Background There now exist a range of efficacious options for the treatment of psychosis in mental healthcare. The importance of recovery, empowerment, dignity and choice among patients with severe mental health diagnoses are important topics in contemporary research and practice. This thesis presents a meta-analytic review followed by a randomised controlled experimental study. These address distinct but related questions which aim to further our understanding of the choices available for intervention in psychosis and whether intervention may improve the ability of psychosis patients to make those choices. Aims The first objective aimed to offer a comprehensive review of the effectiveness of social skills training (SST), which is a psychological intervention for psychosis. SST has fallen out of favour in the UK and is not widely implemented in practice. We hypothesised that SST would demonstrate superiority for the negative symptoms of psychosis. The second objective was to determine whether decision-making capacity regarding treatment among psychosis patients could be improved by the application of a brief psycho-educational intervention targeting the jumping-to-conclusions (JTC) bias, which is a commonly observed cognitive bias in psychosis. We hypothesised that the intervention would improve decision-making capacity. Methods Firstly, a series of 70 meta-analyses are presented in a systematic review assessing the efficacy of social skills training across a number of psychosis outcome domains: positive symptoms, negative symptoms, general symptoms, overall symptoms and social functioning outcomes. Secondly, a randomised controlled experimental study is presented in which 36 psychosis patients in NHS Lanarkshire and 1 in NHS Dumfries & Galloway were allocated to receive either a brief meta-cognitive training (MCT) intervention or an non-specific control presentation lecture. Capacity was assessed at baseline and post-treatment while the impact of the intervention upon capacity was estimated by ANCOVA. Mediation analyses assessed whether changes in the JTC bias mediated outcome. Findings In the meta-analytic review, SST demonstrated superiority over treatment as usual (TAU. g=0.3), active controls (g=0.2-0.3) and comparators pooled (g=0.2- 0.3) for negative symptoms; and over TAU (g=0.4) and comparators pooled (g=0.3) for general psychopathology. In the randomised controlled study, MCT demonstrated large effects on two capacity outcomes; overall capacity (d=0.96, p < .05) and appreciation (d=0.87, p < .05). Exploratory analyses suggested a mediating effect of JTC (d=0.64, p < .05). Interpretation SST demonstrates a magnitude of effect for negative symptoms similar to those commonly reported for CBT for positive symptoms and may have potential for wider implementation in mental healthcare settings. The randomised controlled study suggests that psycho-educational interventions targeting capacity have clinical utility and may be developed for implementation. Limitations included lack of blinding, no fidelity checks and inclusion based on clinical diagnosis therefore a larger randomised controlled trial addressing these limitations is warranted.

The research examines New Labour’s Third Way policies and the impact New Deal for Communities (NDC) regeneration programme had on participation in health care. This longitudinal study (1998-2007) explores participatory joint working, welfare state, social capacity, health inequalities, citizen involvement and community capacity. It captures the experiences of local community and front-line workers whilst delivering the Health Focus Group (HFG) in the NDC programme. Using action learning reflection techniques, the study analyses a purposeful sample of 15 from the local community, front-line workers, and strategic respondents involved in the NDC health programme. The research demonstrated the NDC did increase participation, joint working and involvement of local actors 1998–2003. The importance of communication, leadership and relationships was recognised as an important catalyst for developing community governance models. The new action learning spaces initiated, designed and delivered 19 new models of joint local clinical, community and complementary health and well-being projects. In 2001, New Labour introduced public private finance initiatives with the Primary Care Trust (PCT) which conflicted with the local actors’ involvement in the participatory joint decision-making. The reconfiguration of health and social care services and the new public health models introduced complex governance and monitoring models, further distancing the local actors from the process. Strategic staff changes in key governance positions also adversely affected the communication and trust established with local actors. The research concluded operational, tactical, and strategic alignment is necessary to maximise joint participation in decision-making.

Landscape architects, many of whom practice the design principles of the New Urbanism, have become increasingly involved with the participatory planning process. A key principle of New Urbanism, the participatory planning process is incorporated in an attempt to ensure that any new development - or alteration of an existing development - meets the needs of the community for which the design is created. This study examines data gathered from a web-based survey addressing the alternate, stakeholderess charrette approach. It was distributed to participants of charrettes facilitated by the Mississippi Main Street Association and is an attempt to understand the perceptions of those actively involved in the process. The purpose of this study was to examine this alternate approach to charrette facilitation and identify trends associated within. The analysis of stakeholder perceptions may prove beneficial in identifying trends that threaten charrette efficiency while highlighting trends worthy of replication in future charrettes.