The nursing staffs who work in the NHS mental health in-patient wards sometimes physically restrain their patients. Whilst there are studies that have looked at the different aspects of the use of physical restraint, none has specifically investigated the experiences and perceptions of the staff on the use of the patient centred model of physical restraint in managing untoward incidents in the setting. As a trainer on the General Services Association model of physical intervention, I worked collaboratively with staff from two NHS mental health inpatient wards, users of physical restraint techniques, to explore their experiences, perspectives and indeed the effectiveness of the patient centred approach to physical restraint in their respective wards. Following a review of the relevant literature, the choice of a qualitative type of investigation based on the unmodified Husserlian phenomenological framework was made. To complement this style of investigation, focus group and semi-structured interviews were used to collect primary data from the study participants. Phenomenological recommendations were adopted in the analysis of data. Six core themes including: physical restraint of a patient is for safety and patient centred practices during restraint process emerged from the huge data. The findings confirmed that patient centred approach to physical restraint was effective with the patient groups in the participating wards. Participants emphatically stated that the model enabled a quick retrieval of the therapeutic relationship with their patients. This is in keeping with the ethos of mental health care which is reliant on therapeutic relationship with the patient.

Government initiatives over the last fifteen years have emphasised a need to promote high standards within residential care for people with intellectual disabilities (ID). Emphasis has been placed on ensuring a competent workforce so as to promote high-quality support and prevent abuse. Clinical psychologists provide consultation and training to staff teams and have an important role to play in the care of people with ID. Despite the focus on competence, residential staff continue to have few qualifications and training opportunities. They are also poorly paid, which suggests that they are not valued as highly as other professions, despite doing a very demanding job. These issues pose the question of what has changed since government papers of the last decade and what issues remain. A literature review was completed to explore staff practice and factors that help and hinder competent working. Studies showed that staff faced daily dilemmas between policy and practice and that support from psychologists could be experienced as unhelpful. In order to ensure high-quality care for people with ID, it is essential that practice is informed by appropriate policy and theory. Since research was grounded in adult services, the empirical study sought to explore these issues further in a sample of ten staff members working with children with ID. Using semi-structured interviews and template analysis, the study aimed to identify whether or not these staff members experienced the same challenges with policy and theory and what support they wanted. It was found that very similar challenges were experienced when working with children. Participants provided further insight into these challenges and the support they needed. Findings are discussed in the context of how psychologists and policy-makers can be more useful. Following this, a reflective commentary is presented, offering reflections on the research process.

Difficulties with emotion regulation are reported as commonly experienced by people with intellectual disabilities (PWID). These difficulties can lead to the involvement of PWID with forensic services, and the requirement for them to undertake psychological therapies aimed at improving their regulation of emotion. This thesis firstly provides a critical review of the quantitative evidence for the effectiveness of interventions addressing the most prevalent form of emotion dysregulation for PWID in community-based and inpatient forensic services: anger and outwardly-directed aggression. Sixteen studies met the inclusion criteria and offered promising evidence for the effectiveness of a range of psychological approaches in improving anger and reducing aggression. However, firm conclusions and generalisability of findings were precluded due to the pervasive methodological shortcomings across studies, and accordingly, recommendations for future research and service providers were made. Second, this thesis empirically explores the process of engagement and perceived change for PWID in forensic services attending dialectical behaviour therapy (DBT). The perspectives on “what works” in DBT are gathered via interviews with nine participants and analysed using a constructivist grounded theory-informed methodology. The resultant model highlighted a temporal process within which participants encounter a difficult and coercive journey from compliance and avoidance, to acceptance and integration of change. The model was discussed in relation to current theory on the process of change, and clinical implications were made in respect of improving the support provided to PWID attending DBT in forensic settings. Future research is encouraged to explore and address perceived coercion and aversive elements within psychological interventions for PWID, to enhance treatment experience, effectiveness and evaluation. Finally, reflections were offered in the critical appraisal section of this thesis on the potential challenges of conducting research with PWID in forensic settings and the recurrent theme of coercion noted in respect of this population.

