title: Mental health service users' perceptions of their physical health

authors: Heinz, Stefan Sebastian

subjects: Mental health

abstract: Background: Severe mental illness is linked to poor physical health and shorter life expectancy. Most research focuses on mental health professionals’ views to improve physical health of those with mental illness. However, little is known about mental health service users’ perspectives and their perceptions of their physical health. 

Objectives: This research study aimed to examine mental health service users’ perceptions of their physical health, including challenges to and enablers to health improving strategies. Moreover, the study investigated mental health service users’ experiences, views on general practice care and preferences for suitable health care delivery. 

Participants: The participants were mental health service users who were engaging with Mental Health and Addictions services of the Waikato district. Study participants consisted of survey participants (n = 167), and interviewees (n = 6). While three Māori and three non-Māori service users participated in the interview, Māori and Pacifica (n= 54) and non-Māori (n = 82) contributed to the survey. 

Methods: The mixed method study involved two phases. Phase I gathered quantitative data from an online Qualtrics survey, measuring participants’ quality of life using the 12-item Short Form (SF-12) survey, and determining their demographics and preferences relating their physical health. The primary outcome measures of the survey were the SF-12 (determining self-assessed physical and mental health), in correlation with questions relating physical health, and demographics. Statistically significant questions that arose from the survey, were explored in second phase. Phase II collected qualitative data using semi-structured interviews with mental health service users. The qualitative data analysis used an inductive approach.

Results: The quantitative data analysis involved a parsimonious modelling approach that included two general linear modelling analyses of covariance (ANCOVA). The analysis revealed statistical significance between the participants’ SF-12 PCS and ethnicity (p = 0.043), time in mental health service (p = 0.005), contact with general practitioner (p = 0.001), and mental health and addiction medication (p = 0.05). In addition, participants SF-12 showed statistical significance between participants’ physical component score (PCS) and between the combination of ethnicity, age, and gender (p = 0.041). Moreover, the analysis highlighted an additional link between participants’ mental component score (MCS) and their preference to improve their physical health (p = 0.038). The key findings of the free-text responses of the survey revealed four key themes including accessibility and availability, people want to be healthy, staff attitude, and medication. The results of the interviews revealed three main themes including physical health perception, the role of medication, and the importance of the relationship with the GP. 

Conclusion: Mental health service users perceive their physical health as an interconnected construct of health. They have complex physical health experiences and require a collaborative approach from primary and secondary care services. In addition, they have a desire to improve their physical health, however, face barriers such as diagnostic overshadowing, side effects of psychotropic medication and poor accessibility. Staff in general practices and mental health professionals should be mindful of these barriers and are required to provide individualised holistic care tailored to the preferences and needs of people with severe mental illness.

text: Mental health service users' perceptions of their physical health Background: Severe mental illness is linked to poor physical health and shorter life expectancy. Most research focuses on mental health professionals’ views to improve physical health of those with mental illness. However, little is known about mental health service users’ perspectives and their perceptions of their physical health. 

Objectives: This research study aimed to examine mental health service users’ perceptions of their physical health, including challenges to and enablers to health improving strategies. Moreover, the study investigated mental health service users’ experiences, views on general practice care and preferences for suitable health care delivery. 

Participants: The participants were mental health service users who were engaging with Mental Health and Addictions services of the Waikato district. Study participants consisted of survey participants (n = 167), and interviewees (n = 6). While three Māori and three non-Māori service users participated in the interview, Māori and Pacifica (n= 54) and non-Māori (n = 82) contributed to the survey. 

Methods: The mixed method study involved two phases. Phase I gathered quantitative data from an online Qualtrics survey, measuring participants’ quality of life using the 12-item Short Form (SF-12) survey, and determining their demographics and preferences relating their physical health. The primary outcome measures of the survey were the SF-12 (determining self-assessed physical and mental health), in correlation with questions relating physical health, and demographics. Statistically significant questions that arose from the survey, were explored in second phase. Phase II collected qualitative data using semi-structured interviews with mental health service users. The qualitative data analysis used an inductive approach.

Results: The quantitative data analysis involved a parsimonious modelling approach that included two general linear modelling analyses of covariance (ANCOVA). The analysis revealed statistical significance between the participants’ SF-12 PCS and ethnicity (p = 0.043), time in mental health service (p = 0.005), contact with general practitioner (p = 0.001), and mental health and addiction medication (p = 0.05). In addition, participants SF-12 showed statistical significance between participants’ physical component score (PCS) and between the combination of ethnicity, age, and gender (p = 0.041). Moreover, the analysis highlighted an additional link between participants’ mental component score (MCS) and their preference to improve their physical health (p = 0.038). The key findings of the free-text responses of the survey revealed four key themes including accessibility and availability, people want to be healthy, staff attitude, and medication. The results of the interviews revealed three main themes including physical health perception, the role of medication, and the importance of the relationship with the GP. 

