Research suggests elite athletes have an equal, possibly higher, probability of developing mental ill-health as the general population. However understanding of these issues amongst athletes and coaches remains largely unknown. The perceptions of 20 elite athletes and 16 elite coaches of mental ill-health amongst elite athletes were explored. Two concurrent, three round Delphi methods, using descriptive statistics and thematic analysis, were used to compare groups’ responses. Athletes and coaches expressed different opinions and experiences of mental ill-health amongst elite athletes. However, both felt the pressure athletes place upon themselves is a significant contributing factor and that obsessive compulsive disorder (OCD) and anxiety may be particularly prevalent. Whilst associated stigma was thought to be a barrier to support seeking, both groups felt sport and clinical psychologists would provide the most appropriate support, with coaches playing an important role. Implications for coaches, clinical and sport psychologists are explored and suggestions for future research are presented.

Voice hearing has a diverse history but is currently understood as symptomatic of a disease within psychiatric frameworks. Alternatives to 'treatment' include peer-support 'Hearing Voices Network groups' (HVNGs) which have grown in popularity and exist alongside treatment-based hearing voices groups. Few studies have investigated processes underlying change in HVNGs. Established research into therapeutic factors and personal recovery may provide frameworks elucidating change processes. This study aimed to investigate how HVNG attendees experienced change within the group and how this change influenced their lives. A qualitative design was employed using interpretative phenomenological analysis (IPA) to elucidate group processes through immersion in the perspectives of group attendees. Semi-structured interviews were conducted with eight individuals who were purposively sampled from two HVNGs. Interviews lasted from 34 to 54 minutes, were recorded on a Dictaphone and later transcribed verbatim. Four superordinate themes emerged: 'healing', connecting with humanity; group as an emotional container; making sense of the voices and me; and freedom to be myself and grow. The study concluded that relationships, safety, exploration of voices and group ownership are key components of HVNG and fit into frameworks of therapeutic factors and recovery processes. Development of HVNGs should take these processes into account. Future studies should further elucidate processes.

Young people within the youth justice system experience three times higher rates of mental health problems than the general youth population yet are one of the least likely groups to seek help. Very little theory or research is available within this population to explain these high rates of unmet need. This study aimed to develop a theory about the barriers and facilitators that Youth Offending Team workers experience when supporting young people to access mental health services. Eleven semi-structured interviews were conducted with participants; eight youth offending team workers, two young people and a mental health worker. Interviews were audio-recorded and transcribed verbatim before being analysed using “grounded theory”. This method was chosen to allow the in depth exploration of participants experiences and the development of theory within an under researched area. The results showed that Youth Offending Team workers appeared to play a crucial role in supporting a young person’s help seeking from mental health services. A preliminary model was developed which demonstrated the complex relationships between six identified factors which influenced this role. The study concluded that Youth Offending Team workers would benefit from more support, training and recognition of the key role they play in supporting young people to become ready for a referral to mental health services. Mental health services could be well placed to provide this. Clinical implications are discussed. Further research is needed to develop our understanding of what influenced the help seeking of this vulnerable population.

Culture can often influence how psychological distress is experienced and where help is sought. South Asians are the largest ethnic minority group in the United Kingdom (UK). This paper aimed to explore how second-generation South Asian adolescents make sense of their experiences of psychological distress and the meanings attributed to help-seeking. Semi-structured interviews were carried out with nine second-generation adolescents aged 13-19 years. Interpretative Phenomenological Analysis was employed. Five superordinate themes emerged from the analysis: feeling distressed, negative impact of family and cultural ideals on the self, connectedness to others, perception of help-seeking outside the family and intergenerational differences in help-seeking. The results indicated that help is sought from families when participants perceive they are able to relate to the source of distress. However, when there is a lack of understanding of distress, participants sought this from external sources of help. Professional help-seeking appeared influenced by the interplay between not meeting family ideals, intergenerational differences in understanding of distress and the stigma of seeking help. Clinical and research implications are discussed.