The attitude of the general population to people with intellectual disability (ID) provides an important background for policy development. Furthermore, because of changes in attitudes over time and across cultures, it is vital to ground each country’s policy development on data from that country. This dissertation provides a cross-cultural and cross-sector analysis of attitudes to people with ID in Libya and in the UK, using questionnaire studies of three groups in each country: science students, psychology students and professionals in ID support services. The questionnaire used was the established Community Living Attitude Scales for Intellectual Disability (CLAS-ID). The CLAS-ID has four sub-scales: Empowerment (in decisions affecting their life), Exclusion (desire to segregate with negative affective tone), Sheltering (the need to supervise and protect) and Similarity (to normally achieving people). Initially, the CLAS-ID was translated into Arabic and validated with a small sample of respondents. Studies 1 and 2, which were undertaken in 2010, used the CLAS-ID for a Libyan sample and for a UK sample. The results indicated that the Libyan sample showed significantly lower scores on Empowerment, Similarity and Sheltering than the UK sample, but no significant difference on Exclusion. A range of within-group differences were also found. Study 3 was undertaken in 2012, using a similar sample to that of Study 1, and allowed investigation of the effects of the Arabic Spring on attitudes to ID in Libya. Despite the trauma, stress and insecurity in the wake of by the Libyan revolution, except for Exclusion there were a significant changes in attitudes to people with ID from 2010 to late 2012. Study 4 undertook an equivalent comparison of UK scores over the same time period. For the UK the most relevant event in this context was the massive media coverage of the London Paralympic Games 2012. Significant (and desirable) changes in all four CLAS-ID dimensions were found, with particularly strong effects for Empowerment and Inclusion. The implications of these findings and those in the earlier studies are discussed, limitations considered, and directions for further research outlined.

This thesis addresses strategic litigation with a focus on tackling human rights violations occurring in institutional residential settings in European countries for people with intellectual impairments. The thesis aims to determine the potential value of strategic litigation as a means to recognise and enforce the rights of this group, as well as to explore how this potential value can be realised. The thesis adopts socio-legal research empirical methods, by exploring the experiences of key stakeholders involved with strategic litigation in the field of disability (including intellectual impairments) and human rights. Legal documentary analyses have been performed to establish the context for this research, at national (England, Ireland and Spain), European (Council of Europe -CoE- and European Union -EU-), as well as global levels. Qualitative interviews have been conducted with supranational and national disability and human rights organisations, and with lawyers working in the three national legal systems. The findings reveal diverse factors that contribute to shaping the current state of affairs with regard to relevant national and supranational strategic litigation. People with intellectual impairments in institutional residential settings in European countries face several barriers to accessing justice and strategic litigation. Strategic litigators have to overcome the major barrier of making contact with this group. Strategic litigators experience further barriers to bringing strategic cases (for example, a lack of human resources). The findings include suggestions for overcoming and/or reducing some of these barriers. In the area of access to justice and strategic litigation, for many people who are part of the group under analysis, there is either no, or poor, recognition. Strategic litigation has potential for tackling human rights violations happening in institutional residential settings. However, certain circumstances need to be met in order for this to happen. This thesis suggests different options for key stakeholders to be able to work towards overcoming the aforementioned challenges, thereby making it possible for strategic litigation to achieve its potential.

This thesis explores the lived experiences of people with learning difficulties who remained within their home inner London borough of Kensington and Chelsea between 1971 and 2007: an era when many others were moved out-of-area. A multiple-method design combined autobiographical data from people with learning difficulties with oral history evidence from key witnesses and archive sources. The research had three main aims: 1. to explore how people with learning difficulties, including individuals with high support needs, could compile and share their life stories and experiences of local support. This required openness to the development of new methodological approaches. 2. to draw upon these previously unexplored life stories to better understand what had supported people to 'stay local'. This required an examination of how community-based services and support had evolved in the locality and how crisis periods, when individuals were at risk of a move out-of-area, were resolved using local networks and services. 3. to consider the application of the research to contemporary social care a policy and practice. This necessitated a review of findings in the light of their relevance to the delivery of increasingly localised and personalised support for adults with learning difficulties. Through use of mobile interviews, individual life journey maps and co-produced borough maps, the research explores and presents new methodological approaches to support the sharing of life stories. Findings were that staying local was initially due to care provided by families, many of whom built up their own informal networks of support in the locality,. Analysis of how crisis periods were locally resolved identified the importance of responsive short break and supported living services, staff who advocated for local support and long-standing relationships between individuals, families and local services.

