This study investigated the psychological impact on professionals in the non-mental- health sectors, of working with suicidal people. It sought to provide a deeper understanding of the meaning that such professionals attribute to their experiences of this kind. Four professional groups were included: Police Officers, Ambulance personnel, Intensive Care Nurses and Medical Practitioners. Questionnaire results provided a contextual overview, to which was added the rich descriptions of lived experience that emerged from narrative interviews. This is the first time that personal, in-depth accounts about their experience of the task have been collected from front-line staff working with suicidal people. A purposive sample of 34 interviewees was selected from the 103 questionnaires returned. One person from each profession was interviewed a second time. An analysis based upon the hermeneutic circle ensured that the process was iterative and the interpretation of phenomena holistic. Psychoanalytic theory was used to provide a framework within which this complex area of experience could be explored and represented. Professionals were found to be affected by experiences with suicidal people according to the core aspects of their own internal world. Negative staff attitudes were understood to arise out of feelings evoked in such work, such as fear and inadequacy, which may conflict with the professional's sense of identity. A spectrum of detachment defences was noted and a dynamic relationship between individual and group defences was revealed. Models were developed to illustrate the nature of the defensive system and categories of features which were found to make suicidal incidents salient and pernicious for the professionals concerned. As a result of the findings it is recommended that specific training and ongoing clinical supervision be provided for non-mentaI-health professionals, to equip them to understand service users who self-harm and also the psychological impact of this work upon themselves and upon their colleagues.

The topic of this research is the study of the discourse on suicide in postwar Japan. The purpose is to investigate the process of the formation of the image of suicide throughout the postwar period in non-fictional media, and in particular in newspaper coverage, suicide how-to manuals and suicide websites. This thesis covers the whole post-war period, from 1946 to 2008, focusing particularly on the 1990s when there was a rapid growth of Internet associations, suicide pacts, and web suicide groups. At the same time, suicide has become a much-reported topic in the mass media. The result of these new trends has been a striking increase in suicide clusters, in new methods of suicide, as well as the emergence of new dynamics such as group suicide and suicide communities. Most existing research, despite a variety of theoretical approaches, has analysed suicide largely as an unchanging expression of traditional Japanese values. By contrast, I highlight the evolution of the media discourse in representing and narrating the act of suicide and its motivations, unveiling the conditions under which the historical appearance of suicide is formed, reinterpreted and reinvented. Finally, I explore the recent growth of suicide manuals, websites, and chatrooms, in order to understand the extent to which this contributes both to new patterns and recurrent anxiety. This research seeks to use this analysis to explore a number of characteristics of and hypotheses about postwar Japan, including: the extent to which the fragmentation of postwar society, experienced in contrast to imagined prewar homogeneity, has led to a search for affiliation with what have been called 'sub-tribes'; the extent to which the individual does indeed model his or her behaviour on that of the 'sub-tribe' as a reference group; the way in which the lack of legitimized patterns, in the aftermath of defeat, has driven the reinterpretation and reinvention of new suicide 'rites'; and finally the extent to which the discourse on suicide is reflected in the controversial periodization of postwar Japan.

It is possible to identify two broad approaches within research regarding suicide behaviour The first aims to clarify individual sociodemographic or psychological characteristics that identify "at risk" individuals The second recognises the importance of understanding the meaning that suicide behaviour has for the individuals concerned. This study aimed to elaborate recent research that has identified the importance of understanding the meaning that people give to using particular suicide methods. This study investigated the relationship between the meanings that suicide attempters give to suicide methods and the meanings that they attach to living and dying. Eight people who had made suicide attempts were each asked to list eight methods of suicide - four that they were likely to use and four that they were unlikely to use. They then ranked the methods in order of how likely they were to use them. Using Repertory Grid Technique, participants generated constructs regarding the suicide methods. They then rated the methods according to the poles of the constructs they produced. Using the same constructs, participants were then asked to rate additional grid elements regarding dying and living The construct rating patterns of the grid elements were then correlated using Kendall's Tau-B correlation The results of this study indicate that different people view different suicide methods differently. Also, the relationship between the meanings attached to particular methods was found to be a function of the degree to which methods differed in their acceptability rankings In addition, the results from this small sample indicated that the meaning that suicide attempters give to using their most preferred suicide method is associated with the meaning they attach to living and dying. For some individuals, this association was apparent only at a more fundamental level of construing. Interpretations of these results are offered and their clinical implications discussed Limitations of the current study are acknowledged and suggestions to improve the approach to this research question are given.

