In this thesis the intricacies of service user and staff perceptions of psychological interventions for mental health difficulties were explored. Expanding upon this theme, mothers and staff on a Mother and Baby Unit (MBU) were asked about their views regarding the acceptability and feasibility of the implementation of a parenting intervention, Baby Triple P Positive Parenting Programme (Baby TP). This investigation is presented as four papers: a literature review, two empirical papers (a & b) and, a critical review and personal reflection of the research process.The literature review, a meta-synthesis of qualitative studies, explores service user and staff perceptions of psychological interventions for mental health difficulties. Twenty-eight studies were synthesised to develop comprehensive understanding of subtle, specific and overlapping elements involved in the implementation of psychological intervention. Guided by Noblit and Hare’s (1988) approach, 11 over-arching themes and 25 sub-ordinate themes emerged from the synthesis. Findings provide a detailed description of the concepts pertinent to both service users and staff. Implications are identified for service managers and clinicians in obtaining optimum efficiency and outcomes of psychological intervention. The empirical study is a Q-methodological investigation into service user and staff perceptions of the acceptability and feasibility of a parenting intervention, Baby TP, on a MBU. This study is split into two population-specific papers. Overall five main factors were identified (service users: three; staff: two), which provides new insights into the acceptable and feasible elements of a parenting intervention within this specialist setting. The findings highlight a positive consensus as to the acceptability and feasibility of Baby TP in a MBU setting alongside a number of identified needs pertinent to service users, staff and the setting. Clinical implications and recommendations are provided to address identified areas of need for both populations within this setting. The third paper is a critical review of the thesis illustrated through personal reflections of the research process.

Drawing on the theoretical influences of Mad and Disability Studies; philosophical conceptualizations of epistemic injustice (Fricker, 2007), ethical loneliness (Stauffer, 2015), and psycho-emotional disablism (Reeve, 2012; Thomas, 1999; 2007); disability/service user/feminist ethics; a decade of Mad Movement community organizing; as well as autobiographical illustrations and empirical data from two collaborative research projects, this thesis describes my efforts to live a Mad politics in the community, academy, and social work education. Central to this politics, and to the overall contribution of the thesis, is its focus on (1) the recognition and redress of affective-epistemic harms that are often ignored by legislative/social welfare approaches to in/justice; and (2) the generation and refinement of Mad knowledge/ways of knowing that respond to our own priorities as Mad people, rather than those of mental health systems. It contributes to these areas of Mad Studies theory in several ways: First, by recognizing and politicizing the often ignored affective-epistemic effects of abandonment and neglect Mad people experience from society, including loneliness, anger, resentment, distrust, low expectations of others and lack of confidence. Second, by seeking new conceptualizations (such as epistemic loneliness) and contributing to existing ones (like expectations of just treatment, psycho-emotional disablism) in order to more adequately interpret and attest to these harms and call for their redress. Third, by affirming emergent Mad moral and epistemological frameworks, especially those that manifest in the aftermath of harm and account for ontologies of knowing. Fourth, by developing Survivor/Service User Research approaches to analysis (listening for resonance, everyday forms of service user resistance, and ‘quiet’ data) that value affective engagements with data and perceive and respond to Mad onto-ethico-epistemologies in and on their own terms. Ultimately, this work calls for greater relational justice, and an expansion of what we owe each other. / Thesis / Doctor of Philosophy (PhD) / This thesis contributes to Mad theory by recording some of the things I learned while trying to survive in the world, community organizing, the academy, and social work education as a Mad person. To do so, I reflect on the existential and ethical questions I brought to my doctoral studies, the people, texts, and concepts that I found particularly good company during this time, and my Mad methods of living/doing/knowing. Three separate but interconnected articles then follow. These are about (1) moving with loneliness as a Mad student; (2) resisting unmet expectations as service user ethics, and (3) how pedagogical partnerships between students and faculty/staff can cultivate marginalized students’ confidence in their knowledge. The thesis ends with a discussion of its overall contributions to how we conceptualize the psycho-emotional harms produced through sanism/disablism and the ways we understand what Mad knowledge is and how it is generated.

No / The aim of this study was to evaluate newly developed performance feedback tools from the student perspective. The tools were innovative in both their mode of delivery and the range of stakeholders they involved in the feedback process. By using the tools in health and social care settings, students were able to engage in interprofessional assessment of common competences and obtain performance feedback from a range of stakeholders not commonly involved in work-based learning; these included peers and service users. This paper discusses the ways in which the performance feedback tools were developed by a collaborative programme and compares their delivery, across a wide range of professions and work-based settings, in paper-based, web-based and mobile formats. The tools were evaluated through a series of profession-specific focus groups involving 85 students and 7 professions. The data were analysed thematically and reduced to three key categories: mode of delivery, assessment tool dynamics and work-based issues. These will be discussed in detail. The students agreed that the structured way of capturing and documenting feedback from several sources would support their practice placement learning. The reflective nature of the tools and the capacity for guiding reflection was also welcomed. The concepts of gaining service user, peer and/or interprofessional feedback on performance were new to some professions and evoked questions of reliability and validity, alongside appreciation of the value they added to the assessment process.