Cash payments in the form of direct payments have become an essential tool in the distribution and provision of social care support. This development has been hailed to represent ‘a potentially revolutionary challenge to [the] unequal relationship between providers and receivers of care’ (Glasby & Littlechild 2002: 137), which has shifted the position of social care recipients from ‘service users’ to commissioners, developers and managers of their own support and created the role of personal assistant. This thesis explores this challenge through the experiences of newly created ‘employers’ with learning difficulties and their personal assistants, within the discourses of independence, choice, control and empowerment which stand as central principles within the personalisation agenda (DH 2007a; DH 2007b). The personalisation agenda is argued to be situated within the at once competing and complementary analysis of the Independent Living Movement and New Labour’s analysis of the ‘new global realities’ (Cerny & Evans 2004), which requires a re-negotiation between the citizen and the state. These direct employment relationships represent one of the critical points at which our relationship with the state is in the process of flux. It is this, our relationship with the state in social care, heralding new forms of responsibilised citizenship in the form of citizen-consumers (Clarke et al 2007) and citizen entrepreneurs (Scourfield 2007), in combination with the changing social relations of support in the form of personal assistants, that is of interest. Drawing on disability studies and feminist analysis situated within the political economy, this thesis explores, with equal interest, the experiences of employers and personal assistants. Whilst it is clear from this project and others (Gramlich et al 2002; Stainton & Boyce 2004; Prideaux et al 2009) that directly employing personal assistance offers the opportunity to create a personalised support arrangement, however questions emerged around the equality of that opportunity and implications for a workforce which has historically remained low status, low paid and unsupported (Ungerson 1997a). These questions brought into perspective how ‘empowerment’ is experienced and encouraged an analysis in which support relationships are characterised as much by ‘interdependence’ as ‘independence’, questioning the extent to which the ‘commodification’ (Ungerson 1997b) of support represented the value, or lever of empowerment. Rather, it was the personal and in-formalised aspects of these relationships that offered value and which returns us to a recognition of the social in the personal.

No description available.

Background. Previous research examining staff responses to clients with a learning disability and challenging behaviour have focused on behavioural models, and Weiner's (1980) helping behaviour model. More recently, Willems et al. (2010) considered the interactional nature of the staff-client interaction using Benjamin's Structural Analysis of Social Behaviour (1974). This was considered novel to this study. They developed the Staff Client Interactive Behaviour Inventory (SCIBI) on the basis of this model. Aims. The aim of the current study was thus twofold: to pilot the SCIBI in a British population, investigating possible relationships between staff responses ('helping behaviour') and the SCIBI factors, and to assess the psychometric properties of the SCIBI. Method. The SCIBI was originally piloted in a Dutch sample, and thus the language composition was adjusted initially. This study recruited frontline support staff in community settings for adults with a learning disability and challenging behaviour (N = 67). All participants completed the SCIBI, Intrex questionnaire (Benjamin, 1983,2000) and measure of helping behaviour in response to an identified target client. The factors of the SCIBI were correlated with staff helping behaviour to explore possible relationships. The psychometric properties of the SCIBI were also assessed (internal consistency, test-retest reliability & concurrent validity). Results. A significant positive relationship was found between helping behaviour and assertive control on the SCIBI. The results of this study found poor reliability for the SCIBI in a British sample. The concurrent validity of the SCIBI was only found to be good enough for the hostility factor of the SCIBI. Conclusions. To conclude the results of this study found little support for a relationship between the SCIBI factors and helping behaviour. Further, the pilot data investigating its psychometric properties in a British population demonstrated poor reliability and validity. The SCIBI in this study had several limitations.

This doctoral thesis explores the experience of intimate relationships for people with intellectual disabilities, with a focus on caregiver support. It includes a literature review, research paper, critical review and ethics section. The literature review is a qualitative meta-synthesis of the difficulties experienced by caregivers relating to the sexuality of people with intellectual disabilities and examines how caregivers address these difficulties. The synthesis produced five meta-themes: 'Fear and Uncertainty', 'Impact of Perceptions of Sexuality', 'The Same and Different', 'Balancing the Roles of Protector and Facilitator' and 'Conditional Sexuality: Conditional Support'. The findings suggest key issues for caregivers in relation to addressing the sexual needs of people with intellectual disabilities and makes recommendations for future research and clinical practice. The research paper then examines similar issues from the perspective of people with intellectual disabilities themselves. Previous literature suggests that people want relationships and people with intellectual disabilities have historically been denied their human rights. An interpretative phenomenological analysis was conducted exploring the experience of intimate relationships for nine adults with intellectual disabilities. Four main themes were identified; desiring relationships; expressing sexuality; doing relationships; and who has control? Implications for clinical psychology theory and practice are discussed. The critical review explores some of the considerations needed when conducting qualitative research with people with intellectual disabilities. It details some of the adjustments made and gives additional reflections on the research process.