This thesis is a sociological analysis of the role of executive discretion in decisions about the release of restricted patients. Located in England and Wales, the thesis is an empirical study of the decision-making process, based on fieldwork conducted from 2005-2006 at the Mental Health Unit of the Home Office, and with non-government actors in the system including legal and clinical practitioners, and mental health and victim organisations Studying the intersection of mental health and criminal justice at the site of the restricted patient system, the mechanisms for preventive detention within mental health policy have implications for the increasing effort to control dangerousness within criminal justice. Using key areas of literature from criminology, sociology and socio-legal studies, the conceptual tools of analysis include contemporary analyses of penal policy, particularly concerns to control risk; legal decision-making: and constructions of public opinion and their effects on criminal justice policy. The thesis argues that, while the role of executive discretion was originally intended to meet the public protection agenda, much of the protection offered is symbolic, based largely on reassurance of public fears. The notion of 'the public' is constructed in opposition to the interests of patients, and through particular groups constitutive of the public, including victims of patients. The dominant conception in how the executive understands the public is as people fearful and at risk. This is a reflection of contemporary criminal justice policy which is increasingly looking for frameworks to control dangerousness in ways that the criminal law, because of its traditional reliance upon conviction and consequent sentencing, cannot offer; and whose objects are not only offenders, but other so-called risky individuals whose perceived threat to the public justifies an increasing range of mechanisms for containment.

The King’s Centre for Military Health Research has collected data on a cohort of approximately 10,000 UK Service personnel from 2003-2008, some of whom (n = 2,253) have left the military over the period in which data collection has occurred. This thesis focuses on those individuals previously in regular (i.e. full-time) service who have left the Armed Forces. At the point of leaving, personnel undertake a number of activities intended to facilitate their transition into civilian life and employment; this is termed "resettlement". Concern is often raised about the ex-Service community’s mental health, homelessness, re-entry into the civilian workforce, and general reintegration into civilian society. Working with this cohort data, this thesis investigated the demographics of Service personnel undertaking resettlement; their transition outcomes in terms of mental health, employment, housing situation, social network, and other markers of social exclusion; the relationships between these outcomes; and the effects of resettlement. Primarily, this thesis shows that resettlement provision has an effect on transition as a result of two relationships – it is associated with higher likelihood of employment, and independently with better mental health. Through these relationships, resettlement has indirect effects on every other domain of transition. Additionally, I have demonstrated that unsuccessful transition is related to pre-enlistment adversity, and lacking a long-term partner. Military factors play relatively little role in post-Service outcomes, although the method by which the individual leaves Service can affect their transition; those who leave in an abrupt, unplanned manner (including those with medical discharges) are more at risk. Outcomes improve with time after the individual has left service. Overall, this thesis shows that ex-Service personnel do not generally have difficulty transitioning to civilian life, and this transition is facilitated by undertaking resettlement. Nonetheless, some groups are at greater risk of poor transition outcomes.

Despite a high prevalence of domestic violence among service users, most cases remain undetected by psychiatric services. Moreover, little is known about the attitudes and opinions of service users and clinicians, regarding psychiatric services response to domestic violence. This research comprises three studies that aimed to: (1) systematically review the prevalence of domestic violence among psychiatric service users; (2) systematically review the effectiveness of interventions for psychiatric service users disclosing domestic violence, and (3) qualitatively explore the experiences and expectations of psychiatric service users and clinicians in relation to domestic violence. Study One: 42 studies were reviewed. Among high-quality studies measuring lifetime partner violence, the pooled prevalence in female inpatients was 37.6% (95% CI 24.3-51) and 31.6% in the one study of males across mixed psychiatric settings. Study Two: Three studies were reviewed. Insufficient evidence was found to establish the effectiveness of cognitive behavioural therapy or domestic violence advocacy. Study Three: Semi-structured interviews were conducted with 24 service users and 25 clinicians. Interviews focused on attitudes towards routine enquiry, experiences of being asked/asking about domestic violence, and views on what interventions had been or would be helpful. Overlapping themes among clinicians and service users included the dominance of the medical diagnostic and treatment model and the establishment of specialist services for abused service users. Service user specific themes included unanimous agreement towards routine enquiry, barriers to disclosure (e.g. blaming attitudes, fear of consequences) and clinicians’ assistance with their complex needs. Clinician specific themes included mixed views about the implementation of routine enquiry, barriers to enquiry (e.g. role boundaries, competencies and confidence to address abuse) and the need for improved referral pathways and support at an organisational-level. The development and implementation of system-level interventions and evidence-based treatments are crucial to improving psychiatric services identification and response to domestic violence.

