The current neoliberal political narrative has positioned families experiencing multiple stressors and struggling against adversity as responsible for their difficulties, making poor choices and avoiding opportunities to change their lives. Mothers are especially blamed and held responsible for maltreatment of their children, within a framework of child protection. A Grounded Theory approach is used to explore the experiences of mothers who have been through intensive family support programmes as part of the ‘Troubled Families’ initiative. The women describe how they have had little control over their lives, experienced abuse in most of their significant relationships, and end up ‘broken’, losing all sense of self. They shut down and feel intense shame, leading to mental health problems and substance misuse. This is on a background of coping with poverty and inequality, creating immense daily stress. They find strength through their relationships with their children, suggesting removal of them may be detrimental.

The International Classification of Functioning, Disability and Health (ICF) is a taxonomic framework that provides a biopsychosocial understanding of intellectual disabilities (ID). It was hypothesised that the use of the ICF would help highlight physical health difficulties in people with ID and promote a wider, more holistic view of ID. There was an additional practical aim concerning widening competing categories of athletes with ID to include physical health. The study consisted of two stages. In Stage one the ICF-based questionnaire was developed with an expert panel. Stage two aimed to test this using a naturalistic, cross-sectional design, between three pre-existing groups: elite athletes competing through INAS; sub-elite athletes; and athletes with Down syndrome (DS). Seventy-seven athletes took part. The results suggested that a separate competing category for athletes with DS should be considered, as this group could currently be considered disadvantaged in terms of their physical health when compared to INAS athletes. It was hoped this research would inspire further debate on a taxonomy for intellectual disabilities and the potential advantages of this, particularly in helping to ensure physical health problems in this population are not overlooked.

Background: In recent years, evidence for the positive effects of singing with people with dementia has been substantial. Some research has used physiological measures to analyse the impact of singing, however this method has not before been used in a community study with people with dementia; this study explored the interactions between these areas of research. Method: A mixed methods, quasi-experimental design was employed in this exploratory, within-subjects study. Physiological measures of stress (salivary cortisol and heart rate) and subjective measures of wellbeing and stress were obtained during a choral singing group from 17 participants, 10 with a dementia and 7 caregivers. Data were also collected during a non-singing control condition. Interviews investigating the influence of the singing group were conducted with caregivers and analysed using thematic analysis. Results: Quantitative results showed positive effects of group singing on subjective stress and wellbeing, with some significant increases in composite wellbeing, happiness and optimism. Stress hormone results were mixed but the majority showed a decreasing trend. Heart rate variability significantly increased for people with dementia which may be associated with the significant increase in happiness, as shown in previous research. Qualitatively, group singing was overall reported to have a positive influence on people with dementia and caregivers. These influences included effects on mood and cognition, and positive aspects of the intervention were described. Conclusions: The findings suggest that additional research is warranted to further investigate interactions of physiological and psychological variables related to choral singing in people with a dementia. Methodological difficulties of saliva collection with this population need to be addressed if stress hormones are used in future research.

Background: People with autism may experience higher rates of mental health difficulty, yet access to appropriate mental health support and services has been recognised as challenging. Aims: This study aimed to explore whether components of the Theory of Planned Behaviour (TPB) could explain variance in IAPT clinicians’ intention to carry out interventions for mental health difficulties in people with High functioning autism (HFA) or Asperger’s syndrome (AS). It also explored the effect on intention of past experience of carrying out these interventions. Method: There were two stages to the study. The first stage involved a qualitative elicitation study, which investigated attitudes, subjective norms and perceived behavioural control factors in carrying out the interventions. The second stage was a questionnaire-based study. The questionnaire was created following content analysis of the qualitative data, and was completed by clinicians currently working in Improving Access to Psychological Therapy (IAPT) services (n=88). The data were then analysed using multiple regression. Results: The theory of planned behavioural model predicted 56.5% of the variance in intention to carry out interventions for mental health difficulties for people with (Autism Spectrum Conditions (ASCs)). The most significant components in predicting intention were indirect attitude measures, direct measures of perceived behavioural control, and indirect subjective normative referents. Past experience of carrying out these interventions was significantly associated with intention when the individual had no experience of working with people with ASCs previously. Conclusion: Further explorations of unaccounted variables impacting on intention to carry out interventions for mental health difficulties with people with ASCs could be valuable. Clinical implications include additional training for therapists in ASCs and development of adapted materials if part of the intervention. Future research could focus on therapy efficacy other than for cognitive behavioural therapy and in-depth accounts from therapists and service users with ASCs as to their therapeutic experiences.

Research suggests athletes have an equivalent, possibly higher, likelihood of developing mental ill-health to the general population, however they underutilize the services provided. An action research methodology was employed (over three phases), with the overall aim to improve the provision of psychological support for scholarship athletes. Phase1 explored experiences of mental health, from the views of seven scholarship athletes and two scholarship mentors. Phase 2 used a focus group to discuss and elaborate on the themes from phase one and phase 3, developed a list of recommendations for services. Thematic analysis was used to analyse information from the individual interviews, the findings of which emphasized the impact of transitions and demands on the athlete’s mental health. Mental health within this group continued to be entwined with stigma, denial and misjudgements and a lack of established conceptualisation. Clinical implications were explored and suggestions for future research were presented.