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Background and Aims: The current thesis explored whether the social norms approach might be applicable to suicidal and self-harming behaviours (SSHBs). A thorough literature review and three empirical studies were conducted. The review indicated that children's and adolescents' SSHBs appear to be related to SSHB in people they know, but the literature assumed accurate knowledge of others' behaviour, and individual behaviours and reference groups were not always well-defined. Study 1: A social norms survey indicated that undergraduate students tend to believe that those close to them are less likely to engage in SSHBs than they reported doing, but that more distal groups are more likely to do so. Proximal groups were also perceived as less likely to approve of SSHBs. Perceived proximal group norms tended to predict reported norms directly, while perceived distal group norms tended to show negative associations with reported norms. Study 2: Similar results were found in an adolescent social norms survey, with proximal groups perceived as less likely to engage in and approve of SSHBs, and distal groups perceived as more likely to do so. Conversely, close friends' norms were perceived similarly to distal group norms. Perceived norms again predicted reported norms, with close friends' norms showing particular importance. Study 3: The final study used qualitative methods to explore the beliefs and experiences behind undergraduates' normative perceptions. A range of knowledge, experience, judgements, and perceived causes, motivations and outcomes of SSHBs were identified, and conceptualisation was complex and often contradictory. Social desirability appeared to impact reported attitudes. Conclusions: Findings suggest that the social norms approach may well be applicable to SSHB, but in different ways to behaviours previously studied. Consideration of target population, reference group and moral/ethical judgements of SSHB is imperative. Implications for the development of theory and directions for further research are discussed.

An invisible shadow was blocking my life making me unable to act or think as I wished to. It was an unpleasant life, a life not worth living. The feeling of desperation brought me to the point where I wanted to finish my life. I had tried to find rel.ease in many ways but I could not find one. I came to academia, hoping to do research on my own misery, to release the tangle binding me and to find a way to live on. Among many methodologies, I found the 'felt-text' of Spry's performative autoethnography and reckoned it could be helpful because it examined each subtle emotion or feeling contained in the narratives where my confusing life stories were told. Therefore, I applied the theories of her work in my inquiry on suicidality. In this dissertation, after a Prologue, there is a section of scripts and themes. The texts of my life stories are written in the form of dramatic scripts with narratives on one side of the page and physical movements on the other side. I show the elements of performativity of the texts in this way. After each script of my life stories, there is a theme. These themes are reflections from an aspect of the way I see the events that happened to me given by the title of the theme. After this section, I write about the processes of writing and reflecting as methodology. At the end, I have some thoughts concerning ethical and political issues because of the sensitive nature of this sort of inquiry. The process of writing this dissertation is the process of doing the inquiry and will continue. At different points within the process, some questions were answered, some problems were solved and some of the tangles that choked me were released

Background: Suicide is an important public health problem. Older people constitute the highest rate of completed suicides worldwide, with depression as the leading risk factor within this population. However older people's mental health has long been a neglected area both in terms of public policy and service provision. Research suggests that despite the fact older people visit their primary care practitioner more frequently than their younger counterparts, depressive symptoms and suicidal ideations are often not identified. Furthermore, even when psychological distress is recognised, older people are less likely to be treated or referred on to appropriate mental health services, despite the availability of efficacious treatments. Research suggests that "ageist" attitudes within society adversely affect the health-seeking behaviours of older people as well as health-care practitioners' clinical practice. Such attitudes require particular consideration when attempting to reduce suicide rates in older populations. Aim: The present research looks to enhance understanding of potential barriers to recognising and treating late-life depression and suicidal ideation by exploring GPs' attitudes and self-reported clinical practice in this area. Method: The study adopted a within-subject, questionnaire based design. 399 General Practitioners within a single health board area completed a self-administered questionnaire exploring attitudes towards suicide prevention in older people and selfreported clinical practice in terms of risk assessment with older adult populations. Results: Participants' attitudes towards suicide prevention in older people, on the whole, were marginally negative. Furthermore, there was a positive correlation between participants' attitudes and their self-reported clinical practice in terms of conducting a suicide risk assessment with this population - more negative attitudes were associated with less proactive clinical practice. There was also a relationship between age of participant and attitude where older GPs were more pessimistic regarding suicide prevention in older people. Previous training in suicide risk assessment did not appear to impact on attitudes towards suicide prevention, but did result in more pro-active clinical practice. Discussion: The present study provides a useful insight into GPs attitudes towards suicide prevention in older people and how such attitudes may impact on clinical practice. The findings have significant clinical implications in terms of multi-level approaches to reducing suicide rates within older populations. At an individual level it is important to enhance primary care practitioners' knowledge and skills regarding late-life depression and suicidality, while simultaneously highlighting factors associated with healthy ageing. At a wider strategic level it is necessary to develop sustainable mental health services for an ageing population while reducing age related discrimination and the stigma of mental illness through appropriate public policy and legislation. The potential role of clinical psychology at each of these levels was demonstrated. The strengths and limitations of the present study are also discussed along with suggestions for further research.

