Following a rise in people 'speaking out' about their recovery and thus challenging traditional psychiatric ideas of chronicity, the recovery approach has become a central guiding vision within mental health services. This thesis comprises two parts. The first part applies a genealogical method to conduct a genealogical analysis of the recovery approach through exploration of UK policy within the last decade. This explores the conditions of possibility for its emergence in UK policy and mental health services and its growth. In the second part, a Foucauldian discourse analysis is used to analyse stories of recovery. Recovery stories are collected from organisational websites in the third sector and public sector. Subject positioning and power/knowledge implications are discussed in light of eleven discursive constructions: personal interpretation, person al responsibility, socioeconomic opportunity, self - management, an ongoing process, expertise and sharing stories, professional embodiment, fulfilment through work, living well without work, acceptance of illness and acceptance by others. These 'personal' testimonies might reflect wider discourses in the mental health system. The research shows the powerful interests at play under the discourse of recovery, and the promotion of particular 'truths' that this brings with it. Counter to this are smaller sites of resistance. Implications are discussed for clinical practice and further research.

Dementia and caregiving have received increasing research, clinical and political attention over the past forty years. However, such attention has been particularly focused on understanding the biomedical markers and interventions for dementia within majority populations. Little attention has been afforded to understanding alternative conceptualisations of dementia particularly from varying cultural and religious lens’. Existing research which has attempted to explore cultural understandings of dementia has done so in a homogenising manner and masked potential nuances between different cultures and religions. Research has also tended to shy away from exploring the impact of dementia upon spousal relationships. Given spouses (predominately wives) have been shown to deliver much of dementia caregiving this is an important area to illuminate, both for its clinical and moral implications. Taking in to account these two distinct gaps in knowledge, the present study aimed to explore the experiences and meanings of Punjabi Sikh wives in living with husbands who have a label of dementia. This study adopts a grounded theory methodology to explore the experiences of Punjabi Sikh wives living with husbands who have been given a diagnosis of dementia. Based on the accounts of eleven wives, a model was generated which revolved around the various processes associated with living with a husband with dementia. The emergent model consisted of three distinct, yet interacting theoretical processes, the wives’ responses, systemic responses and resistive responses. The wives’ responses centred around how they acknowledged, understood and ultimately lived with changes they experienced in their husbands and themselves. The systemic responses outlined the ways in which participants perceived their wider system to negate their responses through, ignoring, misunderstanding and denying the changes in their husbands. Finally, participants recounted their resistive responses against such systemic pressures. Based on the accounts of the participants, implications for clinical practice and future research are discussed.

Aim: This research project explored the relationship between borderline personality disorder, difficult to treat depression and treatment outcome. Method: The study used data collected in the course of the Tavistock Adult Depression Study (TADS). The TADS was a randomised controlled trial comparing Long Term Psychodynamic Psychotherapy (LTPP) to Treatment as Usual (TAU) for 129 patients whose depression has not been successfully treated by at least two previous interventions. The author of this project took part in rating all patients with the Shedler-Westen Assessment Profile (SWAP-II) – a 200-item personality measure – at the beginning and end of treatment. Statistical analysis explored the relationship between patients’ borderline personality scores at the beginning and end of treatment, and their progress in treatment in terms of decrease in depression severity, and psychological distress, and increase in general functioning. In addition, changes in borderline personality features were also explored in relation to changes on the three main outcome measures. The author included the rest of the SWAP-II personality scales in the analysis, too, as the SWAP-II generates an overall personality profile. Results: Only a small number of patients reached cut-off scores for borderline personality disorder or features. When the SWAP-II borderline scale was entered in analysis as a continuous variable, no significant link was found between borderline personality scores at the beginning of treatment, and treatment outcome. The way borderline features changed in the course of treatment, however, was significantly related to the outcome measures. This was particularly the case for SWAP-II items indicating insecure attachment and affect dysregulation. In addition, patients in the LTPP group who presented with borderline personality features or disorder at the end of treatment were more likely to still experience severe or very severe depression at the end of therapy.

