Studies have shown that a mother’s history of child maltreatment is associated with her child’s experience of internalising and externalising difficulties. This study aimed to characterise the mediating pathways that may underpin this association. Data on a mother’s history of child maltreatment, depression during pregnancy, depression after birth, maladaptive parenting practices and her child’s experience of maltreatment and preadolescent internalising and externalising difficulties were analysed in a sample of 9,397 mother-child dyads followed prospectively from pregnancy to child age 13. The results showed that maternal history of child maltreatment was significantly associated with child internalising and externalising difficulties in preadolescence. Maternal antenatal depression, post-birth depression, maladaptive parenting and child maltreatment were observed to significantly mediate this association. The study concluded that psychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and improving parenting skills, could be offered to mothers with traumatic childhood experiences to help protect against psychopathology in the next generation.

Despite a growing literature base related to both compassionate care and work-related stress in healthcare settings, there is a lack of empirical studies investigating the relationship between these concepts, particularly in medium secure settings. This mixed methods study explored the relationship between compassion (The Compassion Scale) and work-related stress (The HSE Management Standards Toolkit) from the self-report of 51 members of staff in a medium secure setting, including semi-structured interviews with 12 participants. On the quantitative measures, the relationship between self-reported compassion and work-related stress on the quantitative measures was found to be statistically non-significant. However, elements of compassion were found to significantly predict subscales of work-related stress such that high levels of elements of compassion were found to predict higher levels of subscales of work-related stress. Participants constructed several meanings of compassion and its role in the care of the patients they worked with. Several consequences of occupational demands were cited including an increase in work-related stress and less time to build therapeutic relationships or to develop compassion towards patients. The findings of this study can be used to inform the development of staff interventions. Increased consistency of staff groups, increased debriefing opportunities and a review of paperwork responsibilities within staff teams have also been recommended.

The study aimed to examine the relationship between wellbeing, burden, distress and third-wave factors, including self-compassion and psychological flexibility, in caregivers of people with psychosis. The study secondly aimed to trial a new brief group intervention, combining Acceptance and Commitment Therapy (ACT) and Compassion-focused Therapy (CFT) for this population. Twenty-nine participants were assessed at baseline on primary measures of wellbeing, distress, psychological flexibility and self-compassion. Secondary factors including burden and mindfulness were also collected. Correlation analyses were used. Fourteen participants completed the group in intervention and follow-up measures, and pre-post investigations were employed. Lower levels of psychological flexibility and self-compassion were related to lower levels of wellbeing and higher levels of burden and distress. There was a potential mediating effect of psychological flexibility on the relationship between self-compassion and wellbeing. The group intervention was acceptable to caregivers, and there were significant positive changes in self-compassion, distress, burden and mindfulness. The study adds to the existing data regarding wellbeing and burden in caregivers of people with psychosis. This study provides new insights into the factors of self-compassion and psychological flexibility within this population. The ACT with Compassion intervention is a promising, brief intervention which would benefit from further application and evaluation.

Little evidence exists in the literature for how to manage clients who self-harm within low, medium and high secure forensic wards, despite the identified high rates of self-harm within these services. This study sought to investigate the management practices used with clients who self-harm in low, medium and high secure forensic wards, how helpful staff consider these practices and what understanding staff have of the reasons for which clients self-harm. A Delphi survey methodology was employed across three rounds using a multidisciplinary cohort of forensic ward staff, across low, medium and high wards. Physical management strategies were reported as most frequently employed to manage self-harm. Relational approaches to managing self-harm showed the highest rate of consensus for their helpfulness in practice. Consensus was reached across numerous domains explaining reasons for self-harm, including as a ‘communication of distressing feelings’. Statements indicating a negative view of self-harm such as ‘to manipulate staff and gain attention’ received consensus of disagreement. Psychological models and approaches used by clinical and forensic psychologists in the cohort were identified, and helpful elements of these models were identified, including ‘positive focus of approach’ and ‘emphasis on relational working’.

Contrary to the long-held assumptions, borderline personality disorder (BPD) is now considered a treatable disorder. Timely assessment has been recognised as one of the key treatment enablers and basic assessment standards have been stipulated by the UK’s National Institute for Health and Clinical Excellence (NICE). The current study was the first to have specifically investigated the quality of the diagnostic process in light of the government recommendations. Interpretative phenomenological analysis was used to analyse semi-structured interviews with eight adult female service users about their lived experiences with the original diagnostic disclosure of BPD. Five master themes and several subthemes featured in the majority of the participants’ experience: a) answer with a question mark; b) if only…; c) BPD like a star sign; d) star signs are not enough; it’s what happens afterwards!; e) being at the mercy of the system. Most participants’ experiences suggested that the original diagnostic process was largely negative and did not follow the national guidelines. Nevertheless, a minority of positive views also emerged. The findings are discussed with reference to the existing literature, whilst also detailing the study’s limitations, clinical and research implications.

An emerging body of evidence indicates that museum object handling sessions offer short term benefits to people in health care settings. The aim of this study was to further understanding of the psychological and social aspects of a museum object handling group held in an older adult mental health setting. Older adults (N = 42) from a psychiatric inpatient ward with a diagnosis of depression or anxiety took part in one or more of a series of nine museum object handling group sessions. Audio recordings of the sessions were subjected to a thematic analysis. Five main themes were identified: “responding to object focused questions”, “learning about objects and from each other”, “enjoyment, enrichment through touch and privilege”, “memories, personal associations and identity” and “imagination and storytelling”. The first four themes were congruent with existing literature associated with positive wellbeing and engagement outcomes. Imagination and storytelling was a new finding in the group context. This study offers preliminary support for museum object handling group sessions as an intervention in this healthcare setting. There may be potential to develop the therapeutic aspects of the sessions. Further research is recommended and areas for enquiry discussed.

There is a consistent research base that shows that class and inequality is associated with poorer mental health and experiences of distress. Various explanations for this link have been proposed, including psychological, social, structural, material and political factors. Experiences of powerlessness and oppression have also been implicated. Nevertheless psychology focuses predominately on explanations and interventions at the individual level. To explore this incongruence, a Foucauldian Discourse Analysis was completed of texts produced by Improving Access to Psychological Therapies (IAPT), related to the development and practice within IAPT and supervision sessions of high-intensity therapists practicing in IAPT. The emerging discourses are discussed.

Identity can be considered to be socially constructed and developed through narratives about ourselves and our experiences. Having socially valued roles may thus facilitate a positive identity. This study aimed to explore how the experiences of service user involvement (SUI) in health and social care services (specifically, being involved in staff recruitment) influenced the narrative identities of people with learning disabilities. Interviews were conducted with seven people with learning disabilities who had been service user representatives on NHS interview panels. These were analysed using thematic narrative analysis as a framework. All described positive narrative identities, but the degree to which SUI featured in the construction of narrative identities varied. Whilst some found the experience transformative, for others it was not an important part of their narratives. The findings suggest that such experiences formed just one of many narratives that participants drew from to construct their narrative identity.

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.

A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.