since the introduction of a trauma policy and training programme. Method The files of 250 clients attending four New Zealand mental health centres were audited. Results There was a significant improvement, compared to an audit prior to the introduction of the policy and training, in the proportion of abuse cases included in formulations, and, to a lesser extent, in treatment plans. There was no significant improvement in the proportion referred for relevant treatment, which remained at less than 25% across abuse categories. The proportion of neglect disclosures responded to was significantly lower than for abuse cases. Fifty percent of the files in which abuse/neglect was recorded noted whether the client had been asked about previous disclosure, and 22% noted whether the client thought there was any connection between the abuse/neglect and their current problems. Less than 1% of cases were reported to legal authorities. People diagnosed with a psychotic disorder were significantly less likely to be responded to appropriately. Conclusion Future training may need to focus on responding well to neglect and people diagnosed with psychosis, on making treatment referrals, and on initiating discussions about reporting to authorities.

Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.

Les représentations sociales d'une discipline scolaire - l'activité scientifique - et de sa place au sein des autres disciplines formant le curriculum chez des instituteurs marocains

Cette thèse s'inscrit dans les préoccupations récentes du système scolaire marocain à l'égard de la qualité de l'éducation. Ces préoccupations consistent à considérer l'enseignement fondamental (le primaire) non seulement comme un lieu pour apprendre à lire, à écrire et à compter pour se préparer aux études ultérieures, mais aussi, et surtout, comme un lieu de formation de qualité pour tous. La recherche s'intéresse particulièrement à la contribution d'une matière scolaire, l'activité scientifique, à cette formation. L'auteur dégage de la problématique que l'exploitation de l'activité scientifique à la formation des élèves nécessite une analyse à trois niveaux. Le premier est celui des enjeux qu'elle véhicule. Le deuxième niveau est celui du statut qu'occupe cette discipline au sein des autres disciplines. Le troisième est celui de l'implication de cette discipline dans des activités d'enseignement-apprentissage qui s'assurent la cohérence du curriculum . Pour explorer les dimensions retenues, l'auteur s'est intéressé aux représentations sociales que les principaux acteurs scolaires, les instituteurs, détiennent à l'égard de chacune d'elles. L'étude menée s'est basée sur des entrevues réalisées auprès de 32 instituteurs marocains.

Contributo para a aferição e validação da escala de personalidade criativa: avaliação da criatividade na deficiência mental

Dissertação de Mest.em Psicologia( Psicologia da Educação) Faculdade de Ciências Humanas e Sociais, Univ. do Algarve, 2011

Indução de contaminação mental em vítimas de traição numa amostra de indivíduos não-clínicos

No presente trabalho apresentam-se dois estudos. O primeiro dos estudos teve como objetivo a adaptação ao português do Inventário de Obsessões e Compulsões de Vancouver (VOCI; Thordarson, Radomsky, Rachman, Shafran, Sawchuk & Hakstian, 2004). O segundo dos estudos teve como objetivo induzir, de forma experimental, a sensação de contaminação mental através da imaginação de uma situação de traição. No estudo de adaptação do VOCI participaram 180 indivíduos da população geral não-clínica com idades compreendidas entre os 18 e os 75 anos e 120 estudantes universitários com idades compreendidas entre os 18 e os 25 anos que preencheram além do VOCI, a Escala de sensibilidade de Contaminação (S-CTN; Rachman, 2006 cit in Coughtrey, Shafran, Knibbs & Rachman, 2012). Sessenta dos participantes completaram de novo o VOCI após um intervalo de 8 semanas. A amostra final ficou constituída por 292 participantes. Para conhecer a estrutura interna do VOCI, foi realizada uma análise fatorial exploratória. Obtiveram-se 6 fatores que explicaram 39% da variância total. Os fatores obtidos replicaram a estrutura original do VOCI Contaminação, Verificação, Obsessões, Acumulação, Incerteza, Just Right. Quer o total do VOCI quer as seis subescalas obtidas mostraram excelentes níveis de consistência interna, fiabilidade temporal e validade convergente. De acordo com os nossos resultados, podemos considerar que a versão portuguesa do VOCI apresenta garantias psicométricas suficientes para que possa ser utilizada na população Portuguesa. No segundo estudo, participaram 60 estudantes universitários, 30 do género feminino e 30 do género masculino, com idades compreendidas entre os 18 e os 25 anos. Os participantes foram aleatoriamente divididos em dois grupos: um grupo de controlo (GC) e um grupo experimental (GE). Neste estudo recorreu-se a um desenho experimental 2x4 (2 condições x 4 momentos). Inicialmente os participantes preencheram um conjunto de questionários e de seguida foram instruídos para ouvir uma gravação de voz relativa à sua condição (controlo/experimental). Posteriormente foi-lhes dada uma pausa de 5 minutos e, no quarto e último momento, os participantes foram submetidos a uma pequena entrevista final. Os resultados obtidos após a manipulação experimental revelaram que o GE apresentou valores significativamente mais elevados de desconforto que o GC, ou seja, a manipulação experimental desencadeou emoções negativas (tais como a raiva ou a tristeza). Não se verificou, no entanto, o efeito da manipulação experimental relativamente à capacidade dos participantes para localizar a sujidade em alguma parte do interior ou exterior do corpo. Em suma, no presente estudo não foi possível induzir contaminação mental através da imaginação de uma situação de traição bem como a localização da sensação de sujidade, o aparecimento de emoções/sentimentos negativos, do impulso de se lavar, de evitamento e de estratégias de neutralização e de lavagem.

