Browsing by Author "Flisher, A J"

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    A retrospective evaluation of a wilderness-based leadership development programme
    (2011) Draper, C E; Lund, C; Flisher, A J
    The Leadership Project (LP) in Cape Town, South Africa, is a wilderness-based leadership development programme that targets young people from diverse backgrounds. The aim of this study was to evaluate the LP, focusing on process and perceived outcomes. Document analysis and key informant interviews were used to evaluate programme reach and implementation process. Semi-structured interviews and focus groups with past programme participants (n = 46) were conducted to assess perceived outcomes. Study findings indicated that the LP offers a relevant programme and has wide reach through its range of client agencies and organisations. Qualitative findings highlighted that participants' positive experiences and views of the LP came about through the interaction between 'self', 'others'and the 'environment'. Participants' perceived intrapersonal and interpersonal outcomes of the LP aligned with the LP's intended outcomes. Mechanisms of perceived outcomes - leaders, programme activities and programme setting - influenced and facilitated the reflective process. This reflective process (strongly related to the intrapersonal outcome of increased self-awareness) appeared to underlie the interpersonal outcomes of the LP. Therefore, a significant finding of this study was that awareness of self is a key characteristic of leadership development. The nature of perceived outcomes was underpinned by the changing of perspectives, and the LP was described as either starting or contributing to a process of change, or as a life changing experience. No major improvements to the LP were suggested, but rather participants' responses affirmed the content and delivery of the programme. These findings indicate that a study with a relatively small scope can provide insight into the perceived outcomes of a leadership development programme, particularly one that caters for participants from a diverse range of cultural and socioeconomic backgrounds. The findings have elucidated the manner in which interpersonal outcomes are underpinned by intrapersonal outcomes, and the complexity of these outcomes in terms of assessment.
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    A situational analysis of child and adolescent mental health services in Ghana Uganda South Africa and Zambia
    (2010) Kleintjies, Sharon Rose; Lund, Christopher; Flisher, A J; MHaPP Research Programme Consortium
    Objective: Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana, Uganda, South Africa and Zambia. The findings are part of a 5 year study, the Mental Health and Poverty Project, which aims to provide new knowledge regarding multi-sectoral approaches to breaking the cycle of poverty and mental ill-health in Africa. Method: The World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect quantitative information on mental health resources. Mental health policies and legislation were analysed using the WHO Policy and Plan, and Legislation Checklists. Qualitative data were collected through focus groups and interviews. Results: Child and adolescent mental health (CAMH) - related legislation, policies, services, programmes and human resources are scarce. Stigma and low priority given to mental health contribute to low investment in CAMH. Lack of attention to the impoverishing impact of mental disorders on CA and their families contribute to the burden. Conclusion: Scaling up child and adolescent mental health services (CAMHS) needs to include anti-stigma initiatives, and a greater investment in CAMH. Clear policy directions, priorities and targets should be set in country-level CAMH policies and plans. CAMHS should be intersectoral and include consideration of the poverty- mental health link. The roles of available mental health specialists should be expanded to include training and support of practitioners in all sectors. Interventions at community level are needed to engage youth, parents and local organizations to promote CAMH.
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    Challenges faced by South African health services in implementing the Mental Health Care Act
    (Health & Medical Publishing Group, 2007) Lund, C; Stein, Dan J; Flisher, A J; Mehtar, S
    The World Health Organization (WHO) has drawn attention to the growing global burden of mental disorders, and to recent advances in our understanding of and ability to treat these disorders. Mental disorders accounted for 12% of the global burden of disease in 2000. This figure will rise to 15% in 2020, when it is estimated that unipolar depression will be the second most disabling health condition in the world. In South Africa, neuropsychiatric disorders account for the second highest proportion of the local burden of disease, after HIV/AIDS.
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    From mental health policy development in Ghana to implementation: What are the barriers?
    (2010) Awenva, A D; Read, U M; Ofori-Attah, A L; Doku, V C K; Akpalu, B; Flisher, Alan; Lund, Crick; Osei, A O; Flisher, A J; MHaPP Research Programme Consortium
    Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy, plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro, meso and micro levels. These were used to identify barriers to the implementation of mental health policy, and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources; lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders.
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    Methamphetamine use and sexual risk behaviour in Cape Town South Africa: A review of data from 8 studies conducted between 2004 and 2007
    (2011) Parry, C D H; Plüddemann, Andreas; Myers, B; Wechsberg, W M; Flisher, A J
    Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This study aimed to review research conducted in Cape Town on the link between methamphetamine use and sexual risk behaviour. Method:A review of published research conducted in Cape Town between 2004 and 2007 was undertaken using PubMed, EBSCOhost and Science Direct. Results:Eight studies were identified, both quantitative and qualitative, and focusing on diverse populations, such as learners in school, out of school youth, adults in the community, men who have sex with men and sex workers. The total sample across the studies was 8153. Across multiple studies methamphetamine was fairly consistently associated with early vaginal sex, condom use during sex, having casual sex and other HIV risk behaviours. For some sub-groups the direction of the relationship was in an unexpected direction. Conclusion: The consistency of the findings across studies highlights the increased risk for contracting HIV among methamphetamine users, and reinforces the importance of interventions addressing both methamphetamine use and unsafe sexual behaviour among young people and other sectors of the population. The need for further research is also considered, particularly research that will explain some of the racial differences that were found.
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    Needs and services at an in-patient psychotherapy unit
    (2007) Joska, J A; Flisher, A J
    Objective: To describe the impact of services provided, during an admission, on unmet needs and correlates of unmet needs. Method: The study used a modified version of The Camberwell Assessment of Need (CAN) to assess the perceived needs of 100 patients on admission to a psychotherapy unit, Valkenberg Hospital, Cape Town. At discharge, the study documented the extent to which the patients had perceived services and interventions to be useful. Results: The mean number of needs on admission was 8.6. At discharge, help received was highest for psychiatric needs. The services most often regarded as useful were organised group activities and therapies. Regression analysis suggests that a lower level of education and the presence of borderline personality traits contribute significantly to unmet need on discharge. Conclusion: The in-patient program is effective in meeting psychiatric needs, but less useful for addressing psycho-social needs. These needs may exacerbate psychiatric problems and should be managed more actively before, during and after an in-patient stay
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    The neurobiology of HIV dementia: implications for practice in South Africa
    (OMICS International, 2011) Joska, J A; Hoare, J; Stein, Dan J; Flisher, A J
    In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.
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    The prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa
    (AOSIS, 2006) Kleintjies, S; Flisher, A J; Fick, M; Railon, A; Lund, C; Molteno, C; Robertson, B A
    Objective: To provide estimates of the prevalence of selected mental disorders in the Western Cape, based on the consensus achieved by a working group established for this purpose. Method: An expert working group was established to provide technical expertise for the project. Potential risk factors likely to influence local prevalence rates were identified. Annual prevalence rates for adults and for children and adolescents were derived by consensus, informed by a systematic literature review. Prevalence rates were derived for individual disorders and adjusted for comorbidity. Results: The overall prevalence was 25.0% for adults and 17.0% for children and adolescents. Conclusion: Prevalence rates of child, adolescent and adult mental disorders were derived in a short period of time and with the use of minimal resources. Although of unknown validity, they are useful for policy development and for planning service utilisation estimates, resource costing and targets for service development for local mental health needs. This in the absence of an existing methodologically sound national prevalence study. We recommend that policy and programme developers draw on the expertise of local academics and clinicians to promote research-informed planning and policy development in the public sector.