THESIS TITLE: Constructing Mental Health Problems: A ...

THESIS TITLE:

Constructing Mental Health Problems: A critical inquiry into the views of professionals working with children, parents and families

SUBMITTED:

February 2007

SUPERVISOR: Professor Isaac Prilleltensky

STUDENT:

Ruth Schmidt Neven

INSTITUTION: Victoria University of Technology: School of Psychology

DEGREE:

Doctor of Philosophy

Acknowledgements My sincere thanks go to the professionals who participated in the research project that led to this PhD dissertation. In particular, I thank my supervisor Professor Isaac Prilleltensky for supporting the research, for his patience, and for continuing to supervise me despite his move to the United States. My supervisory experience under his guidance has been both stimulating and enjoyable. I am particularly grateful to Professor Prilleltensky for introducing me to the widening horizons of psychology with respect to critical and community approaches and to the importance of being explicit about the place of values. I am grateful to Victoria University and to Jane Trewin, Student Research Advice Officer for her helpful administrative support, so important for a part-time student, and to the Commonwealth Government for their HECS exemption award. My love and thanks go to my husband Emil who has been unfailing in his generosity and encouragement, and to my daughter Hannah who has tolerated the long hours spent on the computer. Finally, I dedicate this thesis to the many children, parents and families in Australia, and in Britain, with whom I have worked over four decades and from whom I have learned so much.

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Abstract At the beginning of the 21st Century, the field of child and family mental health presents us with a paradox. Whilst over the last fifty years there have been considerable improvements with regard to the physical health of children there have not been equal improvements in their psychological functioning and mental health. Instead, there appears to be an escalation of a variety of psycho - social problems in children and young people. A critical review of current literature and research reveals that child and family mental health problems are constructed within increasingly narrow theoretical, clinical and research frameworks. These emphasise a medical and pathology based construction of children's behaviour, rather than one that takes into account the meaning of children's behaviour within a family and social context. This research project attempts to throw light on this dilemma through conducting individual interviews with twenty - one professionals representing both universal and specialist child and family mental health services. In addition, two focus groups were held consisting of other child and family mental health professionals. The research utilised a qualitative methodology that applied an interpretevist approach to the examination of the data. This included a critical examination of the discursive practices and range of discourses that professionals employ in their everyday practice and the way in which these practices and discourses reflect values and attitudes to meaning, power, and the use of knowledge and in giving legitimacy to particular actions and interventions. Whilst the findings indicate the predominance of a blame-discourse on the part of the professionals who present themselves as the buffers between the parents and the child, a closer examination reveals

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that for the professionals, the use of the buffer position functions as a defense. The findings indicate a parallel process between the parents and the professionals in which the latter operate largely in the absence of a coherent framework regarding the developmental needs of children, and with an uncritical acceptance of a predominantly medical model approach to children's behaviour. The self referential and hierarchical nature of each of the professional disciplines and services appeared further to contribute to levels of fragmentation within these services as well as to the absence of the voice of the child. The discourse of complaint and compliance on the part of the professionals in relation to their managers and heads of service further compromised their ability to act as advocates for children. The findings are analysed within the context of a socio-cultural critique that suggests congruence between the bio-behavioural construction of children's behaviour and the depleted vision of childhood and parenthood in society at large. The findings lead to a number of recommendations that are predicated on the assumption that the construction of child and family mental health cannot be considered as discrete from the construction of child and family wellness. A number of specific recommendations are made concerning the need for an ethical value based and Children's Rights approach with regard to child and family mental health.

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Doctor of Philosophy Declaration

I, Ruth Eleanor Diana Schmidt Neven declare that the PhD thesis entitled Constructing Mental Health Problems: A critical inquiry into the views of professionals working with children parents and families is no more than 100,000

words in length, exclusive of tables, figures, appendices, references and footnotes.

This thesis contains no material that has been submitted previously, in whole or in

part, for the award of any other academic degree or diploma. Except where

otherwise stated, this thesis is my own work.

Signature Ruth Schmidt Neven

Date

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