This research is a retrospective single-case-study analysis of an intensive child psychotherapy treatment begun with a seven year old boy called ‘C’, referred to specialist CAMHS for severe depression following a suicide attempt. The research question concerns itself with the identification of precipitating and protective factors surrounding this event and the design of a method by which to do so. The method designed for this purpose is: the ‘4 Column Method’: influenced by ‘grounded theory’, ‘complexity theory’ and ‘psychoanalytic observation’, suitable for identifying naturalistic patterns and themes hidden within spontaneously occurring psychoanalytic data sets and allowing transference affects to be systematically tracked. The research has resulted in the identification of six Core Variables whose developments impact upon one another. Notable is that of an inverse co-relation between an increase in the core variable ‘Developmental Thinking’ paralleling a decrease in the expression of non-developmental Core Variables: ‘Uncontained Aggression’, ‘Primitive Anxiety’ and a powerful sense of relational ambivalence: ‘Equivocal Object’. Identifying the role of frequency in the therapist’s response during a process of transforming non-developmental Core Variables into those that support Developmental Thinking has also been important, as too: the making of tentative links between C’s expressed internal experience with his experience of his external world which helped guide him through an ‘encaptive conflict’ (Gardner 2001:12), and assisted in the corrective re-organisation of C’s experience of a fractured reality (Anderson et al 2012). Another key finding to be identified within this research is the connection between experiences of early trauma, domestic violence and the expression of suicidal concerns.

Introduction: The subject of self-harm in the adolescent population is a source for public concern likely grounded in the suicide rates for this age group and the perception that the risk of suicide is increased for individuals who regularly harm themselves. This leaves clinicians working with those who self-harm with the task of assessing the risk of those who access services. The literature base for risk assessment of suicide/self-harm is populated with studies which focus on the ‘whats’ of risk assessment, for example: what a clinician needs to cover to ensure safety or what service users think of their assessment. I argue the need to build on this knowledge base, and understand the ‘hows’ of risk assessment, e.g. how does a therapist complete an assessment and how does a therapist ensure engagement. The current study takes place within the context of a Systemic Family Therapy study and explores how a therapist completes their assessment with a family. Method: Grounded Theory was employed in order to analyse videotapes of Systemic Family Therapy sessions. A single case of a female adolescent was selected based on characteristics of her therapy. The key research questions address the processes the therapist employs to move between therapeutic and assessment tasks; how the therapist’s approach changes in the face of changing risk; and how the therapist maintains engagement throughout the therapy. Results: Themes emerging from the data revealed that the therapist employs a number of subtle processes in order to switch interchangeably between assessment and therapy tasks and that these foci are not mutually exclusive. These process occur within the context of a balanced, conversational relationship in which therapist and family has an equal footing. When the perceived level of risk changes, the therapist’s approach still fits within this framework, with a key difference being a more direct establishment of therapist goals. Engagement is maintained by the therapist’s negotiation of balance, collaboration and mutuality within the therapeutic relationship. Furthermore, the therapist moderates emotion in the room in a way that avoids re-traumatisation, and in a way that encourages the family and young person to continue to contribute to the discussions in safety. Discussion: The findings of the current study provides a preliminary model of risk assessment for this particular therapy which facilitates thinking about risk assessment in a wider sphere. The findings of the current study are then considered as part of a growing body of literature, with further recommendations made for future research.

The current paper reviews literature on help-seeking in relation to suicide and attempted suicide. An overview of the extensive research into risk factors associated with suicide is given highlighting the link between mental health problems and suicide. A minority of people with mental health problems seek professional help and even fewer people will go on to receive help from specialist mental health services. The same pattern is seen in those at risk of suicide. The majority will not be receiving specialist support at the time of their death although about half will have had recent contact with their GP. Reasons for not seeking help in times of emotional distress are discussed. Finally, clinical implications arising from the literature are addressed and suggestions are made for future research.

