Section A reviews the literature which has investigated variables found to relate to recovery style in individuals with psychosis. Studies exploring the attachment, self-esteem, depression and executive functioning are evaluated and conclusions drawn. Section B reports the findings of an empirical study investigating the relationship between metacognition, recovery style, anxiety and depression in a community sample of individuals with psychosis. Objective; Research has shown that individuals with psychosis will either integrate their experience of psychosis or seal the experience over. Little is known about what leads to these different styles of recovery but poor attachment, depression, low self-esteem and poor executive functioning have been linked to a sealing-over style. This study hypothesised that sealing is linked to unhealthy metacognitive beliefs and also to higher levels of anxiety and depression. Method; Forty-three participants with a diagnosis of psychosis were recruited. They completed the Metacognitions Questionnaire-30, Recovery Style Questionnaire and the Hospital Anxiety and Depression Scale. Results; Correlational analysis revealed that only one facet of metacognition linked to sealing over; this being positive beliefs about worry and this was maintained when the effects of anxiety and depression were accounted for. Contrary to the hypothesis, recovery style did not correlate with anxiety or depression but unhealthy metacognition was linked to both anxiety and depression. Conclusions; The findings of this study suggest that a sealing-over recovery style may be linked to one specific area of metacognitive dysfunction. They also cast doubt on previous theories which link low mood to a sealing-over style. Limitations of this study include its cross-sectional design. Future research which expands on these findings is encouraged and longitudinal research is particularly called for. Section C provides a critical evaluation of the project, answering four questions regarding what the author has learnt from the study, what might have been done differently, how the study might affect the author‟s clinical work in future and possible future research directions.

Section A reviews the literature related to compulsory admissions under the Mental Health Act (MHA) 1983/2007 of adults presenting with psychosis. It outlines the legal framework and examines empirical data relating to admissions under the MHA 1983/2007. A brief overview of psychosis, its aetiology and key psychosocial models are provided. Consideration of mental health within the legislative framework is offered and the experience of being compulsorily admitted is explored. Finally, further qualitative research is recommended. Section B: The study’s primary objective was to explore the experience and impact of compulsory admissions (under the MHA 1983/2007) on the psychological functioning of adults with psychosis. The study also aimed to develop a preliminary theoretical model. Design: The qualitative ‘Grounded Theory’ method (Glaser & Strauss, 1967) was chosen since it worked inductively from the data and enabled the development of a model. Method: Seventeen participants (eight service-users with psychosis, nine psychiatrists) involved in compulsory admissions were interviewed. Analysis and interviews were undertaken concurrently so initial findings could influence subsequent data collection. Results: Five higher-order categories and 47 categories were identified. These contributed to the development of the ‘A disturbing journey: To and from detention’ model of compulsory admissions. Conclusion: This small-scale qualitative study achieved its objectives, providing a preliminary model and understanding of the compulsory admission experience for adults with psychosis. Key service and clinical implications are discussed. Despite its limitations, the findings indicated scope for further investigation. Section C: addresses four key questions about the study. The first relates to skills the researcher learnt through conducting the study. The second relates to improvements that could be made if conducting the study again. The third relates to clinical implications, and the fourth to further research.

Section A reviews and synthesizes the extant literature on adherence to clinical guidelines, with specific reference to the use of CBT self-help interventions as a mainstay within the IAPT programme. The review also evaluates the utility of one psychological framework, namely the theory of planned behaviour (TPB), in assessing the cognitive factors that may be most associated with compliance in this context. The review ends by suggesting an avenue for future research. Section B In spite of evidence for their efficacy and effectiveness as well as the recommendations of NICE, CBT self-help materials are not used routinely or used as an intervention in their own right in mental health services. Aims: This cross-sectional study set out to assess whether the main constructs of the TPB, namely, attitudes, subjective norms (SN) and perceived behavioural control (PBC), as well as past use, self-help training and demographic characteristics, could predict IAPT psychological well-being practitioners’ (PWPs) intention to use CBT self-help materials in their clinical practice. Method: A convenience sample of PWPs (n=94) completed a web-based, mixed closed and open-response questionnaire, which was developed from an earlier elicitation study with a sub-sample of their colleagues. The data generated were analyzed by linear, multiple regression, mediation, and qualitative analyses. Results: The TPB’s main constructs predicted PWPs’ intention to use self-help materials in their clinical work, with attitude being most significant. Past use of self-help materials emerged as both a direct predictor of intention, as well as indirectly related to intention, independent of the mediating effects of the main constructs. The overall extended TPB model explained a respectable 70% of the variance in intention. However, neither self-help training nor demographic factors were associated with PWPs’ intention. Conclusion: It is recommended that future research could extend the methodology to prospective, longitudinal investigations of PWPs’ actual use of self-help materials. It is hoped that this would further elucidate the cognitive factors that are involved in PWPs’ decision-making when they are actually using the materials. Section C sets out and answers four specific questions that guide a reflective critical appraisal of the processes involved in the execution of this research project.