O presente trabalho tem por finalidade verificar a extensão democrática do Direito de Reclamação do Usuário de Serviço Público no atual modelo gerencial da Administração Pública brasileira, analisando em especial a essência desse instrumento sob dois vieses básicos: o do controle social e o da participação popular na Administração Pública. Para tanto, a fim de compreender seu estágio atual no ordenamento jurídico brasileiro, enquanto instrumento de uma Administração Pública Gerencial, fundamental o estudo das formas anteriores de Administração - Patrimonial e Burocrática. Em um segundo momento, trata-se de analisar o impacto dessa Reforma no direito brasileiro, tanto das alterações da Emenda Constitucional n. 19/98, quanto através das mudanças semânticas de outros institutos jurídicos. Na segunda parte do trabalho o estudo dirige-se especialmente para a abordagem do Direito de Reclamação do Usuário de Serviço Público, analisando sua norma original e sua posterior alteração, bem como o regime jurídico que atualmente se encontra (direito positivo e competência para legislar sobre a matéria). Por fim, examina-se a compatibilidade de tal instrumento sob três conceitos chaves para uma Administração Pública democrática: processo administrativo, controle social e participação popular na Administração Pública. O método de abordagem utilizado é o hipotético-dedutivo, a partir do procedimento monográfico auxiliado pelo histórico; quanto à técnica de pesquisa, esta é apoiada na pesquisa documental em fontes primárias e na pesquisa bibliográfica em fontes secundárias. / This paper aims to verify the democratic extension of the Public Service User's Right of Complaint in the current Brazilian Public Administration management model, analyzing in particular the essence of this instrument under two basic biases: social control and popular participation in Public Administration. Therefore, in order to understand its current status in the Brazilian legal system, as an instrument of a Public Management, it is fundamental to study the previous forms of Administration - Patrimonial and Bureaucratic. In a second moment, it is a question of analyzing the impact of this Reformation in the Brazilian law, as much of the alterations of the Constitutional Amendment n. 19/98, as well as through the semantic changes of other legal institutes. In the second part of the study, the study focuses on the Public Service User's Right of Complaint approach, analyzing its original standard and its subsequent amendment, as well as the legal regime currently in place (positive law and competence to legislate on school subjects). Finally, the compatibility of this instrument is examined under three key concepts for a democratic Public Administration: administrative process, social control and popular participation in Public Administration. The method of approach used is the hypothetical-deductive, based on the monographic procedure aided by history; as for the research technique, it is supported by documentary research in primary sources and bibliographical research in secondary sources.

Background: There is a great need for effective treatments for mental health problems. Randomised controlled trials are the gold standard for evaluating treatments, however recruitment into trials is challenging, highlighting a clear need for evidence-based recruitment strategies. This thesis aimed to systematically develop a recruitment intervention and evaluate its effectiveness for improving the recruitment of participants into mental health trials. Methods: A mixed-methods approach, adopting the Medical Research Council’s complex interventions framework: 1) a systematic review to identify the evidence base and describe the factors affecting recruitment into depression trials; 2) a qualitative study to understand patients’ decision-making process in declining to enrol in a depression trial; 3) development of a recruitment intervention, using Participatory Design methods; and 4) evaluation of the recruitment intervention, using a randomised controlled trial, embedded in an ongoing mental health trial (the EQUIP trial). The primary outcome was the proportion of participants enrolled in EQUIP. Results: From the systematic review, a conceptual framework of factors influencing the decision to participate was developed, which highlighted that the decision to enrol involves a judgement between risk and reward. Findings suggested that patient and public involvement in research (PPIR) might be advertised to potential participants to reduce such perceived risk. The qualitative study found positive views of trials. Interviewees’ decision making resembled a four-stage process; in each stage they either decided to decline or progressed to the next stage. In Stage 1, those with an established position of declining trials opted out – they are termed ‘prior decliners’. In Stage 2, those who opted out after judging themselves ineligible are termed ‘self-excluders’. In Stage 3, those who decided they did not need the trial therapy and opted out are termed ‘treatment decliners’. In Stage 4, those who opted out after judging that disadvantages outweighed advantages are termed ‘trial decliners’. While ‘prior decliners’ are unlikely to respond to trial recruitment initiatives, the factors leading others to decline are amenable to amelioration as they do not arise from a rejection of trials. We recruited a host mental health trial (EQUIP), and worked with key stakeholders, including mental health service users and carers, to develop an intervention using a leaflet to advertise the nature and function of the PPIR in EQUIP to potential trial participants. 34 community mental health teams were randomised and 8182 patients invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR= 0.75, 95% CI= 0.53 to 1.07, p=0.113). Conclusions: This thesis reports the largest ever trial to evaluate the impact of a recruitment intervention. It also reports the largest trial of a PPIR intervention and makes a contribution to the evidence base on trial recruitment as well as to that assessing the impact of PPIR. Two further embedded trials are underway to evaluate the effectiveness of different versions of the recruitment intervention in different trial contexts and patient populations. This will also allow the results to be pooled to generate a more precise estimate of effect; to evaluate the impact of the intervention on trial retention; and to explore patient experiences of receiving the intervention.

