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Purchasing, providing and participating in mental health servicesThis thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.
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Are talking therapies culturally relevant for the British South-Asian community?: a look into the views and experiences of British South-AsiansThe personal experiences of South-Asians who have accessed talking therapy have been widely overlooked in the development of culturally adapted therapies for ethnic minorities in the United Kingdom (Naeem et al., 2015). This research aimed to gain an understanding into the experiences of British South-Asian service users, discovering the views held towards existing mental health services and exploring how their experiences shaped these. Additionally, the experiences of community members and professionals were also explored, with all three groups being sought to discover whether talking therapies were culturally relevant for the British South Asian community in England. This qualitative study consisted of 20 semi-structured interviews carried out with British South-Asian service users (n=4), British South-Asian community members (n=5) and mental health professionals (n=11) who had experience of providing therapy to the South-Asian community. Interviews were analysed using inductive thematic analysis, with four key themes arising within each group. There was consensus among the three groups that specific barriers caused difficulty when accessing services, including cultural norms and perceptions towards mental health, English as a second language and limited cultural understanding within existing services. Findings are discussed in relation to previous research into minority communities and recommendations for future research are made.
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Help-seeking for perinatal mental health: South Asian women’s experiences in LutonThe objective was to identify the current care pathway for Perinatal Mental Health (PMH) in Luton, and to explore South Asian women’s views on factors that influence help-seeking with a view to making recommendations to local service development (LBC, BLMK). Method Focus groups were used to explore the factors (barriers and enablers) that influenced the help-seeking of local South Asian women for perinatal mental health. 5 focus groups (FG) were conducted with n=17 women, from various South Asian countries and ethnic subgroups, all of whom had children who had been born locally. Luton has a large ethnic population in areas of high social and material deprivation, with a fast growing birth rate, placing them at increased risk of perinatal mental illness (PMI), but conversely has low levels of reported mental illness from within these areas. Findings The findings indicate that community; extended family, religious and cultural beliefs have a significant impact on the development, recognition and treatment of PMI, forming a complicated mesh of considerations that need to be integrated when designing local PMH services for differing populations. Conclusion Improving healthcare engagement may require a three pronged approach of; developing more culturally attuned services; a community social awareness programme endorsed by community leaders and; a socio-healthcare programme to sustain healthy spousal and familial relationships and change cultural attitudes towards motherhood to help prevent the development of PMI. These changes may reduce stress in the post-partum year, where caring for a new baby means that illnesses are more likely to develop and contribute to healthy and positive family relationships, with long-term health, social and life trajectory benefits for the family, community and society in general.