Section A: Critically reviews the literature pertinent to how services are helpful for people diagnosed with borderline personality disorder (BPD). This includes service-user research and evidence based on clinicians' experiences. Relevant theories are discussed and the gap in the current evidence base is provided. Section B: Most research evidence relating to BPD focuses on how specialist psychological models are helpful rather than how mental healthcare services relate helpfully to people with this diagnosis. This study explored this further using grounded theory methodology. Semi-structured interviews were conducted with eight mental healthcare clinicians and eight service-user participants diagnosed with BPD. The results suggested that the most helpful services are those that can form a secure, safe and consistent attachment to individuals with BPD. These services should be accepting and validating where responsibility is shared. Least helpful are those with disorganised attachment styles where themes around dependency, invalidation, and rejection are suggested. Further research would be beneficial to ascertain if these findings are supported by other specialist mental healthcare teams with a more diverse population. Section C: Critically appraises the research project and provides reflections about the research process and how the researcher felt when conducting this research project.

The work comprises of three sections, Section A: Literature review This section reviews men's underutilisation of professional health care services and brings together the extant literature on men's help seeking for psychological difficulties. This is discussed specifically in relation to theories of male gender role socialisation and male development. Section B: Empirical Paper. Introduction: Men’s reluctance to access health care services has been under researched even though it has been identified as a potentially important predictor of poorer health outcomes among men. Male gender role socialisation and male development may be important in accounting for men’s underutilisation of mental health service in the UK. Method: A cross-sectional online survey was used to administer standardised self-report measures that were subject to regression analysis. Five hundred and eighty-one men from the UK general population completed the survey and 434 participants formed the final regression model sample. Results: Men who score higher on measures of traditional masculine ideology, normative alexithymia and fear of intimacy reported more negative attitudes towards seeking professional psychological help. Normative alexithymia accounted for the variance in help seeking previously observed by fear of intimacy during regression modelling. Sexuality and ethnicity also significantly accounted for a proportion of unique variance in men’s help seeking attitudes. People who had received previous support from a mental health professional showed more positive attitudes towards seeking psychological help. Conclusions: Men’s attitudes towards seeking psychological help were closely related to traditional masculine ideology and normative alexithymia. A degree of content or construct overlap may exist between normative alexithymia and fear of intimacy in men. Limitations of this study and implications for future research are discussed. Section C: Critical Review. This section provides critical appraisal and reflection on the study and research process. Personal learning is discussed alongside clinical implications and ideas for further research.

Section A provides a conceptual critical review of the literature pertinent to the consideration of Mothers living with HIV/AIDS (MLWHA), with a particular focus on African mothers. This review first highlights relevant contextual factors, including discussing prevalence rates and the current reconceptualisations of HIV. This is followed by theories and research relevant to MLWHA, whilst considering wider contextual, social and cultural factors. Thirdly, the theoretical links of the reviewed literature to coping models and strategies are made, and specific cultural factors considered. Finally, suggestions for future research are highlighted. Section B provides the findings of a qualitative investigation conducted to explore the experience of African women living in the UK after being diagnosed with HIV during their pregnancy. Twelve participants completed a short demographic questionnaire, and participated in a one-to-one semi-structured interview. The interview was designed to address multiple personal, interpersonal, and systemic issues related to their HIV status, and HIV in the context of motherhood. Data were analysed using interpretative phenomenological analysis (IPA). Themes which emerged included: HIV being part of one’s wider tapestry, community and systemic influences and responses to HIV, experiencing a different story of HIV, and the mother-child relationship. Strikingly, the aspect of HIV that these women reported finding most distressing was their inability to breastfeed, which seemed central to their cultural identity as mothers. While the generalisability of these findings is clearly limited, nevertheless it seems important for clinicians to (i) recognise that HIV may not always be the primary difficulty facing their clients, and may be amongst numerous other factors, (ii) consider systemic and contextual factors, including cultural influences and past trauma, (iii) focus on client resources and capacity for resilience, and (iv) support clients to access local resources, including support groups, (v) attend to issues around confidentiality, disclosure decisions and breastfeeding, and (vi) hold in mind the potentially powerful and helpful affect for these women of witnessing different narratives around HIV. The continuing need to counteract stigma and discrimination, including from health professionals and from the media, was also apparent. Section C provides a critical appraisal and reflection on the research process, including, evaluating what research skills were learned, which research skills the researcher wishes to develop in the future, what would the researcher have done differently given the chance, how will the research shape or inform the researcher’s clinical practice, and what future research related to the studied area would the researcher consider carrying out.

