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.

Power issues in the relationship between service users and clinical psychologists have received little attention from a postmodern perspective. The recovery approach and the scientist-practitioner model as recommended in best practice guidelines creates an argument for investigating power dynamics in academic and practical disseminations. This study aimed to investigate the social construction of service users and clinical psychologists in articles. Twelve articles and opinion pieces written by clinical psychologists and service users were sampled from publications of the Clinical Psychology Forum. A Foucauldian Discourse Analytic method was used to identify dominant discourses and counter-discourses. The discourses were linked to the power dynamics in play between relevant institutions. The analysis identified an economic discourse, a technical-rational discourse and an expert discourse as constructing service users and clinical psychologists. Clinical psychologists were found to have more discourse availability than service users, and in a position to make choices, whereas service users were found to have availability to a limited number of discourses with fewer options of subjectivity. A need for clinical psychologists to make conscious choices in practice was implied.

Forensic services have been described as largely based around the needs of men who form the vast majority of in patients. However women’s offending behaviour is quite distinct from men's: they are more likely to have a personality disorder, most commonly borderline personality disorder (BPD) and to have been victims of abuse both as children and adults. Abuse and borderline personality disorder are characterised by problematic relational styles which cause the person great distress. In the forensic services admission is not based upon treatment readiness and it may be difficult for women to form healthy relationships with care staff or their peers. The recovery model has been recently applied to the forensic service and emphasises that improving relationships is a fundamental target. Women in forensic services have said that their peers can help them to feel connected and less stigmatised but also they can find each other's behaviour very disruptive and disturbing. This research set out to develop a theoretical model of the peer relationships of women with BPD in forensic care using grounded theory methodology. 12 women with a diagnosis of BPD were interviewed about their experiences in forensic care. A model was developed that characterises how women's experiences of relating with each other will depend upon ward characteristics and personal readiness for forming relationships. This will determine whether the person is interacting in a survival mode where relationships are superficial or able to attempt to engage at a deeper relational level with their peers. Such engagement may perpetuate relational difficulties, or have the potential to develop recovery through fostering hope, providing encouragement, developing insight and learning new ways to connect with others and manage problems.

Little research has looked in detail at the subjective experience of adolescents who have been admitted to psychiatric hospital and the potential impact of this on their developing identity. This study aimed to construct a theory of the perceived impact of hospitalisation on the identity of young people admitted to a psychiatric ward, the ways young people might manage threats to their identity and any perceived impact of diagnosis. Nine young people aged 15-17 were interviewed in depth about their experience of admission and any perceived impact on their identity. Young people were current in-patients or ex-patients attending follow-up treatment in the community. Grounded theory methodology was employed in this study. A preliminary model is proposed showing the process from admission to post-discharge with hypothesised impacts on personal and social identity at each stage. Positive outcomes were associated with an improved sense of self and self-efficacy. In contrast, the development of an “illness” explanation for one’s difficulties while in hospital may be a risk for a more negative self-concept and a less favourable future outlook. The study concluded that longitudinal research is required to ascertain long-term outcomes of the proposed model. Emphasizing psychological formulation may ameliorate the perception of individual ‘deficit’ that appeared to be associated with diagnosis.

Research suggests elite athletes have an equal, possibly higher, probability of developing mental ill-health as the general population. However understanding of these issues amongst athletes and coaches remains largely unknown. The perceptions of 20 elite athletes and 16 elite coaches of mental ill-health amongst elite athletes were explored. Two concurrent, three round Delphi methods, using descriptive statistics and thematic analysis, were used to compare groups’ responses. Athletes and coaches expressed different opinions and experiences of mental ill-health amongst elite athletes. However, both felt the pressure athletes place upon themselves is a significant contributing factor and that obsessive compulsive disorder (OCD) and anxiety may be particularly prevalent. Whilst associated stigma was thought to be a barrier to support seeking, both groups felt sport and clinical psychologists would provide the most appropriate support, with coaches playing an important role. Implications for coaches, clinical and sport psychologists are explored and suggestions for future research are presented.