Contribution of Mental Health Service User Groups to Mental Health Services and Policy in Ghana : The Case of Mental Health Society of Ghana

RESUMO: Este estudo procurou documentar a perspectiva (s) dos utentes de saúde mental e das associações de prestadores de cuidados sobre a prestação, o papel e a contribuição de serviços de saúde mental da comunidade tal como foram percebidos por um número de informadores-chave, incluindo os utentes do serviço mentais e os próprios prestadores de cuidados. O caso específico da Sociedade Saúde Mental do Gana (MEHSOG) foi o foco deste estudo. O modelo foi o de um estudo de caso, utilizando discussões de grupo e entrevistas com informadores-chave como instrumentos de recolha de dados. Estas ferramentas de colheita de dados foram complementadas por observações dos participantes e pela revisão de documentos da MEHSOG e dos vários grupos de apoio da comunidade de auto-ajuda que compõem a associação nacional. O estudo revelou que os utentes dos serviços de saúde mental e seus prestadores de cuidados constituem um importante grupo de partes interessadas na prestação de serviços de saúde mental da comunidade e no desenvolvimento de políticas que tenham em conta as necessidades e os direitos das pessoas com doença mental ou epilepsia. O envolvimento da MEHSOG promove a mobilização de membros e famílias relacionadas com a doença mental de beneficiar de serviços de tratamento bem organizados com um impacto significativo na melhoria da saúde e da participação dos utentes dos serviços e seus prestadores de cuidados primários em processos de tomada de decisão da família e na comunidade processos de desenvolvimento. Os utentes dos serviços por beneficiarem de tratamento, e os prestadores de cuidados primários, por se tornarem mais livres e menos sobrecarregados com a responsabilidade de cuidar, podem passar a envolver-se mais em atividades que melhoramo seu estado, o de suas famílias e das comunidades. A advocacia dos membros da MEHSOG para conseguir que a “Mental Health Bill” se transforme numa Lei foi também um desenvolvimento significativo resultante da participação ativa dos utentes do serviço em chamar a atenção para uma nova e inclusiva legislação de saúde mental para o Gana. Entre os fatores e oportunidades que permitiram aos utentes dos serviços de saúde mental e aos prestadores de cuidados primários de pessoas com doença mental apoiar activamente a prestação de serviços de saúde mental comunitária e o desenvolvimento de políticas conta-se a contribuição da sociedade civil do Gana, particularmente o movimento da deficiência, e os esforços anteriores de ONGs em saúde mental e dos profissionais de saúde mental para ter uma nova lei em saúde mental. Observámos um certo número de desafios e barreiras que actuam de forma a limitar a influência dos utentes dos serviços de saúde mental na provisão da saúde mental comunitária e no desenvolvimento de políticas. Entre elas o estigma social contra a doença mental e pessoas com doença mental ou epilepsia e seus cuidadores primaries é um factor chave. O estigma tem alterado a percepção e as análises do público em geral, especialmente dos profissionais de saúde e das autoridades políticas afetando a priorização dos problemas de saúde mental nas políticas e programas. Outro desafio foi a deficiente infra-estrutura disponível para apoiar serviços de saúde mentais que assegurem aos utentes permanecerem em bom estado de saúde e bem-estar para serem advogados de si próprios. A recomendação do presente estudo é que os movimentos de utentes dos serviços de saúde mental são importantes e que eles precisam de ser apoiados e encorajados a desempenhar o seu papel como pessoas com experiência vivida para contribuir para a organização e prestação de serviços de saúde mental, bem como para a implementação, monitorização e avaliação de políticas e programas. ------------------------------------ ABSTRACT: This study sought to document the perspective(s) of mental health users and care-givers associations in community mental health service provision and their role and contribution as it was perceived by a number of key informants including the mental service users and care-givers themselves. The specific case of the Mental Health Society of Ghana (MEHSOG) was the focus of this study. A case study approach was used to with Focus Group Discussions and Key Informants Interviews being the data collection tools that were used. These data collection tools were complemented by participant observations and review of documents of the MEHSOG and the various community self-help peer support groups that make up the national association. The study revealed that mental health service users and their care-givers constitute an important stakeholder group in community mental health service provision and development of policies that factor in the needs and rights of persons with mental illness or epilepsy. MEHSOG’s involvement in mobilising members and education families to come forward with the relations with mental illness to benefit from treatment services were well made a significant impact in improving the health and participation of service users and their primary carers in family decision-making processes and in community development processes. Service users, on benefiting from treatment, and primary care-givers, on becoming freer and less burdened with the responsibility of care, move on to engage in secure livelihoods activities, which enhanced their status in their families and communities. The advocacy MEHSOG members undertook in getting the mental health Bill become Law was also noted as significant development that was realised as a result of active involvement of service users in calling for a new and inclusive mental health legislation for Ghana. Enabling factors and opportunities that enabled mental health service users and primary care-givers of people with mental illness to actively support community mental health service provision and policy development is with the vibrant civil society presence in Ghana, particularly the disability movement, and earlier efforts by NGOs in mental health in Ghana long-side mental health professionals to have a new law in mental health. A number of challenges were also noted which were found to limit the extent to which mental health service users can be influential in community mental health service provision and policy development. Key among them was the social stigma against mental illness and people with mental illness or epilepsy and their primary carers. Stigma has affected perceptions, analyses of the general public, especially health practitioners and policy authorities that it has affected their prioritisation of mental health issues in policies and programmes. Another challenge was the poor infrastructure available to support enhanced mental health care services that ensure mental health service users remain in a good state of health and wellbeing to advocate for themselves. The recommendation from the study is that mental health service user movements are important and need to be supported and encouraged to play their role as persons with lived experience to inform organisation and provision of mental health services as well as design and implementation, monitoring and evaluation of policies and programes.