Improving Access to Psychological Therapies (IAPT ) therapists form a relatively new workforce delivering psychological interventions to people with mild to moderate mental health difficulties in often high-volume environments (Department of Health [DOH], 2008c). Emerging research has suggested that working as an IAPT therapist can be a demanding and stressful role (Walket & Percy, 2014 ; Westwood, Morison, Allt, & Holmes, 2017). Work-related stressors have been linked to physical and mental health difficulties (e.g. Bosma, et al., 1997; Stansfeld, Fuhrer, Shipley, & Marmot, 1999) and the financial cost of stress related illness is considerable (Blaug, Kenyon, & Lekhi, 2007). Across the literature stress has been conceptualised in a variety of ways (Cooper, Dewe, & O’Driscoll, 2001). The transactional approach understands stress through the relational processes between the person and the environment (Lazarus, 2006). Self-compassion (Gilbert, 2010a ; Neff, 2003b), a way of self-relating in times of hardship and suffering, has predominately been inversely associated with perceived stress and has been linked to psychological wellbeing (Neff & Costigan, 2014). This quantitative cross-sectional online project explored IAPT therapists’ levels of perceived stress and examined whether self-compassion moderated the relationship between work-related stressors and perceived stress in IAPT therapists. IAPT therapists reported experiencing levels of perceived stress that were higher than the norm. Self-compassion did not moderate the relationship between work-related stressors and perceived stress. Multiple regressions, employed as model cleansing strategies, revealed that work-related stressors and self-compassion are independent predictors of perceived stress in IAPT therapists and that self-compassion is more strongly related to perceived stress than work-related stressors. The study demonstrates the applicability of Lazarus’ (2006) approach in workplace research. The findings are discussed in relation to self-compassion theory (Neff , 2003b) and affective regulation systems (Gilbert, 2006), and are considered in relation to future research and practical implications around workplace wellbeing.

This research begins with an introduction to the history of welfare and reforms in the U.K., related to political, societal and ideological structures. It highlights the link between work and mental health. This is considered through a psychological lens, by discussing the debate between Waddell and Aylward’s biopsychosocial model versus the social model of disability and how ideas from community and liberation psychology can be applied to the current research. A brief overview of the literature is also discussed. This research aimed to explore the experiences of claiming benefits, conditionality and sanctions for those who had been placed within the Employment and Support Allowance Work-Related Activity Group. It also aimed to explore concepts of employment in this sample. This research took a critical realist ontological position and a contextualist epistemological position. Semi-structured interviews were conducted with 15 participants, who were recruited through an organisation which works with deaf and disabled peoples’ organisations. Interviews were analysed using thematic analysis. Eight themes (and 22 sub-themes) were constructed: ESA WRAG: the good, the bad and the ugly; ruled by conditionality; sanctions and suicidality; the importance of relationships; adaptations and defences; power and politics; fighting back; workplace values. Results are discussed in the context of historical, social, ideological and political power structures as it is argued that the individual cannot be separated from their environment. There is further exploration of how participants’ mental health is impacted by their experiences, which is linked to theory and previous research. Strengths and limitations, dissemination and the researchers’ reflections are discussed as well as clinical implications of the findings, which provides specific examples of implications linked to the findings.

This study investigated the Mental Health and Social exclusion in People experiencing Homelessness and was completed in two phases; A large cross section study in which six screening assessments and a diagnostic test battery were completed with 529 individuals, followed by an exploratory secondary analysis investigating the association between social exclusion factors and mental health disorders. Analysis included the prevalence of the disorders found within this group, comparisons of the reported disorders with that of the general population and the utility of the screening test administered. A logistic analysis was completed for the 8 mental health disorders to understand the association between these and the 21 factors of social exclusion identified from the work of Percy- Smith and the Multiple Exclusion Project. Prevalence rates within the homeless study were found to be significantly higher than that of the general population with major depression and substance dependency being most prevalent. Psychosis yielded the biggest difference between the two populations. Only the AUDIT and DAST were found to be useful screening tools. Twelve indicators were found to be associated with mental health disorders with odds ratios ranging between 1.20 and 4.43. The study added evidence to the growing awareness of the multiply excluded nature of homelessness. Whether homelessness should be given such prominence in their support is debatable. This research supports the need for services that are multidisciplinary and cater for a broad range of needs. With the current reforms to the health and social care system what seems likely is that without more robust data and assessment, homeless individuals will not receive the services that they so clearly need. Further research is needed into the associated factors of social exclusion and their utility within needs assessments and how services should support those individuals with these complex needs.

In their day-to-day tasks, police officers are repeatedly subjected to stressful and traumatic events and as such are at significant risk of developing post - traumatic stress disorder (PTSD). There is a wealth of literature exploring risk and protective factors, however there is still a need to develop our understanding of specific factors which may be unique to the police. In light of this need, two potential factors have been identified for this current research, burnout and social connectedness. Burnout relates to a culmination of stress which is unmanaged and untreated. Social connectedness relates to the internal experience of feeling connected to others and the world around. This thesis is primarily concerned with exploring the relationship between these factors and PTSD and general distress within the context of the police force. This research took place within one UK police force. In total, 93 participants from specialist departments at high risk of exposure to trauma took part in an online survey. The survey included self-report measures of burnout, social connectedness, Post-Traumatic Stress Disorder (PTSD) and general distress. Non-standardised measures also sought to capture demographic information and an additional outcome variable of sickness absence. A series of multiple forced-entry regressions were carried out. Increased symptoms of exhaustion (one aspect of burnout), significantly predicted increased PTSD symptom severity. Further exploratory analyses found that exhaustion significantly predicted two of the four PTSD symptom clusters: intrusion and alterations in arousal and reactivity. The same multiple regression analysis indicated that social connectedness made a significant contribution to the model predicting PTSD symptom severity, greater than that of exhaustion. It was also found that increased symptoms of exhaustion significantly predicted increased general distress, whereas disengagement (a further aspect of burnout) and social connectedness did not. Lastly, it was found that none of the predictor variables made a significant contribution to the model predicting sickness absence. These findings are discussed in terms of their theoretical and clinical implications.

