Background: Psychiatric inpatient staff members work with arguably the most challenging service users. However, reference to these challenges often does not go beyond ‘challenging behaviour’, offering no insight into the actual presentation, thus preventing formulation of the perceived challenges, or subsequent interventions. Moreover, studies have shown that staff responses to challenging presentations can impact on both the staff member and the service user. In particular, staff causal attributions have been shown to impact on their therapeutic response (Apel & Bar-Tal, 1996), as well as being associated with staff emotions (Colson et al., 1987). In turn, the emotional response has been found to be associated with coping, both of which have also been found to effect staff behavioural response, as well as staff members’ psychological well-being (Wykes & Whittington, 1998). However, there have been limited studies assessing these relationships with psychiatric inpatient staff. This may be due to the lack of assessment tools developed for this staff group to measure these particular domains. A specifically designed tool would enable consistent assessment to take place to build on our theoretical knowledge of psychiatric inpatient staff members’ perceived challenges, and their responses to them, as well as highlight specific areas within these domains where further staff training and support is required. Aims: The first aim of the study was to explore psychiatric staff’s views on the challenges they faced when working with service users in inpatient settings, their emotional responses, attributions, and coping strategies about those challenges and then to develop a measure which would accurately capture these (the SEACCS). The second aim was to assess the reliability of the new scale as well as explore relationships within the SEACCS. Finally, the third aim was to assess content and face validity, as well as conduct preliminary psychometric investigations of the construct validity of the newly developed measure. Method: The study was conducted using various methods across three phases. In order to generate items for the SEACCS, a systematic review of the relevant literature and semi-structured interviews took place during the first phase. Secondly, the results of Phase I were combined in order to develop and construct the SEACCS. The third phase involved a postal survey of the SEACCS (including re-test), followed by psychometric investigations to scrutinise the items, explore the reliability, and construct validity of the SEACCS.Results: Twenty three studies were included in the systematic review. The results highlighted inconsistent measurement and findings of the domains concerned. Seven multi-disciplinary staff interviews took place. Thematic analysis was used to conduct four separate analyses focusing on each of the research questions. Several themes and sub-themes were found. Themes such as: ‘Engagement’, ‘Attributions of controllability’, and ‘Behavioural responses’. Findings from the review, thematic analyses, and consultation groups (content and face validity) were combined in order to develop the 64 item SEACCS. A total of 76 multi-disciplinary psychiatric inpatient staff members completed the SEACCS, 15 of which completed re-tests. No items were removed following item scrutiny assessments. Preliminary psychometric investigations indicated good reliability, significant relationships across domains within the SEACCS, and partial construct validity with the GHQ-28.Conclusion: The results of the current study provide the first step in the development and construction of a clinically relevant tool that can be used to assess these domains. The methodological limitations and clinical implications are considered, and future directions for research in this area are suggested.

This thesis forms a valuable tool of analysis, as well as an important reference guide to anyone interested in communicating, expressing, representing, simulating and or imagining what it is like to experience psychotic phenomena. Understanding what it is like to experience psychotic phenomena is difficult. Those who have experience with it find it hard to describe, and those who do not have that experience find it hard to envision. Yet, the ability to understand is crucial to the interaction with a person struggling with psychotic experiences, and for this help is needed. In recent years, the psychosis simulation projects Mindstorm, Paved with Fear, Virtual Hallucinations and Living With Schizophrenia have been developed as teaching and awareness tools for mental health workers, police, students and family members, so that they can better understand psychotic phenomena. These multimedia projects aim to improve understanding of what a person in psychosis is going through. This thesis represents a journey into taking a closer look at their designs and comparing them to biographical and professional literature. In doing so, throughout the chapters, a set of considerations and design challenges have been created that need to be taken into account when simulating psychosis. After a series of artistic case study labyrinths, Suicide Pigeon, Intruder, and Intruder 2.0, two final ‘do-it-yourself-psychosis’ projects have been created that have taken the aspects collected into account: The Labyrinth and The Wearable. Together these two projects form experiences that may be considered analogous to psychotic experiences. My original contribution to knowledge lies, on the one hand, within the function that both The Labyrinth and The Wearable have on a person’s ability to gain a better understanding of what it feels like to be in psychosis, and on the other hand within the background information provided on the context and urgency of psychosis simulation, how the existing simulations may be improved, and how labyrinthine installation art may contribute to these improvements.

This is an ethnographic study of discourses and experiences concerning sexual exchanges among kin “who are too closely related to marry each other” (OED), or what in lay language is called “incest”. I investigate the ways in which a certain kind of incest, that between older men and younger women, primarily from different generations, is experienced by women of predominantly rural origin, who have been hospitalized in the major public psychiatric hospital in Bolivia, in Sucre. In this sense, this research is as much a study of incest as it is of psychiatric institutionalization. These experiences will be considered in the context of a wider field of ethnic, class and gender discourses that are produced by medical staff, community organizations, as well as national judicial institutions. The category of 'incest' is problematized in terms of how kinship is constructed, not only as a series of dynamic discourses (as practices whose effect is the production of events) but also as mobile experiences, however socially regulated. With this in mind, I present an account of Andean concepts and treatment of incest, as well as of legal and medical categories. Specifically, I focus on the play between discourses in the context of the psychiatric hospital, the judicial court and the communities of selected inmates. I show how the inmates' experiences of intergenerational incest and sexual violence in general are related to the dominant ethnic, class and gender narratives produced by medical staff, community organizations, and judicial institutions.