Section A consists of a critical review examining the research evidence relating to the effectiveness of reflective practice groups for staff in psychiatric inpatient settings, and the role of psychologically trained practitioners in providing facilitation using psychological formulations. Section B. The role of applied psychologists working in inpatient services is developing with a greater emphasis on providing support and consultation to staff teams. The research suggests that psychologically trained practitioners who facilitate reflective practice groups using psychological formulations can assist staff in developing a deeper understanding of patients’ difficulties, with the potential for improved treatment outcomes. This study aimed to address some of the gaps in the research by exploring the experiences of acute psychiatric inpatient ward staff attending reflective practice groups facilitated by psychologically trained practitioners. Using semi-structured interviews, nine multidisciplinary staff from four acute wards participated in the study. Grounded theory methodology was applied to investigate how staff experienced, processed, and operationalised psychological knowledge in their clinical practice. The results suggested staff increased their psychological understanding through a process of guided reflection, development of theory-practice links, and validation. This enhanced a capacity for mentalization, which generated a more compassionate and empathic stance. The clinical, theoretical and research implications are presented. Section C presents a critical appraisal of the research process.

Individuals experiencing a mental illness are often stigmatized. Children also stigmatize those who experience a mental illness. There is national interest in reducing the negative effects of stigma, especially in children. Unfortunately, children anti-stigma interventions are being used without being empirically tested for their effectiveness. A goal of the Opening Minds Anti-stigma initiative of the Mental Health Commission of Canada is to identify programs and resources that have been empirically tested and found to be effective in reducing stigma. This study was funded by the Opening Minds Initiative of the Mental Health Commission of Canada to: First, investigate the effectiveness of providing children ages 11-14 with mental illness education using a storybook in order to reduce their mental illness stigma; and, second, to examine children’s perceptions of the anti-stigma book used to provide the education. A quasi-experimental design was used to test the effectiveness of the mental illness educational storybook in reducing mental illness stigma. The Youth Opinion Survey for Stereotype and Social Distance measurement was used to obtain baseline information before the education was provided. A pre-test, post-test process was used. Several qualitative questions, embedded in the post-test questionnaire, were provided to the children participating with an opportunity to use their own words to describe what they thought about mental illness before and after the education, what they learned from the educational storybook and whether or not they liked the education they received. The results show that the exposure to an educational storybook about children mental illness stigma was effective in reducing the percentage of negative responses at post-test. The participants used less negative words to describe someone “with a mental illness”. An improvement in the overall scores at post-test was seen for both stereotype and social distance. After the study was completed, the feasibility of conducting a study of this type was evaluated. Recommendations for the possibility of using this method for future studies are included. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-07-03 11:39:54.603

Past literature has indicated that jury instructions are not written in ways that result in optimal juror comprehension, and can be improved through various ways of simplification. Prototypes of the insanity defense have also been found to influence juror decision-making. Additionally, individual factors such as attitudes toward and myth endorsement of the insanity defense can influence verdict. The following study explored these effects of jury instruction format, insanity defense consistency, and participant factors on jury understanding and decision-making. Three hundred and eighty jury eligible community members were recruited online for this study. Participants were first asked questions pertaining to attitudes and myths about the insanity defense. Afterwards, each participant read one of two vignettes (an insanity defense consistent case and an insanity defense inconsistent case), and then read one of three jury instructions (traditional, simplified, or flow-chart versions). The participants then reached individual verdicts and answered factual questions about the insanity defense and their perceptions on the defendant. Results indicated that simplified instructions increased participant knowledge over the traditional and flow-chart instructions, but did not influence verdict selection overall. Consistency, myth endorsement, attitudes, and perceptions of the defendant were also all found to contribute to the verdict. These results contribute to the current research on comprehension of jury instructions, especially in the context of an insanity defense case, and may provide additional information for attorneys to consider during the voir dire process.