According to the Office of National Statistics (2011), approximately six million people provide unpaid care to a family member. The growth of interest in the carer role has helped establish the idea that the provision of informal care warrants attention because of the relationship between caring and burden. It has been suggested that living with someone with depression is comparable to that of other serious mental health problems, such as schizophrenia or dementia. Furthermore, there is evidence that partners are most at risk of burden within the informal caregiving context. The meta-ethnography of existing research indicates that qualitative studies which specifically explore the experiences of living with a family member with depression are somewhat heterogeneous regarding types of relationship with the depressed individual. Combining different relationships (e.g. partners, siblings and parents) within the same study makes it difficult to disentangle data and therefore gaining an in-depth understanding of specific experiences is almost impossible. This study therefore aimed to explore the experiences of living with a partner with depression. In-depth interviews were conducted with nine female and four male participants who live with a partner with depression. A critical realist perspective was held and data was analysed using Braun and Clarke’s six phases of thematic analysis (2006), with the assistance of MAXQDA. Results identified five key themes: ‘making sense of the depression’; ‘the depression cannot be compartmentalised’; ‘a light at the end of the tunnel’; ‘learning to navigate the ‘depression’ maze’; and ‘gaining a new perspective’. The findings illustrate that living with a partner with depression is not a static process and that the needs of the depressed partner are constantly changing. Furthermore, although the findings outline a sequential process that appears cyclical in nature, recognition is given that the phases are dynamic and may overlap. Clinical implications and recommendations are discussed within the context of the Care Act (2014).

Since the 1990s there have been continued drives in England to integrate National Health Services and Local Authorities’ social care within a single mental health service, with the aim of bringing about improvements in health and social care (Local Government Association et al., 2016). This is underpinned by the belief that through bringing the different professional health (such as psychiatrists and mental health nurses) and social care disciplines together, people in need will have a single point of access to a range of skills and knowledge, that no one system could deliver alone (Cooper, 2017). However, the very unique professional approaches that have been stated as the reason to place social workers in NHS Mental Health Services have been the ones that mental health social workers have struggled to hold onto in this setting (Allen et al., 2016). This is a thesis of how mental health social workers constructed a professional self within the context of the NHS mental health services. I used a Foucauldian approach and the notion that professional identity is a socially constructed sense of self, produced from discourses, subject positions and a process of subjectification. Twelve social workers were interviewed; seven mental health social workers and five social workers who held positions as managers or educationalists. I asked social workers questions about their professional identity, their answers provided a rich source of ‘talk’ that I could analyse using Parker’s steps to discourse analysis. The findings discuss the nature of social work as a profession, generic and specialist social work, and suggests a typology of subject positions drawn from the mental health social workers’ discourses. These findings provide a useful resource to support critical social work practice, both as an example of how Foucauldian theory and concepts can be a rich toolbox for understanding practice in complex settings, and through the use of the typology of subject positions as a source to prompt self-reflection for mental health social workers’ practice.

The present qualitative research investigates a wide range of psychosocial responses to nakbah across 3 generations of internally displaced Palestinian families living in Israel through intergenerational narratives. Situated in a context of political violence and internal colonialism, the research was conducted with a mixed method design bringing together Interpretive Phenomenological Analysis and Grounded Theory, and informed by a constructionist-systemic perspective that better accounts for the complexity of refugees’ experience (Papadopoulos, 2002), and for the social and cultural differences imbedded in resilience and trauma constructs as performed by individuals, families, and communities. The theory expands the “trauma grid” model (Papadopoulos, 2002, 2006, 2007) and shows its intergenerational validity and applicability to internally colonized native populations exposed to a historical trauma and subjected to attacks on their survivance (Vizenor, 1999) and cultural diversity (Samson, 2003, 2008, 2013). The analysis of retrospective and present time narratives of 3 generations of nakbah-related internally displaced Palestinian families within Israel led to the emergence of a theory of complex intergenerational resilience composed of 3 dimensions of AAD (Adversity-activated Development), 2 main dimensions of resilience and 2 additional trauma-spectrum negative responses which were identified as subordinate and unpervasive. The outcome of this research may inform a more culturally sensitive and resilience-oriented understanding, intervention and prevention in the field of mental health among Palestinians in Israel. On the collective level, such a comprehensive approach may produce new insights on Palestinian national identity and its connections with experiences of victimhood and resilience due to past and present conditions of political conflict and social adversity. Limitations and implications for future research, professional practice and policy initiatives are discussed.