Disability is increasingly recognized as a key health construct. In psychiatry, disability is generally measured with psychiatry-specific instruments, and this limits comparison with the wider health field and restricts health policy options. This thesis asks whether a general model, which defines disability as a generic (non-specific) health construct, can provide a framework for mainstreaming psychiatric disability. Within this aim, four chapters address the assumptions of a general model and

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... its application in clinical settings, population measurement, and health policy. General disability measures were applied in psychiatry using the methods of epidemiology and health services research. Using data from a household survey, the first set of studies supported the assumptions of a general disability model: mental disorder diagnosis and disability defined related but distinct groups; similar variables predicted disability in people with mental or physical disorders; and variations in disability due to individual mental disorders could be distinguished. In the second set of studies, general disability measures exhibited sensitivity to change in an outpatient anxiety disorders clinic and in a census of acute psychiatric inpatient units ; however, feasibility was poor in the inpatient setting and clinical utility in the anxiety unit was diminished as disability change could be fully explained by symptom change. In the third set of studies the population measurement of psychiatric disability, using disability burden, was improved by assigning nonoverlapping disability to individual disorders; however, the disability adjustment method was difficult to implement and of only moderate validity. The final chapter demonstrated that a general disability model offers new policy avenues for defining population need, and a transparent expression of the social benefits of psychiatric treatment in terms of improved functioning. The ut~lity of population disability measurement for policy will rest on its sensitivity to mental health outcomes. It is concluded that the distinction between psychiatric and non-psychiatric disability is largely historical, and adopting a general model of disability in psychiatry will be advantageous for clinical, population, and policy applications. This mainstreaming of psychiatric disability is consistent with the broader integration of mental health services with the wider health care sector. Declaration relating to disposition of project report/thesis I am fully aware of the policy of the University relating to the retention and use of higher degree project reports and theses, namely that the University retains the copies submitted for examination and is free to allow them to be consulted or borrowed. Subject to the provisions of the Copyright Act 1968, the University may issue a project report or thesis in whole or in part, in photostat or microfilm or other copying medium. I also authorise the publi~tion by University Microfilms of a 350