My thesis work deals with working with the family of a social services client. Social services can be defined as a set of activities to provide assistance to persons in unfavourable social situations. The main purpose of social services is to preserve human dignity and to encourage the given persons to pursue activities that do not protract or worsen their social situation (in other words, to prevent their social exclusion). People may find themselves in a difficult social situation for various reasons (e.g. because of age or poor health status). The most frequent social services users are seniors and persons with disabilities. With regard to the fact that in the future I would like to work in a job treating the above-mentioned target groups, I focused on them in my thesis. I suppose that mutual cooperation between a family and the staff in the social care providing facility can have a positive affect on the client himself. For this reason, I conceived my thesis in a broader context - a family, a social services user and a social services provider. The thesis is divided into a theoretical and a practical part. The theoretical part describes all the important aspects related to a family, social services and basic characteristics of the Blansko district. In the practical part the target of the thesis was stated. I wanted to learn what problems most families face (not just prior to placing the client to a social services facility, but also in the course of the stay), what their experience with the facility is and whether they are informed about all available social services offered in the area. To compile the thesis quantitative research was applied. I used the method of questioning, the technique of structured interviews with family members of senior home clients and persons with mental disabilities attending a daycare stationary. The thesis could serve as information material on social services not only for families involved in my research, but also for the general public - to provide information about availability of social services for seniors and persons with mental disabilities in the Blansko district in the South Moravian Region.

O presente trabalho tem por finalidade verificar a extensão democrática do Direito de Reclamação do Usuário de Serviço Público no atual modelo gerencial da Administração Pública brasileira, analisando em especial a essência desse instrumento sob dois vieses básicos: o do controle social e o da participação popular na Administração Pública. Para tanto, a fim de compreender seu estágio atual no ordenamento jurídico brasileiro, enquanto instrumento de uma Administração Pública Gerencial, fundamental o estudo das formas anteriores de Administração - Patrimonial e Burocrática. Em um segundo momento, trata-se de analisar o impacto dessa Reforma no direito brasileiro, tanto das alterações da Emenda Constitucional n. 19/98, quanto através das mudanças semânticas de outros institutos jurídicos. Na segunda parte do trabalho o estudo dirige-se especialmente para a abordagem do Direito de Reclamação do Usuário de Serviço Público, analisando sua norma original e sua posterior alteração, bem como o regime jurídico que atualmente se encontra (direito positivo e competência para legislar sobre a matéria). Por fim, examina-se a compatibilidade de tal instrumento sob três conceitos chaves para uma Administração Pública democrática: processo administrativo, controle social e participação popular na Administração Pública. O método de abordagem utilizado é o hipotético-dedutivo, a partir do procedimento monográfico auxiliado pelo histórico; quanto à técnica de pesquisa, esta é apoiada na pesquisa documental em fontes primárias e na pesquisa bibliográfica em fontes secundárias. / This paper aims to verify the democratic extension of the Public Service User's Right of Complaint in the current Brazilian Public Administration management model, analyzing in particular the essence of this instrument under two basic biases: social control and popular participation in Public Administration. Therefore, in order to understand its current status in the Brazilian legal system, as an instrument of a Public Management, it is fundamental to study the previous forms of Administration - Patrimonial and Bureaucratic. In a second moment, it is a question of analyzing the impact of this Reformation in the Brazilian law, as much of the alterations of the Constitutional Amendment n. 19/98, as well as through the semantic changes of other legal institutes. In the second part of the study, the study focuses on the Public Service User's Right of Complaint approach, analyzing its original standard and its subsequent amendment, as well as the legal regime currently in place (positive law and competence to legislate on school subjects). Finally, the compatibility of this instrument is examined under three key concepts for a democratic Public Administration: administrative process, social control and popular participation in Public Administration. The method of approach used is the hypothetical-deductive, based on the monographic procedure aided by history; as for the research technique, it is supported by documentary research in primary sources and bibliographical research in secondary sources.

