Background: In the last few decades the suicide rate in young people has risen in the United Kingdom although with no notable increase in presentations for mental disorder. Concurrently there have been societal and other changes that have affected this age group, including an increased rate of deliberate self-harm, alcohol and drug misuse, unemployment, and divorce. Aim: To describe the main social, clinical and interpersonal characteristics of people under 35 years of age who commit suicide and to identify a model that best predicts suicide in the young. To investigate whether these factors are common in suicides under 25 and 25 to under 35, compared to controls and whether or not suicides under 35 communicate intent. Hypotheses: The association between suicides and severe mental illness was less marked than the influence of other psychological and social factors, namely an increase in adverse life events, a greater misuse of alcohol and drugs, and higher rates of personality disorder and unemployment. Method: Psychological autopsy study with case control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and sex-matched non-suicides obtained through the general practices of the cases. Main variables were social, including unemployment, marital status and living circumstances; life events and interpersonal difficulties; and clinical, including current psychiatric disorder, alcohol and drug misuse, previous self-harm and personality disorder. Results: The main finding of this study was that suicide in young people was preceded by a mental illness, although the distribution of mental disorders differed from earlier psychological autopsy studies of all ages. Young suicides had a number of vulnerability factors in their background that interplay with their prevailing circumstances. Suicides lacked the stable, supportive childhood experienced by their controls but instead may have endured parental separation, abuse and parental psychopathology. They were more likely to be unemployed and have low educational achievements. Their current situations lacked roots, social support often with a background of relationship difficulties. They had an increased likelihood of recent life events, particularly of an interpersonal nature, but also involving criminal activity. Many sought help from their general practitioner within three months of their death and communicated their intent to die. A large proportion deliberately self-harmed in the recent past. Most of the factors associated with suicide remained so in the under 25's and 25 to under 35's except: not being married, forensic problems, and recent contact with the GP which were associated with suicide in the older group but not in the younger group, compared to controls. Living in rented accommodation was associated with the younger suicide group and not the older suicide group compared to their controls. Conclusion: A broad prevention strategy is needed to reverse the recent rise in suicide in young people. This involves developing primary and secondary health care services that are available, accessible and acceptable to young people; improving identification of mental illness; realistic advice on the effects of alcohol and drugs; support in times of interpersonal crises; improving educational and employment potential, including those with a severe mental illness.

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The research was carried out during a time when residential provision for people with learning difficulties in the north of Scotland was changing from being hospital based towards being community centred. The aim was to utilise an understanding of the dynamics of past provision to shed light upon present practice and planning for the future: focussing upon that form of ‘difference’ which has been given the name ‘learning difficulty’. The research utilised records, interviews, narratives and discussion groups to explore the experiences of providers of services, service users and those who were close to them. The research sought to go beyond description; to facilitate respondents in sharing their understanding of the organisation of care services and how it had an effect upon their life chances and self concept. The design of the research, which made use of multiple sources of evidence, was qualitative in its approach. It was undertaken within four ‘sites of interest’:  The archive or the historical record of provision at Lhangbyde Hospital..  Through semi structured interviews with ‘Providers’  A ‘Punters’ discussion forum located within a self advocacy group.  A set of ‘Intimate Narratives’. The method had its roots in constructivist, reflective and post modern currents of thought which confronted the difficulty inherent is making an epistemological distinction between what is out there in the world and the categories of meaning which are resident in the human mind. The goal was to produce texts which promoted dialogue rather than monologue, were evocative rather than definitive, In chapter 8 some ‘Intimate Narratives’ from the researcher’s own life experience as a father and as a facilitator and adviser within a self advocacy organisation were presented directly as stories of everyday experience. In the final two chapters of the thesis an attempt was made to synthesise the overall findings of the research, and to assess their implications for future policy and practice. In chapter 9, under the heading of ‘Reading the Chart: understanding the past and present as a foundation for future planning’ the findings from the four ‘sites of interest’ were gathered together under seven explanatory themes, with the section entitled ‘Gaining a Voice’ achieving an overall pre-eminence.. The last chapter in the thesis (Chapter 10), under the title of ‘The Future Course’ detailed a plan for change and development based on a synthesis of findings. In addition the role of future research in promoting change was examined. The thesis concluded with a ‘plain language’ summary of recommendations.