Rape crisis services ‘Standing Alone’: Policy-making as problem representation: The response to sexual violence in New Zealand 1983-89

<p>After more than 30 years of feminist activism in New Zealand the government policy response to sexual violence continues to be highly contested. This thesis draws on archival material (both official and community records) to trace the competing discourses and agendas within the early policy development process. This process involved the pākehā and Māori women’s rights movements seeking to influence the ways in which the problem of rape was represented and responded to by government within the social policy context. Using Bacchi’s “What’s the problem represented to be?” methodology, the analysis of these discourses identifies the silences and assumptions, as well as the privileged government agenda that redefined, individualised and sought to professionalise the services for rape victims/survivors. I explore the perspectives of feminists involved in the movement and how tensions with the state may be seen to be reflected in the policy process, particularly through the emergence of neo-liberalism, the interplay between liberal and radical feminist views and in the highly contested area of rape education and prevention. Further, I consider how the problem of meeting cultural needs through social policy responses stalled, despite seeming state support for such responses through the 1980s and what it may be about the issue of rape itself and its connection to gender inequality that has contributed to a muted government response to the issue of sexual violence. In a postscript I briefly review current policy discourse and comment on how the focus on rehabilitation, the financial instability of services, lack of adequate provision of appropriate services for women and communities continue to be features of the sector today. I argue that a specific focus on rape education and prevention, critical for reducing the incidence of rape, continues to be severely under attended to, and that this in part reflects continued reluctance to address both the nature of rape and the need for wider structural change in addressing it.</p>

Rape crisis services ‘Standing Alone’: Policy-making as problem representation: The response to sexual violence in New Zealand 1983-89

<p>After more than 30 years of feminist activism in New Zealand the government policy response to sexual violence continues to be highly contested. This thesis draws on archival material (both official and community records) to trace the competing discourses and agendas within the early policy development process. This process involved the pākehā and Māori women’s rights movements seeking to influence the ways in which the problem of rape was represented and responded to by government within the social policy context. Using Bacchi’s “What’s the problem represented to be?” methodology, the analysis of these discourses identifies the silences and assumptions, as well as the privileged government agenda that redefined, individualised and sought to professionalise the services for rape victims/survivors. I explore the perspectives of feminists involved in the movement and how tensions with the state may be seen to be reflected in the policy process, particularly through the emergence of neo-liberalism, the interplay between liberal and radical feminist views and in the highly contested area of rape education and prevention. Further, I consider how the problem of meeting cultural needs through social policy responses stalled, despite seeming state support for such responses through the 1980s and what it may be about the issue of rape itself and its connection to gender inequality that has contributed to a muted government response to the issue of sexual violence. In a postscript I briefly review current policy discourse and comment on how the focus on rehabilitation, the financial instability of services, lack of adequate provision of appropriate services for women and communities continue to be features of the sector today. I argue that a specific focus on rape education and prevention, critical for reducing the incidence of rape, continues to be severely under attended to, and that this in part reflects continued reluctance to address both the nature of rape and the need for wider structural change in addressing it.</p>

What Twitter Can Tell Us About User Experiences of Crisis Text Lines: A Qualitative Study (Preprint)

BACKGROUND Mental health problems are the leading cause of disability worldwide. Despite the prevalence and cost of mental illness, there are insufficient health services to meet this demand. Crisis hotlines have a number of advantages for addressing mental health challenges and reducing barriers to support. Further, mental health crisis services have recently expanded beyond telephone hotlines to include other communication modalities such as crisis chat and text messaging services, largely in response to the increased use of mobile phones and text messaging for social communication. OBJECTIVE Despite the high uptake of crisis text line services (CTLs) and rising mental health problems worldwide, CTLs remain understudied. Thus the current study aimed to address an urgent need to evaluate user experiences with text-based crisis services. METHODS The current study explored user experiences of CTLs by accessing users’ publicly available Twitter posts that describe personal use and experience with CTLs. Data were qualitatively analysed using inductive thematic analysis. RESULTS Six main themes were identified from 776 tweets: (1) approval of CTLs, (2) helpful counselling, (3) invalidating or unhelpful counselling, (4) problems with how the service is delivered, (5) features of the service that facilitate accessibility, and (6) indication that the service suits multiple needs. CONCLUSIONS Overall, there was strong evidence to support the value of text-based crisis support, as many users reported positive experiences of effective counselling that provided helpful coping skills, de-escalation, and reduction of harm. Results also identified areas in need of improvement, particularly ensuring more timely service delivery and effective communication of empathy and support. Text-based services may require targeted training to apply methods that effectively convey empathy in this medium. Moving forward, CTL services will require systematic attention in the clinical research literature to ensure their continued success and popularity among users.

