This work describes the impact of personalisation on users and professional workers identities in four mental health care settings. The development and context of personalisation is identified and set within an emergent narrative of consumer choice and austerity. International personalisation research is compared and a discussion of UK mental health literature is presented. The social constructions of key participants are analysed through their narrative accounts as they undertook identity work while being involved with individual budget pilots, either as users, carers, brokers or mental health professionals. The work employs Stake’s collective case study as the method of combining semi-structured interview data taken from participants in four personalisation studies designed and led by this author between 2008-2011. Narrative social constructionist methods, positioning theory and story-line are used in the analysis to produce a framework of participants’ orientation to personalisation. The importance of nuance as opposed to binary construction towards personalisation is highlighted, as are the positioning actions of independent brokers for the success of personalisation. The importance of co-production and challenging professional asymmetry in health and social mental health care services is clearly made as are the implications for practice. The value of the proposed framework and possible future research are discussed.

This study examines people’s experiences of being a patient on an acute psychiatric inpatient ward in Scotland. Within the existing research base few studies focus on the patient’s experience of acute psychiatric inpatient care, and none of these is set in Scotland. Those that do, indicate that the patient experience of acute psychiatric inpatient care is often negative. The theoretical perspective of this study conceptualises experience as represented in narrative form, thus the data take the form of narratives. Thirteen participants were recruited through the acute ward. Each participant participated in two unstructured interviews focussed on gathering narratives of their experience. Data analysis was holistic, guided by Gee’s (1991) socio-linguistic theories. This holistic analysis culminated in the presentation of each participant’s narrative in poetic form. From the holistic analysis I identified three themes - help, safety and power - that were evident in the analyses of all participants’ interviews. The theme of help represents participants’ expectations that they will receive help on the ward, and their experiences of trying to get this help. Safety represents participants’ expectations pertaining to the ward’s function in keeping them safe, their experience of threat and strategies to keep safe. The theme of power represents participants’ experiences of power relations within the acute ward. I conclude that participants’ experiences of being a patient on the ward are characterised by feelings of frustration, concerns about safety, and the perceived need to focus on self-presentation as they attempt to reach their desired goal of discharge.

Background: Whilst the experience of chronic physical conditions is well documented and has been recognised as relevant for health policy and practice little is known about notions of recovery and prognosis from the point of view of those with long-term physical health conditions. The extent to which people consider the future outcomes of their conditions is relevant to health policy which seeks to engage people in shared decision making, care plans, and self-management. This gap in knowledge about lay perceptions of recovery and prognosis becomes more pronounced when compared with literature from the mental health field in which recovery is one of the dominant foci, is comparatively well researched and in recent years has fed into policy and management approaches.Aims: The aim of the thesis is to explore perceptions of recovery and prognosis with people with long-term physical health conditions and to compare these with perspectives on recovery and prognosis apparent in the mental health field.Methodology: Using qualitative methods, a two phased approach to data collection and analysis was undertaken. Phase 1 used secondary data analysis with two existing datasets to examine whether notions of recovery and prognosis were implicit in narratives about the experience of illness. Phase 2 built on the findings from phase 1 and utilised longitudinal, primary data collection in the form of narrative interviews undertaken at two time points (baseline and 12 month follow-up). The analysis in both phases involved a cross case thematic analysis to look for commonalities and differences across individuals. Data from phase 2 were also subject to a narrative emplotment of individual stories which were used to capture the longitudinal changes in patient perspectives over time.Results: There were similarities with findings from the mental health field (recovery as a complex, nonlinear journey, the input from friends and family, notions of burden and the impact of condition on sense of self). However, there were nuanced differences in relation to physical health conditions which related to expectations about mortality, the experience of time, the extent to which narratives were future oriented and the experience of stigma. The dual focus on mental and physical health recovery proved useful for understanding those experiences of multiple morbidities. The results were used to develop a model of recovery narratives based on two dimensions (expectations and responsibility) which gave rise to four typologies of narratives. The aim of this model was to further highlight and summarise the themes arising from the data analysis.Discussion: The results of this study highlight the importance of understanding notions of recovery and prognosis in order to better understand the experience of illness and self-management. The thesis challenges the blanket use of health promotion strategies for those with and without chronic health conditions and supports a shift in policy focus from improved choice and autonomy to what Mol (2009) refers to as ‘enhanced care’.

Background: The recent uprisings in Syria have displaced many individuals within and outside the country. Despite the large number of people affected by the war, little research captures their experiences. The literature in this area is predominantly of a statistical nature. This is problematic in the field of Counselling Psychology, which moves away from diagnosis to focus on individual experiences. Aim: The aim of this study is to understand the subjective experiences of Syrian refugees in the UK, particularly the strategies that have aided them in coping with these experiences. Research has indicated therapeutic benefits for the communication of coping strategies. Methodology: The research utilised a qualitative methodology, adapting principles of Narrative Inquiry. A total of three males participated in the research. Each participant was asked one opening question prior to beginning his story. Prompting questions were developed according to the content of each narrative. Each interview was transcribed and analysed in Arabic, which was the language spoken in the interviews. An inductive thematic analysis was utilised to analyse each transcript independently. Analysis: Each participant's story was presented separately, as the themes from each narrative differed from the rest. Essam's narrative was identified as consisting of five principal themes; 'Situation in Syria', 'Searching for a Better Place to Settle', 'Journey from Jordan to the United Kingdom', 'Support and Coping Strategies' and 'Feelings'. Mustafa's transcript was analysed as containing four principal themes; 'Experiences of the War While in Syria', 'Support and Coping Strategies', 'Impact of the War on Health' and 'Coming to the United Kingdom'. Talal's interview was analysed as covering six principal themes; 'Political Opinion', 'Experience of Being in the Army', 'Working to Help and Guide Others', 'Escaping from Syria', 'Life in the United Kingdom' and 'Support and Coping Strategies'. Conclusion: This research generates further understanding of the subjective experiences of Syrian refugees residing in the United Kingdom, which can inform future psychological interventions with this population. The participants' descriptions of various coping strategies that helped them with their experiences may help guide practitioners to understand potential barriers to treatment. Furthermore, cultural differences were identified which could also aid in understanding why Syrians may not attempt to access psychological support. Recommendations are suggested for working psychologically with Syrian refugees, alongside acknowledging limitations of the research and suggestions for further investigation and practice.

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