The aim of this flexible, multi-method case-study (after Yin 1994, 2003), was to elicit the 'student perspective' on issues relating to mental well-being within the Higher Education Institution setting. It has been guided by the ideology of the health promotion model, the concept of salutogenesis and the Health Promoting University initiative. Phase One consisted of eleven focus group discussions involving fifty one self-selecting participant undergraduates and a semi-structured interview conducted with the lead medical practitioner of the Medical Centre on site. In Phase Two, a quota sample of 806 undergraduates completed a questionnaire. The three datasets were analysed according to a facilitative and complementary approach (Brannen 2004) and in keeping with assumptions of the paradigms from which they originated. The qualitative data were analysed within the framework provided by Miles and Huberman (1994) and the survey was analysed using the Statistical Package for Social Sciences (SPSS). The findings demonstrated that this multi-site university may have specific difficulties with regard to the provision of equal access to the support services. Reduced pastoral care could pose risks to the mental well-being of some students whereas the allocation of students to a personal tutor might increase levels of social capital and reduce symptoms of 'anomie'. Conclusions of the study suggest that HEIs need an understanding of the concerns of the students and their help-seeking behaviour in order to define 'health assets' and minimise 'health deficits'. Overall, the development of co-ordinated institutional support service provision - that is responsive to the needs of a diverse student body - facilitates and supports the creation of a salutogenic environment that both promotes and sustains mental well-being. Health education programmes need to address the persistence of stigma and discrimination. Attention should be focused on health protection measures so that all groups of students are treated equally and fairly in order to counter-balance a possible residual biomedical approach to health promotion from within the medical sector provision. As a case-study of one university, the findings may be theoretically generalisable to other similar multi-site HEIs in their mental health promotion provision.

Existing research and anecdotal accounts have consistently reported that Jewish people are positively inclined to seek treatment for mental health problems, including making use of psychiatric services and psychotherapy. However, much of this data has been based on samples of American Jewry and there appear to be no existing studies in the UK which have quantitatively investigated whether there are similar help seeking preferences for mental health problems amongst British Jewry. The present study investigated Jewish people’s attitudes and intentions to seek professional help for mental health problems and their experiences of seeking professional help in the UK. Using the theoretical framework of the Theory of Reasoned Action (Fishbein and Ajzen, 1975; Ajzen & Fishbein, 1980) the study also aimed to determine the strongest predictors of intentions and attempts to seek professional help, according to people’s attitudes, perceived social pressure, beliefs about the causes of mental illness and level of religiosity. The study included 126 Jewish people who were predominantly recruited from synagogues and community centres across the UK. Results indicated that a high percentage of this sample would be willing to see a mental health professional if they experienced a mental health problem. According to multiple regression analysis, attitudes towards seeking professional help and stress-related causal beliefs most strongly predicted intention to seek professional help. Despite the sample being non-clinically recruited, 63% of participants reported that they had experienced a mental health problem and the majority of these individuals had sought professional help in the past. Path analysis revealed that actual attempts to seek professional help were directly influenced by intention to seek professional help, perceived social pressure and supernatural causal beliefs. Given the high prevalence of mental health problems and use of professional mental health services amongst this sample, clinical considerations highlighted the need for preventative mental health strategies and culturally sensitive mental health services for Jewish people. Limitations of the study include the use of an opportunity sample which was unable to recruit members of the Ultra-Orthodox Jewish community.