The literature addressing suicidal behaviour in young South Asian women is reviewed. Most published literature cites 'culture conflict' as a causal mechanism for the high rates of suicidal behaviour found in this group. Whilst this concept is undoubtedly of relevance, it is ill defined and does not propose a mechanism through which conflicting cultural roles may lead to suicidal ideation and behaviour. Recent research suggests a role for shame in the suicidal behaviour of young Asian women. A specific pathway is for the first time proposed in this study, by hypothesising that experiencing conflict between Western and South Asian cultures in terms of acceptable moral and social behaviour for women may lead to or at least contribute to suicidal behaviour through the cultural concepts of 'sharam' (shame) and 'izzat' (honour). The shame experienced is thought to relate more to a fear of shaming one's family and/or community, and thereby affecting family honour rather than to Western concepts of shame. Religion is examined as a moderating variable, as research suggests that Muslim women may be at lower risk of suicidality than South Asian women from other religious backgrounds in particular Hindu women. A hypothetical model is proposed linking culture conflict, shame and suicidal behaviour with religion moderating the effect of shame on suicidal behaviour.

This thesis, comprised of a literature review, research paper and critical appraisal, employs qualitative methods to explore the experiences of adolescents who have been admitted to an inpatient psychiatric unit and those who may come into contact with mental health services as a result of their self-harm. The literature review focusses upon young peoples’ experiences of self-harm. This review aimed to contribute to current understanding of self-harm and consider how young peoples’ qualitative experiences relate to the findings of quantitative literature. Existing literature was synthesised in accordance with Noblit and Hare’s (1988) meta-ethnographic approach. The findings of this review are discussed in relation to current theoretical perspectives and the clinical implications are explored. The research paper explores ten adolescents’ experiences of their relationships during admission to a psychiatric inpatient setting using interpretative phenomenological analysis (Smith, Flowers & Larkin, 2009). Participant’s reflected on the complexity of their relationships with professionals. These reports highlighted the tension between their perceptions of professionals who were, simultaneously, perceived to be friends and experts. Young people also reflected upon the intense and meaningful relationships they developed with their peers and the impact of witnessing their friends’ distress. Finally, young people experienced their admission as a period of respite from relational stressors within their usual environment. Admission was also experienced as an opportunity to repair ruptured relationships and experience different ways of relating to others. These themes are discussed with reference to psychological theory and implications for clinical practice are considered. Finally, in the third section of this thesis I discuss my epistemological position, further consider the strengths and weaknesses of the research and reflect on the challenges I encountered when conducting this research.

The relationship between religion and mental health has been the subject of extensive research particularly in recent years. Concurrently, the issues of coping and suicidality have also been widely studied. Significantly however, how religious people cope with harsh life situations and how their religiosity impacts on their coping skills is an area which seems to have been overlooked. The present study analyses how members of one cultural group, the Religious Zionist community in Israel, cope with harsh life situations. Two introductory chapters reporting on previous research relating to religion, mental health and suicide are followed by a historical and psycho-sociological review of the development of the Religious Zionist community over the last 100 years. A qualitative study (n=18) informed the quantitative research (n=124) such that questionnaires were developed through insights gained in the interviews. A synthesis of the qualitative and quantitative studies led to conclusions which have helped to refine the understanding of the relationship between religiosity, coping, and suicidality. Although the study confirms the conclusions of previous research - in general religion creates a buffer to suicidal activity - the results showed a relatively low impact of religiosity on coping: people who regard themselves as religious find it difficult to access their religiosity during harsh life situations. Furthermore, religiosity appears to have a greater impact on suicide acceptance than on suicide ideation. The study highlights the critical role of religious coping as a mediating factor between religiosity and suicide. The thesis suggests certain themes which help to explain the findings, for example the specific complexity of personal and collective identities which characterise the Religious Zionist community, or - more significantly - the possibilty that religious coping is not actually absent but is only available in a second, later stage of coping. As an example of a harsh life event which affected the whole community, the thesis presents a provisional analysis of the Disengagement plan of 2005, and finally the study analyses the significance of the researcher's socio-religious background and its impact on the research.

No description available.