Conclusion: Mental health service users perceive their physical health as an interconnected construct of health. They have complex physical health experiences and require a collaborative approach from primary and secondary care services. In addition, they have a desire to improve their physical health, however, face barriers such as diagnostic overshadowing, side effects of psychotropic medication and poor accessibility. Staff in general practices and mental health professionals should be mindful of these barriers and are required to provide individualised holistic care tailored to the preferences and needs of people with severe mental illness.

year: 2022

title: The structure of a New Zealand community: An essay in the sociology of place

authors: Oppenheim, Roger Stanley

abstract: The study is concerned with the development of a sociology of place arising from observations made in 1969 - 71 in a small town (pop. 1759) in the Auckland region. The ecological approach used by Roger G. Barker and his associates (see for example, Barker, R.G., 1968, Ecological Psychology, Stanford) is used as the starting point for a sociological analysis of the ways in which meaning is embodied in the physical environment and the ways in which these meanings affect social life. 

Part I of the thesis, Preliminary Considerations, deals in three chapters with the problems of a phenomenological analysis of the community. Barker’s approach is critically reviewed and the main analytical concepts, “place” and “milieux” (its concrete isolates) are examined. 

In Part II, Place as a Social Fact, the discussion proceeds by applying and refining the ideas developed in Part I, with particular relationship to the analysis of the Harbourtown milieu inventory. The problems of milieu analysis including those of ecological relationship, of time, and of symbolism are examined in detail. 

Part III returns to a more theoretical consideration and sets out the main structure, problems and applications of the sociology of place. Community is seen as an intersection of time, place and social structure, and this triangle is transposed to deal with other problems. The application of the principles of the sociology of place to problems of planning is discussed. In the final chapter the problem of the relationship between place and community is reformulated as one of aesthetics; it is concluded that community is not compassed in an understanding of its functional or moral aspects out is the object of feeling as an ideal cultural form.

text: The structure of a New Zealand community: An essay in the sociology of place The study is concerned with the development of a sociology of place arising from observations made in 1969 - 71 in a small town (pop. 1759) in the Auckland region. The ecological approach used by Roger G. Barker and his associates (see for example, Barker, R.G., 1968, Ecological Psychology, Stanford) is used as the starting point for a sociological analysis of the ways in which meaning is embodied in the physical environment and the ways in which these meanings affect social life. 

Part I of the thesis, Preliminary Considerations, deals in three chapters with the problems of a phenomenological analysis of the community. Barker’s approach is critically reviewed and the main analytical concepts, “place” and “milieux” (its concrete isolates) are examined. 

In Part II, Place as a Social Fact, the discussion proceeds by applying and refining the ideas developed in Part I, with particular relationship to the analysis of the Harbourtown milieu inventory. The problems of milieu analysis including those of ecological relationship, of time, and of symbolism are examined in detail. 

Part III returns to a more theoretical consideration and sets out the main structure, problems and applications of the sociology of place. Community is seen as an intersection of time, place and social structure, and this triangle is transposed to deal with other problems. The application of the principles of the sociology of place to problems of planning is discussed. In the final chapter the problem of the relationship between place and community is reformulated as one of aesthetics; it is concluded that community is not compassed in an understanding of its functional or moral aspects out is the object of feeling as an ideal cultural form.

year: 1976

title: Birds vs. Clams: Assessing the impacts of South Island pied oystercatcher predation on Toheroa at Ripiro Beach, New Zealand

authors: Vallyon, Lolita-Maria Dolores

abstract: Managing the recovery of interacting species, such as predator and prey, is one of the most challenging factors of an ecosystem-based conservation approach. The actions taken to protect one species may be in conflict with the actions necessary to protect another. For example, the recovery of a predator in an ecosystem can lead to a significant conservation conflict between the protected predator and its protected prey. In these instances, research is required to determine whether a perceived conflict is in fact happening in order to inform proper management decisions. In New Zealand, a conservation conflict exists between an endemic, recovering shorebird, the South Island pied oystercatcher (Haematopus ostralegus finschi), and an endemic surf clam, the toheroa (Paphies ventricosa) at Ripiro Beach, Northland. The toheroa was overharvested until the populations collapsed, with commercial and recreational harvesting bans put in place by the 1970s. The toheroa has continued to decline, and the cause is currently unknown. Oystercatcher predation has been implicated as the reason toheroa populations have not recovered. There have even been calls to cull the birds to protect the clams. Currently, there is no information that would facilitate conservation management in determining the appropriate action to take. My thesis aimed to investigate the claims surrounding this perceived interspecific conflict. It sought to examine the predator-prey interactions between the two species by answering the following three questions: 1) what are the spatio-temporal associations between oystercatchers and toheroa, 2) what is the composition of the oystercatcher’s diet, and 3) what size toheroa are the birds taking? 
Bird surveys were conducted to examine the distribution of oystercatchers monthly from March 2019 to February 2020. Oystercatcher foraging behaviour was observed to collect information on prey type and prey location. Feeding holes left by oystercatcher bills at predation sites were examined to determine oystercatcher predation success. A population survey was conducted on toheroa beds exposed to oystercatcher predation versus control beds to assess if there were differences in the density and size structure between toheroa populations. 