Our current understanding of self-harm and suicide websites is limited and few studies have attempted to explore this phenomenon. Despite this lack of knowledge, they have been heavily criticised in both the clinical literature and the wider media. They have been accused of being 'pro-suicide' and 'antipsychiatry' and some have argued that they 'encourage' suicide and should be banned. This study sets out to explore the perspective of people who use these websites. It is based on the transcripts of interviews with ten people, who were recruited directly from such sites and interviewed via e-mail. Discourse analysis indicated that the participants constructed self-harm and suicide as complex, multifaceted phenomena. The former was considered as principally a way of coping with painful and distressing experiences. The latter was described as an informed choice and a right. These constructions were used to contest the views of these behaviours that were deemed to be prevalent in wider society, namely that self-harm was a form of attention seeking and suicide was the product of mental illness. Participants drew on discourses of 'empathetic understanding', 'friendship', 'community' and 'recovery', when talking about self-harm and suicide websites. These constructed the sites as friendly, supportive communities, which play an important part in the recovery process. One possible function of the discourses is that they give website users access to positive and socially valued identities. They construct the sites as an alternative way of coping with life's difficulties; an alternative both to self-harm and to conventional medical and psychiatric services. The discourses also resist the dominant view of self-harm and suicide websites in the professional literature and the wider media. The latter offer negative constructions, which may serve to protect the status of those professions and to defend them against the idea that their interventions for self-harm and suicide are, for some at least, aversive and ineffective.

Self-harm and suicide prevention remain a priority of public health policy in the UK. Clinicians conducting psychosocial assessments in Accident and Emergency Departments are confronted with a complex and demanding task. There is a paucity of research into the content of psychosocial assessments and the experiences of clinicians conducting psychosocial assessments in Accident and Emergency Departments. This study examines the experiences of people who presented in an Accident and Emergency Department following self-harm or with suicidal ideation, as those are documented in the psychosocial assessments. Furthermore, the study explores the attitudes, feelings and experiences of clinicians working in a Psychiatric Liaison Team, as well as the process of making decisions about aftercare plans. In order to achieve this, qualitative methods were employed. A sample of sixty-one psychosocial assessments was collected and analysed using thematic analysis. The coding of the data was done inductively and deductively with the use of the categories of the Orbach and Mikulincer Mental Pain Scale. Two focus groups with clinicians were conducted and analysed with a grounded theory oriented approach. Stevens’ framework was applied in order to analyse the interactional data in the focus groups. Key themes emerging from the focus groups were shared with serviceusers who offered their own interpretation of the data and findings. The study draws on psychodynamic theories to explore the experiences of clinicians assessing and treating patients with self-harm and suicidal ideation in an Accident and Emergency Department and to make sense of the needs of the patients. The findings are that suicidal ideation and self-harm were assessed and treated in similar ways. Difficulties in relationships and experiences of loss or trauma in childhood and/or adulthood were the two most common themes emerging in the psychosocial assessments. Decisions about aftercare plans were guided by patients’ presentation and needs in conjunction with available resources. Clinicians were found to have various emotional responses to patients’ painful experiences with limited space to reflect upon these at work. Clinicians and service-users commented upon the therapeutic aspect of psychosocial assessments, which in light of the painful experiences reported in the psychosocial assessments could be used to generate more sensitive and meaningful approaches to the care of this population. Providing support and a space for clinicians to be able to think of their task and their responses seems important.