This study is about the exploration of the concept of community, using the Mamelodi Counselling Clinic as the context for the exploration. The members who got involved in different phases in the running of the clinic, went through the process of defining and redefining the concept. This process was based on their experiences and their coevolved reality of what the concept means. These experiences will be discussed and in the end, a punctuated end product of the coevolved meanings will given. Furthermore, an account will be given as to how the running of the clinic evolved with the changes in meaning. The author's perception of the division between clinical and community psychology was altered as a result of the findings in the study and this will also be discussed. / Psychology / M.A. (Clinical Psychology)

The area of mental health distress is one that crosses many disciplines including; psychiatry, critical psychiatry, psychology, critical psychology, history, politics, economics, philosophy, sociology, culture and human geographies (Thrift, 2006). Consequently, there are a complex set of issues to consider when discussing the experiences of being a mental health service user. Notwithstanding this diversity, such representations of mental health have a tendency to position service users as a fairly homogenous and static group of bodies – in other words, they are the stable ‘other’ (Conradson, 2005; Parr, 2000). As a way of exploring the complexity, this thesis sets out to explore the multiplex constituents and heterogeneous ways in which daily service user life is played out within everyday mental health spatial contexts. These spaces incorporate the psychiatric institution, the mental health day centre and the home. Using interviews, ethnography, poetry and visual ethnographies, service users’ experiences are analysed by exploring the relational aspects of the discursive and the non-discursive, such as receiving a diagnostic label and subsequent treatments and the ways in which these practices permeate the embodied and spatial experiences of every day service user life. This corpus of research data suggests that rather than the experiences of mental health distress operating as a stratified set of factors awaiting analysis, there were divergent accounts incorporating positivity, negativity and ambivalence in the ways which service users made meanings of their daily lives (Brown & Tucker, 2010). Consequently, this thesis is framed around the ontological realms of creativity, potentiality and of becoming within and through space (Deleuze & Guattari, 2004; Massumi, 2002). Finally, some implications of the current political changes and how these may impact upon daily service user life are discussed to highlight that mental health service users’ are always on the move.

A literature review examines how mental health difficulties may differ for people with learning disabilities (PwLD) and the general population; with respect to their vulnerability to mental ill-health and the definition, presentation and treatment of mental health problems. Factors which have been found to positively impact on the mental health of PwLD are then explored. The review considers methodological limitations and gaps in our understanding, highlighting a need for further research focusing on mental health recovery for individuals with learning disabilities. Section B presents a study exploring what recovery means for people with learning disabilities and mental health difficulties. Interviews were conducted with nine individuals and Interpretative Phenomenological Analysis used. A model was developed which described participants’ entry to the therapeutic service and their progression towards recovery. The model firstly describes how participants felt entering the service, their Mental Health/Therapy Experience, and explains how these experiences were validated and the recovery process enabled through the therapeutic alliance. Once enabled, the second dimension of the model is detailed, that of the Client Recovery Experience which extends across three phases of recovery. The first phase, Feeling Better describes elements perceived as integral to improved mental health. The second phase, Recovery Ongoing identifies that more input is required. Thirdly, Attainability?: Reality, Ideals and Fantasy, reveals PwLD’s perceptions of recovery and the techniques used in striving to achieve this. Salient features of recovery specific to PwLD are recognised as important to clinical practice, and results suggest there is a need to openly discuss LD identity, and address idealisations surrounding a non-LD one. This would involve setting realistic goals and managing expectations accordingly and focussing on social integration as a way of enabling ongoing recovery.

Criticism of NHS acute psychiatric care has been high within patient experience research, compounded by critical press coverage of inpatient wards. Government policy requires staff to deliver compassionate, personalised care, but there is little research considering staff’s perspectives and experiences of the work. This study aimed to construct a grounded theory of acute psychiatric staff’s experiences, with particular attention to what might facilitate or block compassionate patient care. Semi-structured interviews were conducted with ten ward staff (three men, seven women) across a range of disciplines. Data were analysed using constructivist grounded theory. The model constructed captures the dynamic interactions between eleven categories: Being in a chaotic environment, Feeling limited, Struggling to improve without support, Building patient relationships, Enjoying the work, Staying vigilant, Taking an emotional toll, Putting up a barrier, Supporting each other, Seeing tensions and differences, and Acting as one team. The study concluded that staff described feeling motivated to engage with patients but restricted by practical and emotional demands. While support was provided by colleagues and formal structures, staff could not always make full use of them. Suggestions for future research and clinical practice include changes to practical demands on staff, as well as attitudes towards reflective practice.

Stroke is a leading cause of disability in the UK and has a range of psychological sequelae including apathy, depression and fatigue. Psychological consequences of stroke have been associated with poor rehabilitation outcomes. Apathy, depression and fatigue are often considered to overlap and the research indicates that they may occur both independently and in unison after stroke. Sixty-three people aged over 55 years who had a stroke and lived in the community were included in this study. They were assessed using the Apathy Evaluation Scale, Geriatric Depression Scale, the Fatigue Severity Scale and the Barthel index. Socio-demographic data were also collected along with information about their stroke. 60.3% of participants reached cut-off levels for apathy, 58.6% for depression and 58.7% for fatigue. While there was an overlap in terms of these psychological disorders, they also occurred independently. Physical functioning was the only factor which was related to apathy, depression and fatigue. Apathy was a mediator in the relationship between physical functioning and depression; and depression was a mediator in the relationship between apathy and fatigue. Based on these findings, a significant structural equation model accounting for the relationships between apathy, fatigue, physical functioning and depression was developed. The study concluded that apathy, depression and fatigue are common post-stroke. The inter-relationships between these post-stroke sequelae are also related to the person’s physical functioning and not to age, side of weakness or time since stroke. Results have implications in terms of the clinical assessment and management of post-stroke psychological sequelae.