Bakgrund: Många patienter med psykisk sjukdom har en livsstil som genererar livsstilssjukdomar på grund av brister i egenvården. Detta genererar lidande och samhällskostnader men är något som kan förhindras. Sjuksköterskan har möjlighet att i en holistisk anda förbättra för patienten med hjälp av interventioner. Syfte: Syftet är att beskriva vilka hinder och möjligheter som påverkar patienter med allvarlig psykisk sjukdom till livsstilsförändringar. Metod: Detta är en litteraturstudie där författarna har sökt och granskat vetenskapliga artiklar i olika databaser. I materialet hittades olika teman som har sammanfattats i resultatet. Resultat: De stora hindrena för att förändra sin livsföring är den psykiatriska sjukdomen och den medicinering den kräver. Sjukdomen innebär ofta sociala problem, lågt självförtroende och ångest. Medicinering ger sedering och viktökning. Generellt upplevs gruppaktiviteter som positivt då det ger struktur åt aktiviteter och socialt stöd från andra patienter. Uppmuntran från andra patienter och från personalen är viktig, vars attityd kan vara avgörande. Genom interventioner går det att förändra parametrar som vikt, motionsgrad och kunskap om livsstils hos patienterna. Konklusion: Med ett holistiskt förhållningssätt där patientens alla livsdelar ses som viktiga går det förändra livsstilen för patienter med psykisk sjukdom så att den blir mer hälsosam. Förändringar kräver att hänsyn tas till sjukdomen och medicinering samt att patienten får mycket stöd i en intervention som är individanpassad, men gärna i grupp. / Background: Patients with severe mental illness often experience physical illness as a result of poor lifestyle choices and lack of self care acts. This generates suffering and costs for society. But it is preventable; nurses can work to improve the health of her patient by motivating the patient to participate in health intervention. Aim: To describe obstacles and potentials that affects patients with severe mental illness in health promoting lifestyle changes. Method: Literature review Result: The big obstacles in changing lifestyle are the psychiatric illness and the medication that it involves. Mental illness is often generating in social problems like anxiety and low self esteem. Medication results in weight gain. Group activities are generally viewed as positive and gives structure to daily life and social support. The interventions result in health gains considering weight, activity, knowledge and eating habits. Conclusion: With a holistic view, nurses can help changing the lifestyle of patients with severe mental illness. Group interventions are to be preferred. Interventions must be implemented in line with the illness cycles and the medication.

Bakgrund: Barn som lever med en förälder som har psykisk ohälsa glöms ofta bort av både familj och vårdpersonal bakom förälderns ohälsa. Detta kan utgöra en konsekvens för isoleraring och ensamhet. Samtidigt löper dessa barn en stor risk för att själva drabbas av negativa konsekvenser. Syfte: Beskriva barns upplevelser av att leva med en förälder med psykisk ohälsa. Metod: Syftet besvarades genom en allmän litteraturstudie baserat på 11 vetenskapliga artiklar med kvalitativ ansats. Resultat: Resultatet tematiserades under fyra huvudteman med subteman därtill. Huvudteman som framkom var I skuggan av psykisk ohälsa, Ett stort ansvar för ett litet barn, Den känslostyrda vardagen samt Bristande kommunikation. Slutsats: Av studiens resultat framkommer det att den psykiska ohälsan hos föräldern påverkar barnen på flertal olika sätt både i ung och vuxen ålder. För att hälso- och sjukvårdspersonal ska kunna ge stöd och uppmärksamma dessa barn finns ett behov av adekvat utbildning. Klinisk betydelse: Resultatet kan genom en ökad kunskap om barns upplevelse av att leva med en förälder med psykisk ohälsa bidra till en bättre förståelse för sjuksköterskor och därmed involvera barnen i vården. Den bristfälliga kunskapen som visas kan bidra till att relevant utbildning ges för hälso-och sjukvårdspersonal för en förbättrad kommunikationsstrategi. / Background: Children who are living with a parent who have mental illness are often forgotten behind the parent's illness by family and professionals. That can be a consequence for isolation and loneliness. These children are also are at great risk to also suffer from negative consequences. Aim: To describe the children's experiences of living with a parent with a mental illness. Method: The aim was answered by a general literature study based in 11 scientific articles with qualitative approach. Result: The result thematized four main themes with corresponding subthemes. The main themes that emerged were In the shadow of mental illness, A huge responsibility for a little child, The controlled emotional living and also Lack of communication. Conclusion: From the study’s result is revealed that the parental mental illness affect the child in multiple ways both at young and adult age. The need of education is important so the healthcare can give support and recognize these children. Clinical significance: The result can contribute an increased knowledge about children’s experiences of living with a mentally ill parent and add a better understanding in healthcare that will also involve the children. The lack of knowledge that is exposed today can contribute to relevant educations for nurses to an improved communication strategy.