ARCHITECTING USER-CENTRIC PRIVACY-AS-A-SET-OF-SERVICES: DIGITAL IDENTITY RELATED PRIVACY FRAMEWORK

AbstractDigitalization gives to the Internet the power by allowing several virtual representations of reality, including that of identity. We leave an increasingly digital footprint in cyberspace and this situation puts our identity at high risks. Privacy is a right and fundamental social value that could play a key role as a medium to secure digital identities. Identity functionality is increasingly delivered as sets of services, rather than monolithic applications. So, an identity layer in which identity and privacy management services are loosely coupled, publicly hosted and available to on-demand calls could be more realistic and an acceptable situation. Identity and privacy should be interoperable and distributed through the adoption of service-orientation and implementation based on open standards (technical interoperability). Ihe objective of this project is to provide a way to implement interoperable user-centric digital identity-related privacy to respond to the need of distributed nature of federated identity systems. It is recognized that technical initiatives, emerging standards and protocols are not enough to guarantee resolution for the concerns surrounding a multi-facets and complex issue of identity and privacy. For this reason they should be apprehended within a global perspective through an integrated and a multidisciplinary approach. The approach dictates that privacy law, policies, regulations and technologies are to be crafted together from the start, rather than attaching it to digital identity after the fact. Thus, we draw Digital Identity-Related Privacy (DigldeRP) requirements from global, domestic and business-specific privacy policies. The requirements take shape of business interoperability. We suggest a layered implementation framework (DigldeRP framework) in accordance to model-driven architecture (MDA) approach that would help organizations' security team to turn business interoperability into technical interoperability in the form of a set of services that could accommodate Service-Oriented Architecture (SOA): Privacy-as-a-set-of- services (PaaSS) system. DigldeRP Framework will serve as a basis for vital understanding between business management and technical managers on digital identity related privacy initiatives. The layered DigldeRP framework presents five practical layers as an ordered sequence as a basis of DigldeRP project roadmap, however, in practice, there is an iterative process to assure that each layer supports effectively and enforces requirements of the adjacent ones. Each layer is composed by a set of blocks, which determine a roadmap that security team could follow to successfully implement PaaSS. Several blocks' descriptions are based on OMG SoaML modeling language and BPMN processes description. We identified, designed and implemented seven services that form PaaSS and described their consumption. PaaSS Java QEE project), WSDL, and XSD codes are given and explained.

Virtual Library Services for a Virtual University : User-Oriented Virtual Sites in an Open Library

La llegada de las tecnologías de la información, y su uso cada vez mayor y generalizado que se está haciendo de ellas, ha permitido para que una nueva situación aparezca que, a su vez, ha originado - de hecho, que ha precipitado - una serie de cambios de gran importancia en todos los niveles, pero especialmente en los niveles sociales, económicos y culturales. Este nueva escena ha tenido una gran influencia en el entorno pedagógico. De hecho, la aparición de nuevos modelos educativos como resultado de este cambio ha estado sucediendo de una manera continuada e ininterrumpida durante la década pasada. Estos cambios recientes en los sistemas actuales de enseñanza y de aprendizaje han significado un aumento y un cambio en el tipo de demandas hechas desde las bibliotecas y los centros de documentación.