Research has shown interpersonal relationships to influence experiences of inpatient psychiatric services. This study explored staff and service-users’ talk about relating, and consequences of available/limited social actions. A Foucauldian discourse analysis was used to analyse transcripts from semi-structured interviews and focus groups with current inpatient staff members and service-users with prior experience of being a psychiatric inpatient. Two focus groups (service-users n=10; staff n=6) and five interviews (service-users n=2; staff n=3) were held, with participants responding to questions regarding the discursive object of ‘experiences of relating on inpatient wards’. A dominant ‘medical-technical-legal discourse’ was seen, with two counter-discourses of ‘ordinary humane relating’, and ‘person-centred’. A ‘civil rights’ discourse was drawn on by service-users in the tensions between discourses. The study concluded that the medical-technical-legal discourse perpetuates notions of mental illness as impenetrable to relating. Fearing of causing harm and staff positions of legal accountability generates mistrust, obstructing relating. Ordinary humane relating was vital for service-users in regaining a sense of self. Through ordinary humane relating, a therapeutic relationship could develop, as constructed through a person-centred discourse.

An increasing body of research has sought to determine the impact of Disorders of Sex Development (DSD) on the family of the affected child. Little is currently understood about the support needs of the family and how well these needs are met. With a focus on mothers as primary caregivers, Interpretive Phenomenological Analysis was used to analyse semi-structured interviews with eight mothers of children with DSD about their experiences of support. Four master themes emerged which encapsulated the stages in their child’s development when mothers most needed support, the importance of developing an understanding of the child’s condition, the lack of an acknowledgement of the emotional needs of the parent, and the importance of having close and trusted networks for support. Continuity and availability of support were considered important and while all participants prioritised maintaining privacy about the condition, a minority felt that this impacted on the level of support they received. Key periods of time for support were identified and while some felt that they were well supported others felt that their support did not meet their emotional needs. The results were discussed in light of previous research, and the clinical implications considered.

In recent years in the UK, services introduced personalisation, allowing mental health service users to be in charge of the budgets given to them by social care. Peer brokerage is based on advice regarding the best use of personal budgets. The aim of this study was to understand the experiences of mental health service users being trained and working as peer brokers, and any role of those experiences in their recovery and identity. Six peer brokers were interviewed and the data were analysed using Interpretative Phenomenological Analysis (IPA). Five main themes were identified in the interviews: changing and growing; rewarding and challenging aspects of the role; client-centred approach to peer brokerage; importance of peer-relationships; and the pioneering nature of the role. Participants emphasised that this is a new idea in mental health services requiring commitment and determination in facing obstacles. The study concluded that similarly to previous research on the experiences of peer workers, participants spoke of challenging and rewarding aspects, including learning and benefits from helping others. New themes highlighted by this study show the importance of support from other peers and a humanistic approach to helping others. More UK-based studies are needed to understand peer workers’ experiences and their partnership with services.

Literature suggests that individuals experiencing acute mental health difficulties can benefit from psychological input, with calls to increase psychological provision in inpatient mental health settings in the United Kingdom (UK). Despite this, there is limited research to support this demand, which may in part be due to inherent difficulties in conducting research in this setting. Using an interview design and narrative analysis, this paper explored staff members’ and service-users’ experiences of inpatient psychological interventions in National Health Service (NHS) inpatient mental health settings. Evidence was found to support the use of direct, indirect and strategic interventions for individuals, groups, families and staff teams. Formulation and the therapeutic relationship were conceptualised as common features of such input. Connections between inpatient psychology and change within the stories suggested that interventions can help people make sense of a crisis, improve relationships and contribute to meaningful recovery. Barriers were also presented, suggesting that psychological input in this setting might not be right for everybody. This paper demonstrates that psychological input in the acute inpatient mental health setting is perceived as meaningful and can lead to changes. There is also a sense that this provision can be challenging, highlighting the need for further research.

There is a complex interaction between familial functioning and veteran mental health, with familial relationships often being affected. Family therapy is not routinely recommended or offered for veterans in the UK. This study used a narrative approach to explore the experiences of veterans and spouses having received family therapy. Specifically, this study aimed to explore what stories individuals in an ex-military family would tell of their experience of family therapy, what narrative themes occurred and what the perceived impact on familial relationships was following family therapy. Individual narrative interviews were conducted with four veterans and five spouses. Individual interviews were followed by joint couple interviews with two couples. Main findings suggested that typically veterans would tell a ‘romance’ story while spouses were more likely to tell a ‘tragedy’ or ‘epic’ story. Narrative themes occurring from veterans, spouses and couples included: family therapy helpful, lack of support, changes in veteran, impact of difficulties on family relationships and military culture and transitioning. Finally the study found that family therapy had positively impacted familial relationships, particularly highlighting improvements in couple communication and shared or alternative perspectives to be important. Limitations, clinical implications and future directions are discussed.