This thesis recounts an innovative critical exploration of accounts of child and adolescent mental health (CAMH); sourced from young people's Internet newsgroup contributions and academic/professional publications (both viewed equally as 'data' sources). An original discursive approach, informed by the concerns of 'postmodernism', 'constructionism', 'discourse analysis' and 'narrative inquiry', was developed and employed. Commencing with historical accounts of CAMH, an 'unconventional account' is presented which reads that history in terms of 'marketing'. Considering young people's Internet newsgroup accounts of CAMH as possible 'resistance' to conventional CAMH accounts, investigation into the types of post contributed and the subjects of interest being discussed indicated that self-injury/suicide were of particular interest to young people. Consequently, further in-depth critical investigation of young peoples' accounts of self-injury/suicide followed; comparing their accounts with the received wisdom found in the academic/professional literature. Outcomes indicate that three major themes run through the young people's contributions regarding self-injury/suicide; namely, 'change', 'control' and 'relationship'. Marked agreements between the newsgroup material and the academic/professional literature were established. However, significant differences were also discerned. Young people who selfinjure/ suicide ubiquitously described wishing to 'change' their thoughts/actions; in contradistinction to academic/professional wisdom that questions the genuineness of that desire, viewing such young people as 'difficult clients'. A number of 'questionable arguments' were also highlighted within the existing academic/professional literature. It is proposed that enhanced understanding of CAMEl accounts and their effects challenges the 'individualising' within existing discourses/narratives of young people who selfinjure/ suicide. Implications for enhancing theory/research and care practice are also discussed.

This thesis explores the role of social workers in suicide prevention. Using a mixed methods approach the research examines how social workers understand, and work with, suicidal individuals in multi-agency and interdisciplinary settings. In my first empirical chapter (chapter five) a secondary analysis of the Adult Psychiatric Morbidity Survey (2007) (n=7,403) explores the circumstances under which social workers come into contact with suicidal individuals. Using a multinomial logistic regression it has been possible to establish that substance misuse is associated with social worker contact. This suggests that social workers are having contact with a group at elevated risk of suicide. The second part of the thesis is based on a series of semi-structured interviews with statutory social workers (n=17) (chapters six and seven), service users with a history of suicide attempts (n=3) and Community Psychiatric Nurses (CPNs) (n=3) (chapter eight). A thematic analysis of the interviews found that although statutory social workers had little or no training in assessing suicide, both service users and CPNs believed that social workers have a vital role in supporting suicidal individuals. Social workers found peer learning to be important as both a source of knowledge and learning, and as a support network. The findings of this research indicate that social workers have particular expertise in taking a holistic approach to suicide assessment and prevention. The Approved Mental Health Professional (AMHP) role is also felt to give social workers a strong knowledge of the legal issues that underpin working with this vulnerable group. However further research into the contact between social workers and suicidal service users and the assessment of suicide is necessary. The findings of this thesis have implications for practitioners, policy makers and researchers.

Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013 / The aim of the study was to explore preference for support and the different coping strategies that are employed by adolescents’ following suicide attempt in Limpopo Capricorn district. The sample comprised of 81 adolescents of both male and female who were admitted at public hospitals around the district and referred to psychology department for intervention. Using purposive sampling, data was collected through the use of a questionnaire which was divided into 1. Demographical information, 2. Multidimensional scale of perceived social support (MSPSS), 3. Ways of coping scale (WCS) which consisted of three subscales: active-cognitive, active-behavioural and avoidance strategies. Most participants reported not having support. Participants who expressed support from family, friends and significant others indicated that although family, friends and significant others were equally perceived to be an important source of support, family was more inclined to be the most preferred source of support. This preference differed according to gender as females perceived family to be the most important source followed by friends and lastly significant others, while males order of preference was friends followed by significant others and lastly family; indicating that males are more inclined to have their friends as the most preferred source of support than females. The findings of the study also indicated that suicidal adolescents used avoidance strategies followed by cognitive and lastly behavioural strategies. A significant relationship was established in the use cognitive strategies and coping by adolescents who viewed their support structures as supportive and also with active behavioural strategies. On avoidance strategies there was no significant relationship established highlighting the possibility that those adolescents who feel that they have no support use avoidance as a coping strategy. The recommendations made on the results from this study are that research in suicide should be a continuous process that keeps up with the changing family, political and cultural dynamics of our society. This is crucial since what is considered crucial support today for the adolescent, might not necessarily be viewed as relevant support for the adolescent in the