Despite research demonstrating their effectiveness and recommendations of top-down guidance, little in the way of psychosocial services is being delivered within acute inpatient facilities in the UK. The literature review compiled an up-to-date appraisal of research pertaining to the utility of psychosocial services within adult acute mental health inpatient facilities. Searching databases resulted in eleven studies being critically reviewed. Articles related to inpatients, staff and interventions aimed at the organisational level. Despite similar methodological limitations, psychosocial services positively impacted upon self-cognitions, symptoms, functioning and relapse. Staff training improved clinical practice and promoted feelings of staff empowerment. Organisational research demonstrated the need for stakeholder inclusion and supportive organisational structures, for long-term change. Barriers to change, including staff psychological distress and feeling unsupported were highlighted. Qualitative research is needed that further explores obstructions to change and improvement. The research study explored experiences and priorities of staff working in adult acute mental health inpatient units, regarding the role of psychosocial services. The aim was to consider how this differs to and affects the implementation of national guidelines and scientific recommendations, with a view to making suggestions regarding effective implementation. Eight staff members participated in a semi-structured interview and data was analysed using grounded theory. Data emerged suggesting the ward to be isolated, with a lack of team work and effective leadership. The focus on medication encouraged hopelessness about patient progress and a lack of understanding about patients and their own feelings towards them. Staff felt powerless, unsupported and undervalued. They experienced a lack of professional confidence, performance anxiety and fear of change, resulting in overall ambivalence towards change and improvement. Training and therapeutic services for staff are needed, along with organisational consultancy, to increase effective team work, leadership and staff input into service development. Future research is considered.

A relatively large body of research has highlighted the high (or equal) risk of disordered eating in South-Asian populations in comparison to Caucasians, particularly in the UK. The literature review aimed to examine the empirical evidence for eating disorders and body dissatisfaction in South-Asian populations over the past decade. Through systematic searching a total of 16 studies were identified that met the inclusion criteria. These studies, not without limitations, highlighted the high level of disordered eating in young South-Asian populations compared to disordered eating in other ethnicities. The finding of higher body dissatisfaction in more Westernized South-Asian populations was also evidenced. Despite the findings that South-Asians are at equal risk as other ethnic groups for eating disorders, they remain under-represented in treatment services in the UK. The aim of the research report was to explore the eating disorder experience and journey into treatment for British South-Asian women who were in treatment in eating disorder services. Interpretative Phenomenological Analysis was used to analyse the transcripts from six participants. Three overarching themes emerged: the critical Asian society; the parental response: rejecting, tolerating and accepting; and the role of self and voicing needs. Implications for eating disorder services were made based on the experiences of these participants. The critical appraisal was an account of the research journey. Specifically, it highlighted the difficulties encountered along the process and how the present researcher managed these. It also incorporated the dilemmas for the present researcher in using a qualitative methodology.

Part One: Literature Review - Purpose: To determine current opinions amongst mental health professionals regarding the aetiology of ‘schizophrenia’ Method: Literature searches were conducted using online databases. Search terms included: schizophrenia, psychosis, cause, etiology, aetiology, beliefs, causal, explanatory models, conceptual models, causal beliefs, psychologists, nurses, psychiatrists, staff, professionals, workers. Results: Thirteen relevant studies were identified: 11 cross-sectional surveys, 1 quasi-experimental design, 1 peer-professional autobiographical account. Conclusions: The majority of health professionals favoured biological aetiology. Aetiological beliefs are related to preferred management strategies. Biological aetiological beliefs are amenable to change through the use of a training programme. Part Two: Research Report - Objectives: To explore 1) What understanding staff members have of possible causes of clients’ unusual experiences and distress? 2) What approach do staff members take in promoting recovery and how is this related to their construction of ‘psychosis’? 3) How are differences in opinions about treatment and recovery negotiated between clients and staff or between the individual staff member and the team? Method: Semi-structured interviews were conducted with eight mental health professionals working in four separate Assertive Outreach teams, spanning two regions of the East Midlands. Interview data was analysed using grounded theory methodology. Results: A model was developed based on two continuums between the core categories of ‘expert position’, ‘being with’ and ‘dependence’, ‘independence’. Four contributory categories ‘conceptualisation of mental health difficulties’, ‘focus of recovery’, ‘risk and responsibility’ and ‘team/organizational factors’ influence the position that professionals. Conclusions: Professionals’ approaches to understanding and working with people experiencing mental distress are context-dependent. Biomedical conceptualisation tends to be associated more frequently with the ‘Expert Position’, but other factors such as risk and resource limitations can also move professionals towards this way of working. Part Three: Critical Appraisal - This is a reflective account of the research process and some of the challenges encountered.

Effort or Symptom Validity Tests (SVTs) are used during neuropsychological assessment to assess for negative response bias. SVT failure can be used as evidence that other test results are invalid and to support a diagnosis of malingering. The positive predictive accuracy of a SVT is dependent on its sensitivity, specificity and the base rate of malingering within the population sampled. The British Psychological Society (BPS, 2009) advises that all clinical patients should be assessed for effort using a SVT. However, there is no available data on the likely base rates of malingering within a UK clinical sample. Furthermore, despite test manual instructions, the BPS also advises that examinees should be informed they will be assessed for effort, potentially invalidating test results. A systematic literature review was conducted to ascertain what is currently known about the base rates of malingering. Studies were only included if they enabled the application of the Slick, Sherman and Iverson (1999) criteria for definite or probable malingering to their sample. Four North American Studies yielded 503 litigating, traumatic brain injured participants of which 24.55% were identified as either probably or definitely malingering. This figure was significantly lower than previous estimates, which have suggested the base rate of malingering may be as high as 40% (Larabee, 2003). In order to investigate whether informing people presenting for a neuropsychological assessment that they would be tested for effort affects their SVT results a multi-site experimental design was employed. Participants were randomly assigned to either informed or uninformed conditions and administered a battery of neuropsychological tests including the Test of Memory Malingering (Tombaugh, 1996). Practical difficulties resulted in small sample size and insufficient statistical power to either accept or reject the null hypothesis. Further data collection, research opportunities and clinical implications are discussed.

The first postnatal year is a period when the rate of psychiatric disorder is high, and a correspondingly high rate of suicide might be expected. Age-adjusted mortality ratios for suicide by women in the first postnatal year were therefore calculated from population data for England and Wales for a twelve-year period. The overall mortality ratio was found to be 17- that is, the actual total was one sixth of that expected. The low rate was not found after stillbirth which was associated with a rate of suicide six times that in all women after childbirth. Women who committed suicide after childbirth most often did so in the first postnatal month and there was a tendency to use violent methods. One explanation of the low rate of suicide is that motherhood exerts a protective effect, and further studies were carried out to explore this possibility. In study two, the age-standardised mortality ratio for suicide during pregnancy was calculated by the same method to be 5 - that is, the actual rate was one twentieth of that expected. In study three, the rate of parasuicide by women in the first postnatal year was calculated from catchment area data to be less than half that of age-matched women (odds ratio 0.43). In study four, a cognitive explanation for these results was studied. Women with postnatal depression were found to score less on a questionnaire measuring cognition related to worthlessness, hopelessness and self-harm than women with depression arising at other times. This result suggests that childbearing women, despite their risk of psychiatric disorder, are protected against suicide and self-harm by their relative absence of suicide-related cognitions, and that such cognitions should be a focus for the treatment of other groups at risk of suicide.

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