Caring for a family member at the end of their life can be highly demanding, and those in this role are at increased risk of poor physical and mental health. Policy guidelines indicate that palliative care services have a key role to play in supporting family caregivers. This thesis explores the emotional challenges faced by relatives caring for a dying family member, and the ways in which healthcare professionals can support them. Part 1 is a literature review of psychological interventions for caregivers of terminally ill patients. A total of 23 studies were identified for inclusion, and interventions were classified into four types: problem-solving, psycho-educational/supportive, behavioural and bereavement/meaning-based. The majority of the studies reported positive outcomes, but the strength of their designs varied. Overall, the studies provide encouraging evidence for the benefits of psychological interventions in improving some aspects of caregivers’ wellbeing. Part 2 is a qualitative study exploring the emotional challenges faced by home caregivers. Semi-structured interviews were conducted with 15 recently bereaved relatives who had cared at home for a family member with cancer. Transcripts were analysed thematically using the Framework approach and themes were organised under four categories based on Yalom’s (1980) existentialist theoretical framework: responsibility, isolation, death and meaningfulness. Part 3 is a reflective discussion of the process of carrying out the empirical study and the literature review. The limitations of both projects are considered, as well as some of the broader conceptual, methodological, clinical and contextual issues arising from them.

Purpose: The aim of the present study was to explore sexual behaviour in an adolescent cohort of school attenders from the United Kingdom. Of particular interest was their reported engagement in sexual behaviours that carry a potential risk of becoming pregnant or contracting a sexually transmitted infection (STI) and psychological factors which may be associated with this. Method: 333 participants (253 girls and 80 boys) aged between 16 and 18 years were recruited from educational institutions across the South of England. They completed a questionnaire battery, which included measures of shame, including shame proneness, body shame and self. surveillance, impulsive personality traits, self.esteem and self.compassion to explore the associations of these factors with risky sexual behaviour (RSB). It was hypothesised that these factors would all be associated with RSB in adolescent boys and girls. Results: Impulsivity was most strongly correlated with and predicted RSB in both boys and girls. Shame, including shame proneness, body shame and selfsurveillance, was positively associated with RSB in both boys and girls although the associations between these factors were different depending on gender. Internalised expressions of shame were significantly correlated with RSB in girls whereas outward expressions of shame were more strongly associated with RSB in boys. Selfesteem and self.compassion were inversely correlated with RSB in girls, but this relationship was not reflected as strongly in boys. Conclusions: Shame, impulsivity, self.esteem and self-compassion are all factors correlated with RSB in adolescents but the associations differ between boys and girls. Implications for sex education programmes and clinical work are discussed and suggestions are made for future research to extend the present findings. Keywords: impulsivity; self.compassion; self-esteem; shame; risky sexual behaviour. Implications and Contribution: Findings from this study suggest associations between shame, impulsivity, self-esteem, self.compassion and their relationships with RSB in adolescents. Self-views, in particular, self.compassion and shame and gender differences in their link with RSB are currently under-researched. These preliminary findings contnbute to current research exploring factors affecting RSB in adolescents.

Objective: This study aimed to explore illness representations and attitudes about personal recovery in physical and mental health conditions in a lay sample. Design: 263 participants took part in an experimental study using vignettes describing the symptoms of four conditions: depression, schizophrenia, psoriasis and Type 1 diabetes. The within group factor was condition type (physical and mental health). The between groups factor was duration of symptoms (two weeks/ 'acute' or one year/ 'chronic'). Measures: Participants completed the lllness Perception Questionnaire - Revised for Healthy Individuals (Figueiras & Alves, 2007) and questions regarding their attitudes about the importance of personal attributes, such as optimism and resilience, in recovery (,personal recovery'). Results: The inter-relationship of illness representations followed some of the general patterns found in previous research. Participants attributed mental health vignettes to more psychosocial causes and placed more importance on personal recovery than they did for physical health vignettes, although there were some interaction effects of chronicity. Personal recovery attitudes positively correlated with psychosocial causes in all conditions and perceived personal control in all conditions except diabetes. Conclusion: Preliminary evidence was found that lay attitudes about personal attributes being important for recovery was more endorsed in mental health than physical health conditions and was related to perceptions of personal control and psychosocial causes of illness.

The literature review examines the empirical evidence for a relationship between higher levels of self-efficacy and lower levels of distress amongst family caregivers for older adults with dementia. Each of the relevant studies identified within the review are critically evaluated. Overall the review has illustrated clear evidence for a relationship between self-efficacy and distress in these family caregivers. A negative relationship has been supported in the literature; furthermore self-efficacy appears to have a mediating influence upon distress in family caregivers. The empirical paper examines the role of burnout amongst paid care staff for older adults with dementia. The study examines the roles of reciprocity, self-efficacy and organisational factors upon burnout and also aimed to identify which variable was the greatest predictor of burnout. Sixty-one members of staff in continuing care homes for people with dementia completed self- report questionnaires. Self-efficacy was significantly associated with all the dimensions of burnout and was found to be the greatest predictor of burnout. Low reciprocity with the older adults, age and contracted hours were also found to be significantly associated with burnout. The clinical implications of the study, methodological considerations and recommendations for future research are discussed.