This study investigated the impact of bullying on suicidality in a clinical population of adolescents with autism spectrum conditions (ASCs). Evidence suggests that adolescents that experience bullying are at increased risk of developing suicidality. Adolescents with ASCs are at increased risk of developing suicidality and are at increased risk of being bullied. However, the relationship between bullying and suicidality in adolescents with ASCs has not been investigated. Electronic health records (EHRs) of adolescents (13-17 yrs) with a diagnosis of ASC using the services of a South London mental health trust were analysed. Natural language processing (NLP) was employed to identify mentions of suicidality and bullying in the free text fields of adolescents’ clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality. Bullying at baseline was associated with suicidality over the follow-up period. In addition, female gender, psychosis or affective disorder diagnosis and absence of intellectual disorder diagnosis were associated with suicidality at follow-up. After controlling for functional assessment score bullying did not predict suicidality. Bullying seems to predict future suicidality in adolescents with ASCs. That bullying did not predict suicidality after controlling for functional assessment score may have been due to the impact of lost power or overfitting. The results of this study suggest that mental health clinicians and educators should take reports of bullying seriously.

Background: Older people are more likely to have poorer health literacy skills, experience more health problems and worse health outcomes compared to younger people. Aims: The aim of the study was to explore whether age differences between older people’s and younger people’s performance on a health literacy task would reduce with multimodal health information, presented by video, compared with unimodal information presented by audio and text on its own. Method: 24 older adults and 25 younger adults completed a test predictive of intelligence and an experimental task where they were shown information about health conditions presented by video, audio and text and then asked forced-choice questions on its content. Older adults also completed a cognitive screening test. Results: No significant differences in performance between the age groups were found for video stimuli presentation. Conversely, older adults performed significantly worse than younger participants when shown the audio and text-based stimuli in isolation. The pattern of findings suggests the older group benefited more than the younger group from video stimuli. Conclusions and implications: Older people may benefit more from receiving multimodal health-improving information. Clinicians have a responsibility to communicate health advice in ways most accessible to the older population. Additional work is needed to further investigate how presenting health information to more than one sensory channel could improve older people’s health literacy and health outcomes.

The design of healthcare environments has been shown to produce positive effects for patient outcomes, particularly in mental healthcare. However, relatively little is known about patient experience of design within physical healthcare environments. In this study, fourteen cancer patients were interviewed about their experiences of using a newly built cancer centre that incorporates art and design. Grounded theory methodology provided a framework for the analysis of results and the construction of a theoretical model which represents a first attempt at explaining the relationship between healthcare environments and patients with respect to emotional wellbeing. Results show that central aspects of this particular healthcare environment – orientation, physical aspects of design, and atmosphere – were not like a hospital and these led to diverse patient experiences depending on the individual context, in other words the personal histories and preferences that patients brought. Implications for research and clinical practice, including the benefits of drawing upon helpful aspects of environments as part of a holistic approach to treatment, are discussed.

Despite the severely detrimental impact of child abuse, many adult survivors appear to be resilient, demonstrating a range of successful outcomes. However, conceptualisations of resilience in the literature may be somewhat disconnected from the emotional reality of survivors’ lives. This study aimed to explore the life stories of nine adult survivors of child abuse using narrative analysis, with a theoretical focus on attachment. Narratives were generally hopeful and progressive, engaging in constructions of identities and relationships that amounted to a coherent, positive understanding of life. However, the joys of life did not erase the scars, and many reflected on themes of loss and uncertainty that were more hidden from the world. Attachment theory provided an interpretive frame by which themes were conceptualised as serving adaptive functions. Findings suggest that “getting through” is not a ‘state’ that is reached with completeness, emphasising the importance of elevating the voices of survivors, and encouraging the multiplicity of stories to flourish.

Background. There is a continued interest around the use of Schwartz Center Rounds© (Rounds) to address the emotional impact of caring for clients. Studies indicate positive outcomes for staff and clients, yet there is a paucity of research exploring how these outcomes occur. This study aimed to understand whether attending Rounds had an impact on how staff perceived themselves and their work. Primarily, it sought to understand what psychological processes may facilitate such an effect and at what point these might occur. Method. Eleven staff members were interviewed about their experience of attending a Round. Grounded theory methodology was used to analyse the interview data. Results. Five key psychological processes of occupying a different space, reciprocity, containment, connection and gaining perspective were identified as facilitating an effect on staffs’ perception of self and work. Processes were fostered during Rounds and seemed to continue afterwards. Discussion. This study is the first to explore psychological processes and build a theoretical model of how Rounds work. Findings can be used to inform the continued implementation of Rounds and facilitator training programmes. Directions for future research are suggested.