Towards a User-Friendly Platform for Building Language Resources based on Web Services

This paper presents the platform developed in the PANACEA project, a distributed factory that automates the stages involved in the acquisition, production, updating and maintenance of Language Resources required by Machine Translation and other Language Technologies. We adopt a set of tools that have been successfully used in the Bioinformatics field, they are adapted to the needs of our field and used to deploy web services, which can be combined to build more complex processing chains (workflows). This paper describes the platform and its different components (web services, registry, workflows, social network and interoperability). We demonstrate the scalability of the platform by carrying out a set of massive data experiments. Finally, a validation of the platform across a set of required criteria proves its usability for different types of users (non-technical users and providers).

Design and validation of stateful composite RESTful web services

A web service is a software system that provides a machine-processable interface to the other machines over the network using different Internet protocols. They are being increasingly used in the industry in order to automate different tasks and offer services to a wider audience. The REST architectural style aims at producing scalable and extensible web services using technologies that play well with the existing tools and infrastructure of the web. It provides a uniform set of operation that can be used to invoke a CRUD interface (create, retrieve, update and delete) of a web service. The stateless behavior of the service interface requires that every request to a resource is independent of the previous ones facilitating scalability. Automated systems, e.g., hotel reservation systems, provide advanced scenarios for stateful services that require a certain sequence of requests that must be followed in order to fulfill the service goals. Designing and developing such services for advanced scenarios with REST constraints require rigorous approaches that are capable of creating web services that can be trusted for their behavior. Systems that can be trusted for their behavior can be termed as dependable systems. This thesis presents an integrated design, analysis and validation approach that facilitates the service developer to create dependable and stateful REST web services. The main contribution of this thesis is that we provide a novel model-driven methodology to design behavioral REST web service interfaces and their compositions. The behavioral interfaces provide information on what methods can be invoked on a service and the pre- and post-conditions of these methods. The methodology uses Unified Modeling Language (UML), as the modeling language, which has a wide user base and has mature tools that are continuously evolving. We have used UML class diagram and UML state machine diagram with additional design constraints to provide resource and behavioral models, respectively, for designing REST web service interfaces. These service design models serve as a specification document and the information presented in them have manifold applications. The service design models also contain information about the time and domain requirements of the service that can help in requirement traceability which is an important part of our approach. Requirement traceability helps in capturing faults in the design models and other elements of software development environment by tracing back and forth the unfulfilled requirements of the service. The information about service actors is also included in the design models which is required for authenticating the service requests by authorized actors since not all types of users have access to all the resources. In addition, following our design approach, the service developer can ensure that the designed web service interfaces will be REST compliant. The second contribution of this thesis is consistency analysis of the behavioral REST interfaces. To overcome the inconsistency problem and design errors in our service models, we have used semantic technologies. The REST interfaces are represented in web ontology language, OWL2, that can be part of the semantic web. These interfaces are used with OWL 2 reasoners to check unsatisfiable concepts which result in implementations that fail. This work is fully automated thanks to the implemented translation tool and the existing OWL 2 reasoners. The third contribution of this thesis is the verification and validation of REST web services. We have used model checking techniques with UPPAAL model checker for this purpose. The timed automata of UML based service design models are generated with our transformation tool that are verified for their basic characteristics like deadlock freedom, liveness, reachability and safety. The implementation of a web service is tested using a black-box testing approach. Test cases are generated from the UPPAAL timed automata and using the online testing tool, UPPAAL TRON, the service implementation is validated at runtime against its specifications. Requirement traceability is also addressed in our validation approach with which we can see what service goals are met and trace back the unfulfilled service goals to detect the faults in the design models. A final contribution of the thesis is an implementation of behavioral REST interfaces and service monitors from the service design models. The partial code generation tool creates code skeletons of REST web services with method pre and post-conditions. The preconditions of methods constrain the user to invoke the stateful REST service under the right conditions and the post condition constraint the service developer to implement the right functionality. The details of the methods can be manually inserted by the developer as required. We do not target complete automation because we focus only on the interface aspects of the web service. The applicability of the approach is demonstrated with a pedagogical example of a hotel room booking service and a relatively complex worked example of holiday booking service taken from the industrial context. The former example presents a simple explanation of the approach and the later worked example shows how stateful and timed web services offering complex scenarios and involving other web services can be constructed using our approach.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

AALUMO: a user model ontology for ambient assisted living services supported in next-generation networks

Ambient Assisted Living (AAL) services are emerging as context-awareness solutions to support elderly people?s autonomy. The context-aware paradigm makes applications more user-adaptive. In this way, context and user models expressed in ontologies are employed by applications to describe user and environment characteristics. The rapid advance of technology allows creating context server to relieve applications of context reasoning techniques. Specifically, the Next Generation Networks (NGN) provides by means of the presence service a framework to manage the current user's state as well as the user's profile information extracted from Internet and mobile context. This paper propose a user modeling ontology for AAL services which can be deployed in a NGN environment with the aim at adapting their functionalities to the elderly's context information and state.

