Over the period of the last century in the United Kingdom mental health nursing roles have evolved and adapted in response to changes in mental health related policy and associated changes in the ethos, structure and delivery of mental health services. The conceptual framework informing this thesis drew upon the theoretical perspective of symbolic interactionism underpinning a qualitative, grounded theory approach augmented with the use of situational analysis to explore the processes involved in the development and maintenance of professional role congruity. 'Role congruity' is defined as a functional balance between aspects of role adequacy, role legitimacy and role support. Nine student and ten registered mental health nurses were depth interviewed between 2012 and 2016. Analysis of data was conducted using grounded theory data analysis approaches, with the research context incorporated into analysis using the mapping processes of situational analysis. This analysis yielded the formulation of a grounded theory model entitled 'Establishing Role Congruity', capturing the processes involved in developing and maintaining professional role congruity for this group of mental health nurses. Situational analysis enriched this model by contextualising the captured processes within 'social worlds' and discourses evident within the mental health practice arena. On the basis of this analysis, a conceptual model of 'Role Congruity Alignment' is proposed together with recommendations for contemporary and future mental health nursing roles with regard to the balance between 'generic/eclectic' functions and roles specialising in terms of service user groups and/or therapeutic interventions. Attendant implications for the initial education and subsequent continuing professional development of mental health nurses are summarised.

Objectives: To evaluate the effectiveness of art psychotherapy with adult offenders who have intellectual and developmental disabilities within an inpatient setting. The research looked at significant events taking place within the treatment that supported therapeutic outcomes. The aims of the research were to investigate a range of explanations for measurable therapeutic change that could be plausibly related to the processes observed in therapy. Design: Four single-case studies were conducted with pre-treatment, treatment, and post treatment assessment using multiple measures of change and observations of process. Participants: Four male participants with mild intellectual and developmental disabilities from an NHS medium-low secure forensic hospital in the UK. Intervention: Each participant completed up to 20 individual art psychotherapy sessions within six months. The treatment sought to engage each participant in making personally generated art work which was then discussed with the therapist. Main outcome measures: Core Conflictual Relationship Theme (CCRT); Daily Self-Rating Scale for specific symptoms; Personal Problem Scale; Modified Overt Aggression Scale (MOAS); Brief Symptom Inventory 18 (BSI-18); Glasgow Anxiety Scale for adults with Intellectual Disabilities (GAS-ID); Glasgow Depression Scale for people with a Learning Disability (GDS-LD); Rosenberg Self-Esteem Scale (RSES). Results: The main outcomes show a post-treatment reduction in aggressive styles of interacting with others for two participants in a medium secure unit. Daily Self-Rating Scale measures show an improved post-therapy trend for three participants, with all participants reporting improvement on the Personal Problem Scale and positive changes in CCRT interpersonal schemas. Behavioural and relational outcomes were observed to promote pro-social responses towards others three months following the end of treatment. Art psychotherapy was found to have positive therapeutic benefits for each of the four participants.