In recent years there has been a growing body of literature regarding the experiences and well-being of people providing care to a relative with dementia. There is some evidence within this literature that sub-groups of caregivers respond differently to the caregiving situation. In particular, findings have tended to suggest that women caregivers experience more burden and distress than men ( eg Gilhooly, 1984a; Gilleard et al , 1984) , and that spouses of the care recipient experience more burden and distress as carers than children (eg George & Gwyther, 1986; Gilhooly, 1984a). Various explanations have been postulated, one of which focuses on caregivers' expectations of themselves in providing care: it has been speculated that women may have higher expectations of themselves (eg Schnoover et al, 1988), due to a sense that in providing care they are fulfilling an appropriate or anticipated role. It is suggested here that a similar argument may be extended to spousal caregivers. This study, then, aimed to investigate the levels of expectation of 27 caregivers, and any role this factor may play in determining levels of burden and distress. Differences between the expectations of women and men, and spousal and child caregivers were also investigated, as was the effect of expectations on the use of social support. Contrary to hypotheses, it was found that expectation levels were inversely related to levels of burden, and there were no differences between sub-groups. There was evidence of differentia1use of support for caregivers with different levels of expectation: those with higher expectations of themselves reporting the availability of more informal supports, but lower frequency of contact with services than those with lower expectations. The results provide a characterisation of the more burdened caregivers being those who have lower expectations of themselves to provide care, who are less involved in caregiving and receive more support in the role. Potential explanations for these findings are discussed, limitations imposed by the methodology of the study are outlined and clinical implications of the present results are considered,

This study narrates the organisation of mental health care via an ethnographic case study of a NHS Trust mental health directorate in England in the 1990s, during implementation of the Care Programme Approach (CPA). It seeks to understand how things are organised such that someone gets treated, by someone; in some way, and how far this mode of organisation commits people to courses of action and makes them accountable. Various stories are told - in different ways, using different theoretical frameworks, and pitched at different levels of analysis. The thesis deploys two 'ontological themes' to do this: sense-making and authorising. Sense-making refers to the processes of how people understand and act; authorising refers to the limits and stabilisation of sense-making, the fixing and legitimation of versions of the truth. The systems story of organisation narrates a gap between what was anticipated by government policy by introducing the CPA, and what happened, with regard to systems of care and forms of responsibility and accountability. 'The teamwork story narrates organising as accomplished through daily work practice. A ceremonial order in team meetings of primus inter pares results in different kinds of responsibility and accountability to that indicated in the CPA. The patienthood story narrates how people are transformed into objects of mental health work. Becoming a psychiatric patient is more diffuse than much labelling theory presumes. and is the product of specific forms of organisation. The thesis concludes by discussing the kind of organisation that allows for more or less authorised versions of what has been, and what should be, done. It suggests two ideal-typical forms of organisation, different kinds of 'structural context' within which organising may take place. The thesis produces two 'grand narratives' with regard to organisation: one, about the structure-process distinction; the other, about the evaluative nature of tales.

This research utilised qualitative methods to gain a deeper insight into the policy, planning and practice of school-based drug education than had previously been achieved in Scotland. Semi-structured interviews were carried out with staff in nine Grampian secondary schools together with a case study of one school. The case study involved direct lesson observations as well as in-depth interviews and feedback sessions with stakeholders in drug education including staff and 48 pupils. In both parts of the study schools were selected by theoretical sampling, each interview was transcribed in full and all data were annotated and analysed with the aid of specialist computer software. Validity and reliability were enhanced by constant vigilance in data analysis and by various procedures including reactivity analysis, peer examination,triangulation and consideration of any potential bias on the part of the researcher. The highest standards of ethics were applied throughout the study. Whereas previous studies have revealed the lack of impact of drug education on drugtaking behaviour in young people, this research is unique in attempting to explain this lack of impact. The research findings revealed that teaching and learning processes in drug education were below best practice as defined by the relevant research literature and national guidelines. Four key underlying issues were identified: (1) A lack of clarity and understanding about the goals of drug education;( 2) A lack of time and support for researching, planning and reviewing drug education; (3) A low priority assigned to Personal and Social Education (PSE) in general; (4) A failure to recognise drug education as a broad and complex subject requiring considerable expertise to teach. Fundamental changes to how drug education is approached both locally and nationally would be required to resolve these issues in full. Ihe nature of these changes is discussed in detail in the thesis.

Young people are recognised as citizens with rights and competence to participate in decision making. The United Nations Convention on the Rights of the Child and the Children Act 1989 identifies their right to participate in social services decision making. Much of the published information on their participation has focused on involvement as individuals in case planning rather than as stakeholders in strategic policy making. This research examines how a particular organisation – social services – has responded to the participation rights of young people who are looked after. The thesis provides a critical review of current practice. It uncovers the extent of young people's participation in social services policy making and explores the perceptions of key stakeholder groups involved in the process. A national survey was used to elicit quantitative and qualitative information from a representative sample of social services departments. Semi-structured interviews with key stakeholders in the policy process provided data from three diverse case study sites. Overall, data confirmed that stakeholders did not recognise young people's right to participate. Social services were unclear about the basis of their relationship with young people in the policy process; this confusion undermined young people's ability to influence policy decisions. Findings also showed that the power of managers in departments constrained the ability of young people to shape policy. Consumerism, rather than rights, was the underlying principle which defined participation as service-led rather than user-led. In light of these findings, which emphasise the dissonance between the theory of participation and its practice, a number of recommendations are made at national and organisational level to improve the quality of young people's participation.

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