Social work involves working intimately with clients who are or have previously found themselves in difficult life situations. The intimate work with clients is one of the reasons why the social work is considered emotionally demanding. The aim of the study is to highlight how social workers are influenced by clients emotions, as well as increase the understanding of how social workers can manage the emotional strain that an intimate work with clients can cause. Based on a qualitative research effort and qualitative interviews with seven social workers from “individual and family welfare” in the southeast of Sweden. When analysing the empirical data, three main themes emerged: the emotional work of social workers, management of emotions during the interaction with clients and strategies for managing emotional strain. Goffman´s theory of dramaturgy as well as Lazarus and Folkman´s theory of coping strategies are used to create an understanding of the research problem. Results of the study show that collegial support was deemed to be a common strategy as well as the most significant for managing emotional strain.

O presente trabalho tem por finalidade verificar a extensão democrática do Direito de Reclamação do Usuário de Serviço Público no atual modelo gerencial da Administração Pública brasileira, analisando em especial a essência desse instrumento sob dois vieses básicos: o do controle social e o da participação popular na Administração Pública. Para tanto, a fim de compreender seu estágio atual no ordenamento jurídico brasileiro, enquanto instrumento de uma Administração Pública Gerencial, fundamental o estudo das formas anteriores de Administração - Patrimonial e Burocrática. Em um segundo momento, trata-se de analisar o impacto dessa Reforma no direito brasileiro, tanto das alterações da Emenda Constitucional n. 19/98, quanto através das mudanças semânticas de outros institutos jurídicos. Na segunda parte do trabalho o estudo dirige-se especialmente para a abordagem do Direito de Reclamação do Usuário de Serviço Público, analisando sua norma original e sua posterior alteração, bem como o regime jurídico que atualmente se encontra (direito positivo e competência para legislar sobre a matéria). Por fim, examina-se a compatibilidade de tal instrumento sob três conceitos chaves para uma Administração Pública democrática: processo administrativo, controle social e participação popular na Administração Pública. O método de abordagem utilizado é o hipotético-dedutivo, a partir do procedimento monográfico auxiliado pelo histórico; quanto à técnica de pesquisa, esta é apoiada na pesquisa documental em fontes primárias e na pesquisa bibliográfica em fontes secundárias. / This paper aims to verify the democratic extension of the Public Service User's Right of Complaint in the current Brazilian Public Administration management model, analyzing in particular the essence of this instrument under two basic biases: social control and popular participation in Public Administration. Therefore, in order to understand its current status in the Brazilian legal system, as an instrument of a Public Management, it is fundamental to study the previous forms of Administration - Patrimonial and Bureaucratic. In a second moment, it is a question of analyzing the impact of this Reformation in the Brazilian law, as much of the alterations of the Constitutional Amendment n. 19/98, as well as through the semantic changes of other legal institutes. In the second part of the study, the study focuses on the Public Service User's Right of Complaint approach, analyzing its original standard and its subsequent amendment, as well as the legal regime currently in place (positive law and competence to legislate on school subjects). Finally, the compatibility of this instrument is examined under three key concepts for a democratic Public Administration: administrative process, social control and popular participation in Public Administration. The method of approach used is the hypothetical-deductive, based on the monographic procedure aided by history; as for the research technique, it is supported by documentary research in primary sources and bibliographical research in secondary sources.

This thesis investigated the experience of taking part in a psychosocial assessment following an episode of self-harm from the service user perspective. Psychosocial assessments are a key aspect of self-harm management in secondary care, designed to identify needs and risk and determine further care. This study utilised interpretative phenomenological analysis to privilege the voices of service users and produce in-depth, contextualised understandings of the experience of assessment and its impact on future help-seeking and engagement with services. Data collection consisted of semi-structured interviews with thirteen participants soon after their hospital attendance; follow-up semi-structured interviews were also completed with seven participants three months later, to explore patient-derived outcomes from assessment and hospital attendance. The lived experiences of participants were characterised by two main features: experiences of life as a struggle and of the self as “less than”. As a result of these struggles and experiences of powerlessness and devaluation, participants mostly saw self-harm and suicide as a natural progression in their narratives. Expressions of suicidal intent reflected a struggle between a desperate desire for change and hopelessness in the face of current circumstances. The key message gained from participants’ accounts of assessment was that the interaction with staff had the power to reinforce or challenge hopelessness and negative self-evaluations. In addition, the way an assessment was conducted had influence beyond the hospital: as an experience which created or reinforced expectations for future instances of help-seeking; as a deterrent or an encouragement to seek help; and as the first step along the path to change. Unfortunately, participants’ experiences of aftercare were dominated by a sense of stagnation due to the failure of services to follow through with promises of aftercare, which affected their attitudes towards future help-seeking and towards themselves. This thesis is the first study to utilise an in-depth idiographic methodology to explore and contextualise the service user experience of psychosocial assessment following self-harm within the wider circumstances of their lives. It demonstrates how patient-staff interactions within the hospital and after discharge can affect future help-seeking through reinforcing or challenging the hopelessness and self-negativity of patients.