“They Aren’t Going to Do Jack Shit”: Text-Based Crisis Service Users’ Perceptions of Seeking Child Maltreatment-Related Support From Formal Systems

Many of the children reported to child protective services (CPS) exhibit signs and symptoms that allow others to recognize their abuse or neglect and intervene; others, especially adolescents, must disclose their experiences to be identified. Relatively little is known about young people’s disclosure experiences, but individual, interpersonal, and cultural factors appear to influence when and how young people disclose. Technology-facilitated approaches, such as text- or chat-based hotlines or crisis services, may be one way to help young people share their maltreatment experiences and seek help. The current study contributes to the small body of literature that includes nonsexual maltreatment disclosures and sheds some light on how to support young people during their disclosures. We conducted a qualitative content analysis of all conversations from a text-based crisis service that resulted in a report to CPS ( n = 244). Many of the texters had previously sought support from their peers or parents, and some had engaged with more formal systems. Many young people were hesitant to reach out to formal systems in the future, in part because of negative experiences during past disclosure experiences. Young people may be more likely to seek support through their preferred communication medium, so providing text- and chat-based communication may be one way to encourage and facilitate disclosure. As these resources become increasingly available, determining best practices for receiving disclosures through technology-facilitated platforms will be critical.

Caring Transitions – A Care Coordination Intervention to Reduce Suicide Risk Among Youth Discharged From Inpatient Psychiatric Hospitalization

Background: Suicide risk following youth psychiatric hospitalization is of significant concern. This study evaluated Linking Individuals Needing Care (LINC), a theory-driven, comprehensive care coordination approach for youth discharged from crisis services. Aims: To pilot LINC's potential effectiveness in increasing service utilization and decreasing suicide risk. Method: Participants were 460 youth patients who received LINC for approximately 90 days following discharge from crisis services. Service utilization, depressive symptoms, and suicide-related variables were measured at baseline and 30, 60, and 90 days after baseline. Results: Patients significantly increased the use of various beneficial, least restrictive services (individual therapy, medication management, and non-mental health supports) over the 90-day intervention. Significant decreases were observed in depressive symptoms, suicide ideation, and engagement in suicide-related behaviors. Limitations: Absence of a comparison group and nonparticipating families limit causal conclusions and generalizability. Conclusions: LINC may be a promising new approach following inpatient hospitalization that can engage and retain youth in services, likely resulting in improved treatment outcomes. This approach was designed emphasizing patient engagement, suicide risk assessment and management, safety planning, community networking, referral/linkage monitoring, coping and motivational strategies, and linguistic/culturally responsive practices to meet service and support needs of high-risk suicidal youth.

Missed appointments in mental health care clinics: A retrospective study of patients’ profile

Background: Missed appointments (no-shows) are a problem and common in outpatient clinics especially in psychiatric setting.Objective: This study aimed to describe the extent of no-shows in a regular psychiatric outpatient clinic, and to assess associations of missed appointments with patients’ demographic and clinical characteristics and types of services provided.Methods: Data collection from a hospital psychiatric clinic charts was conducted from administrative years 2017-18 and 2018-19, using descriptive analyses.Results: In the administrative year of 2017-18, the no-show rate was 9.5%, adding 10.7% for cancellations, for a total of 20.2%. In 2016-17, rates were 9.7%, with 17.3% cancellations, for a total of 27%. Rates varied from clinical groups (2.5% for borderline personality disorders patients to 30% for young psychotic patients) and by professionals (psychiatrists 5.6%, psychotherapists 23.3%) and for crisis services 21.9%.Conclusions: No-show numbers are comparable to other clinical sites but remain a challenge in delivering seamless and efficient services. A qualitative study will be conducted as a second phase to examine root causes and provide opportunities for service improvement.