Results did not support the hypothesis that the oystercatchers are the cause behind the limited recovery of the toheroa, but they did indicate that the birds may be having localised impacts. There was limited overlap with toheroa, as the birds were found predominantly at the southern half of Ripiro Beach and were only associated with two major toheroa beds. Observations found that bivalves are a significant food resource for oystercatchers and the birds have a high predation success rate. There was a significant difference in the density and size structure between toheroa populations in beds that were oystercatcher predation sites and those at no-predation sites. However, even in the areas with the most intense oystercatcher predation, toheroa have persisted over time. While there potentially is a small local impact, overall, the South Island pied oystercatcher is not responsible for the continuing decline of the toheroa across the whole of Ripiro Beach and are not causing devastation as claimed. 
The perceived conservation conflict between the two endemic species is likely incorrect. This research demonstrates the importance of acquiring information on interacting species prior to management action to protect one of those species. Information presented in this thesis can be used to support conservation managers in making informed decisions to protect both the toheroa and the South Island pied oystercatcher.

text: Birds vs. Clams: Assessing the impacts of South Island pied oystercatcher predation on Toheroa at Ripiro Beach, New Zealand Managing the recovery of interacting species, such as predator and prey, is one of the most challenging factors of an ecosystem-based conservation approach. The actions taken to protect one species may be in conflict with the actions necessary to protect another. For example, the recovery of a predator in an ecosystem can lead to a significant conservation conflict between the protected predator and its protected prey. In these instances, research is required to determine whether a perceived conflict is in fact happening in order to inform proper management decisions. In New Zealand, a conservation conflict exists between an endemic, recovering shorebird, the South Island pied oystercatcher (Haematopus ostralegus finschi), and an endemic surf clam, the toheroa (Paphies ventricosa) at Ripiro Beach, Northland. The toheroa was overharvested until the populations collapsed, with commercial and recreational harvesting bans put in place by the 1970s. The toheroa has continued to decline, and the cause is currently unknown. Oystercatcher predation has been implicated as the reason toheroa populations have not recovered. There have even been calls to cull the birds to protect the clams. Currently, there is no information that would facilitate conservation management in determining the appropriate action to take. My thesis aimed to investigate the claims surrounding this perceived interspecific conflict. It sought to examine the predator-prey interactions between the two species by answering the following three questions: 1) what are the spatio-temporal associations between oystercatchers and toheroa, 2) what is the composition of the oystercatcher’s diet, and 3) what size toheroa are the birds taking? 
Bird surveys were conducted to examine the distribution of oystercatchers monthly from March 2019 to February 2020. Oystercatcher foraging behaviour was observed to collect information on prey type and prey location. Feeding holes left by oystercatcher bills at predation sites were examined to determine oystercatcher predation success. A population survey was conducted on toheroa beds exposed to oystercatcher predation versus control beds to assess if there were differences in the density and size structure between toheroa populations. 

Results did not support the hypothesis that the oystercatchers are the cause behind the limited recovery of the toheroa, but they did indicate that the birds may be having localised impacts. There was limited overlap with toheroa, as the birds were found predominantly at the southern half of Ripiro Beach and were only associated with two major toheroa beds. Observations found that bivalves are a significant food resource for oystercatchers and the birds have a high predation success rate. There was a significant difference in the density and size structure between toheroa populations in beds that were oystercatcher predation sites and those at no-predation sites. However, even in the areas with the most intense oystercatcher predation, toheroa have persisted over time. While there potentially is a small local impact, overall, the South Island pied oystercatcher is not responsible for the continuing decline of the toheroa across the whole of Ripiro Beach and are not causing devastation as claimed. 
The perceived conservation conflict between the two endemic species is likely incorrect. This research demonstrates the importance of acquiring information on interacting species prior to management action to protect one of those species. Information presented in this thesis can be used to support conservation managers in making informed decisions to protect both the toheroa and the South Island pied oystercatcher.

year: 2020