Doctor of Philosophy (PhD)
Department of Nursing - Faculty of Health & Behavioural Sciences
Webster, Sayumporn, Maze to care: the process of pathway to initial care of young adults aged 18-25 with their first presentation of a mental disorder, PhD thesis, Department of Nursing, University of Wollongong, 2004. http://ro.uow.edu.au/theses/237
This study explores the lived experiences of a group of young people prior to coming into contact with mental health services for the first time. It asked, what was the pathway like for these young people, what happened to them and how did they experience and interpret that, and what was the extent and nature of delays in accessing care? The study uses the grounded theory method and encompasses Glaser and Strauss (1967) constant comparative method in the uncovering of the grounded theory, Strauss and Corbins (1990) work in the analysis, and Glasers (1978) work on theoretical sensitivity to guide data collection and analysis. Grounded theory focuses on how people view their experiences, how they interact and how these processes change (Wilson and Hutchinson 1996), and hence is an appropriate way to investigate the phenomenon. The purposive sampling consists of eight males and twelve females whose ages ranged from 18 to 23, from one Sydney Area Health Service. Twenty three semi-structure interviews were conducted over a fifteen months period. Analysis was undertaken concurrently, and the computer software application NVivo was used to manage the data. Finding a way represents the core category and is the basic social process by which young people experience the pathway to care. Finding a way can be conceptualised as a four-stage process. The stages which emerged from the data included a) first sign in the early stages of the illness, often greeted with denial and incomprehension, and self medication with alcohol and other drugs; b) recognition of the symptoms as a sign of mental illness, indicating that one needs help; c) understanding, discovering information about the illness and its impact on themselves and others; and d) resolution. At this point, effective care is successfully and, for most, voluntarily accessed. People progress through each process at different rates and for some, the journey to resolution may be short-circuited in earlier stages by particular incidents or exacerbations of their illness, leading to involuntary commitment to involuntary care. A fifth category, barriers and facilitating factors, refers to those processes and factors which impede or speed the progress to care and which can occur at any stage of the process. A model, called the Maze to Care, was developed from the findings. Unlike others, this model focuses on the pre-care rather than the post-care environment and reflects the perspective of the consumer. It can be used to direct attention to social and systems interventions which would enhance the capacity of young people and their families to recognise the symptoms of mental illness and access appropriate care.