Explaining party cohesion and discipline in democratic legislatures: purposiveness and contexts

Legislative party discipline and cohesion are important phenomena in the study of political systems. Unless assumptions are made that parties are cohesive and act as unified collectivities with reasonably well-defined goals, it is really difficult, if not impossible, to consider their electoral and legislative roles usefully. But levels of legislative party cohesiveness are also important because they provide us with crucial information about how legislatures/ parliaments function and how they interact with executives/governments. Without cohesive (or disciplined) parties,1 government survival in parliamentary systems is threatened because executive and legislative powers are fused while in separated systems presidents' bases of legislative support become less stable. How do we explain varying levels of legislative party cohesion? The first part of this article draws on the purposive literature to explore the benefits and costs to legislators in democratic legislatures of joining and acting collectively and individualistically within political parties. This leads on to a discussion of various conceptual and empirical problems encountered in analysing intra-party cohesion and discipline in democratic legislatures on plenary votes. Finally, the article reviews the extant empirical evidence on how a multiplicity of systemic, party-levels and situational factors supposedly impact cohesion/discipline levels. The article ends with a discussion of the possibilities and limitations of building comparative models of cohesion/discipline.

Please Don't Make Me Ask for Help: Implicit Social Support and Mental Health in Chinese Individuals Living with HIV

Thesis (Master's)--University of Washington, 2013

Using Workload Measurement Tools in Diverse Care Contexts: the Experience of Staff in Mental Health and Learning Disability Inpatient Settings

Introduction The critical challenge of determining the correct level and skill-mix of nursing staff required to deliver safe and effective healthcare has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. Aim It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool (SNCT) and the Mental Health and Learning Disability Workload Tool (MHLDWT) in mental health and learning disability environments. Method Following a 4-week trial period of both tools a survey was distributed via Qualtrics on-line survey software to staff members who used the tools during this time. Results The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however specific criticisms were highlighted regarding their suitability to psychiatric intensive care units (PICU) and learning disability wards. Discussion This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. Implications for Practice With increasing fiscal pressures the need to provide cost-effective care is paramount within NHS services. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

The Impact of Thought Speed and Variability on Psychological State and Threat Perception: Further Exploration of the Theory of Mental Motion

Thought speed and variability are purportedly common features of specific psychological states, such as mania and anxiety. The present study explored the independent and combinational influence of these variables upon condition-specific symptoms and affective state, as proposed by Pronin and Jacobs’ (Perspect Psychol Sci, 3:461–485, 2008) theory of mental motion. A general population sample was recruited online (N = 263). Participants completed a thought speed and variability manipulation task, inducing a combination of fast/slow and varied/repetitive thought. Change in mania and anxiety symptoms was assessed through direct self-reported symptom levels and indirect, processing bias assessment (threat interpretation). Results indicated that fast and varied thought independently increased self-reported mania symptoms. Affect was significantly less positive and more negative during slow thought. No change in anxiety symptoms or threat interpretation was found between manipulation conditions. No evidence for the proposed combinational influence of speed and variability was found. Implications and avenues for therapeutic intervention are discussed.

Mental Toughness Moderates Social Loafing in Cycle Time-Trial Performance

Purpose: The purpose of this study was to determine if mental toughness moderated the occurrence of social loafing in cycle time-trial performance. Method: Twenty-seven men (Mage = 17.7 years, SD = 0.6) completed the Sport Mental Toughness Questionnaire prior to completing a 1-min cycling trial under 2 conditions: once with individual performance identified, and once in a group with individual performance not identified. Using a median split of the mental toughness index, participants were divided into high and low mental toughness groups. Cycling distance was compared using a 2 (trial) × 2 (high–low mental toughness) analysis of variance. We hypothesized that mentally tough participants would perform equally well under both conditions (i.e., no indication of social loafing) compared with low mentally tough participants, who would perform less well when their individual performance was not identifiable (i.e., demonstrating the anticipated social loafing effect). Results: The high mental toughness group demonstrated consistent performance across both conditions, while the low mental toughness group reduced their effort in the non-individually identifiable team condition. Conclusions: The results confirm that (a) clearly identifying individual effort/performance is an important situational variable that may impact team performance and (b) higher perceived mental toughness has the ability to negate the tendency to loaf.

Cálculo mental com números racionais : um estudo com alunos do 6º ano de escolariedade

Tese de doutoramento, Educação (Didática da Matemática), Universidade de Lisboa, Instituto de Educação, 2016