Section A: A literature review was conducted to identify the negative and positive impact that working with adult trauma clients has on therapists. Key theoretical concepts and possible causal mechanisms are summarised and the research evidence supporting these concepts is reviewed. The key limitations to the extant literature and future research are discussed. Section B: Background: Therapists who work with trauma clients are impacted by this work both positively and negatively. However, most studies have tended to focus on the negative impact of the work, the quantitative evidence has been inconsistent, and the research has primarily been conducted outside the UK. Method: An online questionnaire was developed which used a standardised measure to assess compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in 253 UK therapists working with adult trauma clients. Results: Whilst the majority of therapists scored within the average range for CS and burnout, 70% of scores indicated that they were at high risk of STS. Maturity, time spent engaging in R&D activities, and a higher perceived supportiveness of management and supervision predicted higher potential for CS. Youth and a lower perceived supportiveness of management predicted higher risk of burnout. Higher risk of STS was predicted in therapists engaging in more individual supervision and self-care activities, as well as those who had a personal trauma history. Discussion: These results are discussed in light of previous research. Of particular note is that exposure to trauma stories did not significantly predict STS scores as suggested by STS theory. Contextual and methodological limitations and ideas for future research are highlighted. Section C: A critical appraisal of the research process is summarised which answers the four set questions. A final personal reflection is also given.

Section A presents a literature review of the issues and challenges facing fathers in the postnatal period, in the context of an historical marginalisation of fathers in the study of child development. The review leads to a specific focus on the limited research evidencing the increased risk fathers face to their mental health, when coping with a partner's admission to a Mother and Baby Unit (MBU). Section B Fathers' experience of the joint admission of a partner and child to an MBU has been the subject of limited research, despite initial findings suggesting fathers are at increased risk of postnatal paternal mental health difficulties. This qualitative study aimed to explore the lived experience of fathers in this context, to inform the validity of future research in the area. Interpretative phenomenological analysis was carried out following semi-structured interviews with six fathers in south east England. Five master themes showed that these fathers experienced the onset of their partners' postnatal mental health difficulties as unexpected and traumatic. Fathers needed to acknowledge limits in their ability to help, and the necessity of calling on specialist services. During admission, fathers felt pulled physically and emotionally between managing their own needs, and the needs of their partner and new baby. Themes showing the MBU admission challenged their fathering role and identity were contrasted with the importance fathers placed in treatment needing to be a 'family affair', inclusive and supportive of the father, and mindful of the impacts on the couple relationship. The impact of culture on fathers' adjustment to involvement at the MBU was noteworthy. In conclusion, this research helps understand the importance of including the father where appropriate in a mother's recovery programme, and helping the father define a role alongside the clinical team. The findings of the study validate the efforts of government policy to build effective family focused perinatal services. Section C sets out the journey taken from the ethnographic inception of the research idea, through dilemmas encountered in carrying out the study, to reflections on what was learnt during the process.

Section A provides an overview of the impact of parental mental health difficulties on the person’s family. The current health policies and clinical guidelines in relation to family-inclusive care are discussed, along with research exploring service users’ families' views and experiences of adult mental health services. Studies investigating mental health professionals’ family-inclusive care practices are critically reviewed, followed by a consideration of how psychological theories conceptualise parenthood. The paper concludes by identifying areas for future research in this field. Section B is an empirical paper. Background. Potential negative outcomes for children who grow up with a parent suffering from mental illness are well-documented, including attachment difficulties and later mental health problems. However, research to date has not investigated how therapists conceptualise their clients’ parenthood, with the aim to protect the future mental health of the clients’ children. Aims. To explore how parenthood is considered in therapies provided by psychologists in adult mental health services. Method. In-depth interviews were carried out with psychologists working in adult mental health services in the UK. Thirteen psychologists were interviewed, and the data were analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: drivers, therapist factors, psychological theorising, client variables, and risks. The inter-relations between these categories are complex, and the degree of psychologists’ consideration of their clients’ parenthood is based on the nature of such overlaps. Conclusions. Psychologists are skilled at formulating the role of their clients’ parenthood, but do not necessarily address and support this role directly. The reasons for this are multifaceted, but any lasting change in practice is likely to require changes in services’ infrastructures and policies that support family-inclusive practices. Section C provides a critical reflection of the research project by addressing four pre-determined broad questions: the development of my own research skills in the course of the project, how the project could have been improved, how conducting this research has impacted on my own clinical work with clients, and areas for future research.