Remote storage, facilities, materials selection, and user services /

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Police allocation manual user's guide : determination of the number and allocation of personnel for police traffic services for state-wide agencies /

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User satisfaction with allied health services delivered to residential facilities via videoconferencing

We have investigated the role of videoconferencing in allied health service provision to high-care clients in rural residential facilities. Videoconferencing equipment was set up at a rural aged-care facility and a metropolitan allied health centre; ISDN transmission at 384 kbit/s was used to link the equipment. Twelve residents were assessed by both videoconference and face to face across five allied health disciplines (a total of 120 assessments). User satisfaction was measured using questionnaires and focus groups. Face-to-face assessment took significantly longer than videoconferencing assessment. However, the mean satisfaction ratings for face-to-face assessments were higher than for videoconferencing and the majority of the staff preferred the face-to-face format. Videoconferencing was particularly useful for consultations and the initial stages of the assessment process. A number of issues relating to the videoconferencing equipment, to the environment in which assessments were performed and to the clients themselves need to be addressed in order for this form of service delivery to be effective.

Accessing networked services : a user interface design problem

This research investigates the general user interface problems in using networked services. Some of the problems are: users have to recall machine names and procedures to. invoke networked services; interactions with some of the services are by means of menu-based interfaces which are quite cumbersome to use; inconsistencies exist between the interfaces for different services because they were developed independently. These problems have to be removed so that users can use the services effectively. A prototype system has been developed to help users interact with networked services. This consists of software which gives the user an easy and consistent interface with the various services. The prototype is based on a graphical user interface and it includes the following appJications: Bath Information & Data Services; electronic mail; file editor. The prototype incorporates an online help facility to assist users using the system. The prototype can be divided into two parts: the user interface part that manages interactlon with the user; the communicatIon part that enables the communication with networked services to take place. The implementation is carried out using an object-oriented approach where both the user interface part and communication part are objects. The essential characteristics of object-orientation, - abstraction, encapsulation, inheritance and polymorphism - can all contribute to the better design and implementation of the prototype. The Smalltalk Model-View-Controller (MVC) methodology has been the framework for the construction of the prototype user interface. The purpose of the development was to study the effectiveness of users interaction to networked services. Having completed the prototype, tests users were requested to use the system to evaluate its effectiveness. The evaluation of the prototype is based on observation, i.e. observing the way users use the system and the opinion rating given by the users. Recommendations to improve further the prototype are given based on the results of the evaluation. based on the results of the evah:1ation. . .'. " "', ':::' ,n,<~;'.'

Browsing for information by highlighting automatically generated annotations:a user study and evaluation

The realization of the Semantic Web is constrained by a knowledge acquisition bottleneck, i.e. the problem of how to add RDF mark-up to the millions of ordinary web pages that already exist. Information Extraction (IE) has been proposed as a solution to the annotation bottleneck. In the task based evaluation reported here, we compared the performance of users without access to annotation, users working with annotations which had been produced from manually constructed knowledge bases, and users working with annotations augmented using IE. We looked at retrieval performance, overlap between retrieved items and the two sets of annotations, and usage of annotation options. Automatically generated annotations were found to add value to the browsing experience in the scenario investigated. Copyright 2005 ACM.

User involvement in UK cancer services:bridging the policy gap

Recent UK government initiatives aim to increase user involvement in the National Health Service (NHS) in two ways: by encouraging service users to take an active role in making decisions about their own care; and by establishing opportunities for wider public participation in service development. The purpose of this study was to examine how UK cancer service users understand and relate to the concept of user involvement. The data were collected through in-depth interviews, which were analysed for content according to the principles of grounded theory. The results highlight the role of information and communication in effective user involvement. Perhaps more importantly, this study suggests that the concept of user involvement is unclear to many cancer service users. This paper argues the need for increased awareness and understanding of what user involvement is and how it can work.