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Prior research has outlined the presence of stigmatising opinions towards people experiencing psychological distress within the general population in UK society. These stigmatising opinions may result in the discrimination of a person in receipt of psychological services. Previous research has highlighted the adverse effect that stigmatising beliefs may have on a person experiencing psychological distress in terms of social exclusion, increased symptomatology and lowered self-esteem. To date, attempts to document the contributing factors to such attitudes have been largely speculative.;The aim of this study was to gain insight into how members of the general population conceptualised their attitudes towards mental health, and identify factors that they perceived to be influential in the development of these attitudes. In particular, the role of the family in this process was considered to be of importance. The present study focused on the accounts of family dyads, one generation apart, to aim to develop this understanding further.;Using grounded theory methodology, transcripts of interviews with seven participants were analysed and a model was developed to represent the process of developing an understanding about mental health. This model was characterised by the fluid core category of 'Seeking to Understand' and demonstrated a process of evaluation of a 'mentally ill' person.;The core category and six main categories are discussed in relation to the literature. A review of the methodology and reflections on the research process are provided. It is suggested that clinicians should consider the influence of client's beliefs about mental health prior to beginning therapy. The implications of considering family, clinical training and wider societal systems are also considered.

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This study explored whether the cross-cultural value paradigm 'individualismcollectivism' is a useful explanatory model for mental illness stigmatisation on a cultural level. This has never before been directly investigated despite numerous clues of its potential importance in previous related literature. The paradigm asserts that in 'collectivist' cultures, people are more strongly interdependent with their in-groups, and are more likely to give priority to the goals of their in-groups than people from 'individualistic' cultures, who are instead more likely to value and desire autonomy and independence from their in-groups, and give priority to their personal goals than to their in-group goals. Three hundred and five individuals from four UK-based cultural groups (white-English, American, Greek/Greek Cypriot, and Chinese) were successfully recruited for a quantitative survey through the use of non-randomised snowball and quota sampling. Twenty-two of these individuals were later qualitatively interviewed in a one-to-one, semi-structured manner. Questions regarding where the four cultures fit within the individualism-collectivism paradigm, how acculturation affects the individualismcollectivism paradigm, what other factors explain stigmatisation, and the level of stigmatising attitudes present in these cultures, were also integrated into the methodological components in an attempt to explore these other important themes. The results partially supported the hypothesis that the paradigm can be applied to explain mental illness attitudes. Increases in the paradigm's explanatory power corresponded with a cultures' stigmatisation level. Specifically, the more stigmatising a culture's mental illness attitudes are, the more likely collectivism effectively explains these attitudes. In contrast, the more positive a culture's mental illness attitudes, the more likely individualism effectively explains attitudes. Educational level, mental illness experience, and, particularly, mental illness knowledge, were other powerful and consistent stigma explanatory factors, although the stigma affect of these and impact of other key themes were unique to each cultural group. The results also revealed that successfully acculturating to a new culture can impact on one's cultural values including levels of individualism-collectivism. The American cultural survey group held the most positive mental illness attitudes, followed by the white English group. Both groups also scored high on levels of individualism. The Greek/Greek Cypriots and Chinese held the least positive attitudes and were also found to be generally collectivistic. None of the survey groups' scores were wholly stigmatising, which suggests a positive shift towards more tolerant attitudes having taken place in recent years even in the Greek/Greek Cypriot and Chinese cultures. This is illuminating as these are traditionally particularly stigmatising cultures, which qualitative interviewees also argued. A number of important recommendations for policy and practice that aim to reduce stigma and highlight the importance of culture are proposed. These include anti-stigma campaigns needing to be culturally and linguistically appropriate and sensitive; using in-group, second-generation members of closed and collectivist communities/cultures to deliver of anti-stigmatising initiatives and; training practitioners to understand the impact of individualism-collectivism on mental health attitudes. Further, a consideration of the individualism-collectivism paradigm should be included in any future research aiming to provide a holistic understanding of the causes of mental illness stigma both on an individual and cultural level.