Examining the Relationship between Body Mass Index and Health-Related Quality of Life Perception among People with Mental Illness

People suffering from mental illness are three times more likely to die prematurely from ‘natural’ causes than those without mental disorders as a result of their physical condition. Their life expectancy is reduced by 12-19 years. Obesity is commonly associated with mental illness and accounts for increased risk of cardiovascular disease, diabetes mellitus, stroke, heart disease, some cancers and osteoarthritis. This paper examined the relationship between body mass index (BMI) and health-related quality of life perception using the Short-Form Health Survey 36 among people living with mental illness. A Multivariate Multiple Regression model was employed to estimate the variables that influence and/or contribute to the relationship between body mass index and the three domains of health perception chosen based on preliminary tests. Sex, financial adequacy, presence of chronic physical illness and unmet needs of healthcare were the mediators used in this model. BMI, chronic physical illness and unmet needs of healthcare estimated a relationship of a participant’s physical functioning

Care with Aloha: Preventing Suicide in Oahu, Hawaii

This dissertation examines iterations of care in preventing suicide in Oahu, Hawaii. Rates of suicidal ideation among young people in Hawaii have been high over the past decade, peaking in 2009 at nearly double the U.S. average for this age demographic. My fieldwork (2014—2019) follows the efforts of prevention workers in Honolulu, Hawaii and shows that a majority of those involved in (predominantly unpaid) prevention work share affective connections to the cause of prevention, with many having personally lost someone to suicide. In this dissertation, I position suicide prevention workers’ care with aloha as an alternative to depersonalizing approaches of Western suicide prevention efforts, which rely on protocol. I examine aloha’s many contested meanings and (mis)uses in and beyond Hawaii and draw on ethnographic examples to reveal how care workers in Hawaii describe a type of “watchful” (Garcia 2010) care and explicitly aim to personalize their interactions with aloha. And yet, my ethnography reveals that there are troubling inconsistencies when putting this type of care into practice. In this dissertation, I ask whether care as the primary tool of suicide prevention workers in the United States must be viewed as being either helpful or harmful, productive or nonproductive. Through examining suicide care in Hawaii, I ask whether these dualistic concepts might be better evaluated as coexisting rather than competing. Regarding the forms of care that are produced in prevention work in Hawaii, care seems to be simultaneously loaded with and empty of meaning—a statement that, my dissertation reveals, shares similarities with the word and concept of aloha—and is complicatedly both effective and ineffective, regulated and unregulated. In this ethnography, I understand care as a practice, an ethics of the self, an action, a form of (exploitable) labor, a (bio)political endeavor that produces and reinforces inequalities—but fundamentally, I view care as something that is relational, that is produced out of a desire to relate with others. This dissertation suggests that rather than relying on these dualities, we might instead view care as a kind of open-ended concept: as something on a flexible spectrum, open to possibility

The Phenomenology of Independent Living: Examining the Lived Experience of Young Adults From Out-of-Home Care in Wisconsin

Abstract: Interpretive Phenomenological Analysis was used to examine how young adults with prior out-of-home care experience make meaning of the Independent Living (IL) process (Smith, Flowers & Larkin, 2009). Participants had been in foster care, kinship care, and informal care settings. All participants were enrolled at the university or had recently graduated from the university. All participants were female, white, and from mixed geographic background. None registered as having disability, although evidence of Adverse Childhood Experiences (ACES) was shared. Only one study participant had prior experience with an IL contractor. Individual interviews were conducted, followed by a focus group. The how and what of the learning about topics of IL were explored. Additional questions probed how meaning was made from the formal or informal IL learning experience. Familiarity with New Public Service themes found in local, county, state government was also explored. While each participant pointed out the uniqueness of their experience, the study found similarities sufficient to identify themes, sub-themes and patterns in their experiences. Themes included context of Basic Needs, as well as content in Priority of Education/Work, Attention to Task/Organization, and Challenges with Health/Relationships. Patterns woven through the experience and meaning expressed by participants included safety, work ethic, and healthy relationships. The participants’ desire to impact public policy through the study was apparent. Recommendations for practice, research and policy were addressed, along with need for collaborative research among professionals in the field, academics, and the young adults whose voices of experience need to be at the policy table reinforcing the theme that grounded the study, “Nothing about us without us” (Charlton, 2000)

Evaluating iris scanning technology to link data related to homelessness and other disadvantaged populations with mental illness and addiction

The overall objectives of this research were to assess the functionality of iris scanning technology in a community setting and to evaluate the acceptability to shelter clients of using iris scanning as a form of identification. In order to assess the feasibility of implementing iris scanners in a shelter setting, the research team documented the number of people who agreed to be scanned, the number of people who declined, and the number of successful scans completed. The research team collected 200 scans over the course of 3 visits. A second iris scan was requested of 50 individuals to allow the research team to assess whether the technology accurately identifies someone over a period of time. The results indicate that most people found the technology acceptable, and that the number identifier was consistent over repeated scans

Beyond Clinical Reduction: Levinas, the Ethics of Wonder and the Practice of Autoethnography in Community Mental Health Care

Abstract The central claim of this thesis is that wonder has the capacity to interrupt the institutional entrancement of the clinician to exert a gravitational pull on her awareness. This can “awaken” her from the normalized perspective of clinical praxis, and a clinical environment that defiles the vulnerable help seeker while contributing to the clinician’s moral disengagement or paralysis. In making this claim, our inquiry revisits many well-rehearsed ethical questions about the therapeutic relationship, the construct of mental illness and its care, the politics of power within the institution of community mental health care, and the supposed and real dangers of emotional intimacy in the clinical relationship. These questions also point uncomfortably—devastatingly—back to why and how the ethics of educated and dedicated clinicians can be diluted, for which the possible “cure” of wonder is being sought here. Wonder represents but one aspect of our ethical analysis in this interdisciplinary study. We turn in equal measure to an emerging strand of moral research, called autoethnography, and to the radical ethical vision of Emmanuel Levinas who informs our final understanding of wonder. In this inquiry, autoethnography takes the form of a short story in chapter 2 and as a series of personal epiphanic vignettes thereafter. Autoethnography affectively illuminates the theory being presented here and evokes the horrifying imperative of our ethical quest that calls for radical institutional change, albeit enigmatically. It is in Levinas’ ethical vision, however, that the clinician may discover the astonishing holiness and relationality at the heart of the clinical relationship and all this implies. This perfection, apprehended through the stunning approach of the vulnerable help seeker, extends an ethical invitation to the beleaguered clinician that she can hardly resist, but that she will almost inevitably fail to answer