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Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia.Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage.Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support.Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality.Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions.Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless. [ABSTRACT FROM AUTHOR]

Purpose Team formulation, used to understand patient problems and plan care, is a growing practice in adult mental health and learning disability services. The purpose of this paper is to explore definitions applied to team formulation (as distinct to therapy formulation), its underpinning theories, and the inter-relationship between the team and the process of formulation.Design/methodology/approach A database search (main search term of team formulation) of peer-reviewed studies was conducted using PRISMA guidelines. A main and second reviewer conducted quality appraisals and thematic analysis. Data were analysed by convergent qualitative synthesis design using thematic analysis to transform evidence from quantitative and qualitative studies into qualitative findings.Findings Initial searching produced 4,532 papers, 10 of which were eligible for inclusion. Team formulation has no distinct definition. Theories underpinning the practice of therapy formulation emanating from general psychological theory underpin team formulation. Seven studies applied psychological theories to the examination of team formulation. No studies examined the impact of the team on the formulation. Six themes were generated regarding the impact of team formulation on the team; "increased knowledge and understanding", "altered perceptions, leading to altered relationships, feelings and behaviours", "space to reflect", "useful when stuck or challenged", "perceived increase in effectiveness" and "improved team working".Research limitations/implications Limited evidence and variable quality compromised the availability of review evidence.Originality/value This is the first review to examine team formulation through the context of the team. The authors argue that a conceptual framework to encompass team inputs, processes and outputs in team formulation practice should guide future research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to illustrate the hostility many young women who are also mothers experience within their everyday lives.Design/methodology/approach The paper will draw on qualitative research, incorporating a narrative approach, to illustrate the hostility many young mothers experience on a daily basis. The research design included a focus group, semi-structure interviews and participant observations.Findings The paper reports the findings of a study that explored the experiences of young women who are also mothers. The author presents the findings that indicate that many young women, who are also young mothers, experience hostile reactions and interactions as part of their everyday lives.Research limitations/implications The small sample size means that this study cannot be generalised, but it does contribute to the growing body of qualitative evidence in relation to young mothers.Practical implications The findings suggest that there needs to be more recognition and acknowledgement of the hostility young women experience. Such hostility could have deleterious consequences on the young women, their parenting ability and also on the children.Originality/value This paper documents the experiences of young women who are also mothers and how they experience hostility as a daily occurrence. The hostility ranged from verbal to non-verbal and how they felt they were being treated, inferences about their sexuality to stereotyping. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore keyworkers’ experience and perceptions working with people experiencing homelessness and the use of psychologically informed approaches in an Irish context.Design/methodology/approach In this paper a qualitative descriptive methodology was employed and face-to-face in-depth semi-structured interviews were conducted. Data collected were analysed using a thematic framework and transcribed by the researcher.Findings It was the view of the keyworkers psychological approaches allowed them greater understanding of psychological trauma and its effects promotes safe physical and emotional environments builds rapport between staff and clients and enables keyworkers to work more effectively with people with complex needs. There was also convincing evidence staff are quite receptive to training.Originality/value Given there is no research exploring the use of psychologically informed approaches in homelessness service settings, this study researched an area that has not yet been explored in Ireland. This qualitative descriptive research provides a platform from which further research can be conducted. It is hoped that highlighting the psychological issues of homeless people, the data obtained will help improve Irish homeless services, and the findings extracted beneficial in terms of future service developments, professional training and education. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe the barriers and facilitators to an effective transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). It also presents a new entry into considering how the transition can be improved.Design/methodology/approach Insights into the transition from CAMHS to AMHS were gathered through eight semi-structured interviews with mental health professionals. Two methods of data analysis were employed to explore the emerging themes in the data and the observed deficit approach to organisational development.Findings The findings identified a vast volume of barriers in comparison to facilitators to the transition. Adolescents who transition from CAMHS to AMHS initially experience difficulty adapting to the differences in the services due to the short duration of the transition period. However, despite the established barriers to the transition, adolescents tend to adapt to the differences between the services. Findings also showed a negative framing towards the transition amongst the mental health professionals which resembles a deficit approach to organisational development.Originality/value This paper explores mental health professionals’ perspectives regarding the transition in Dumfries and Galloway, Scotland. The transition is increasingly recognised as an area in health care that requires improvement. This research provides a new way to consider the transition by exploring the perceived deficit approach to organisational development in the services. [ABSTRACT FROM AUTHOR]

Purpose The perspectives of people with dementia and their care partners regarding “extra care” housing are currently unknown. The purpose of this paper is to report findings of a consultation study exploring the perceived barriers and facilitators of a relocation to extra care housing, from the perspective of people living with dementia, and their care partners.Design/methodology/approach Fieldwork consisted of paired or 1-1 interviews and small focus groups with potential users of an alternative model of extra care support for people living with dementia in the South of England. The consultation took place between June and August 2013. The interviews and focus groups were audio recorded, transcribed verbatim. The transcripts were analysed thematically.Findings Benefits of extra care were identified as the opportunity for couples to remain living together for longer, creating a supportive, dementia-friendly community, and a reduction in the strain experienced by the care partners. Barriers centred on a sense of loss, stress and uncertainty. Living and caring at home was perceived as preferable to shared care.Research limitations/implications The findings presented here have limited generalisability for two reasons. First, the shared care approach consulted on was very specific. Second, the participants form a purposive sample and as such are not representative of a wider population. Despite best intentions, the voice of people with dementia, are underreported in this consultation. Only one person with early on-set dementia was interviewed and the remaining two people with dementia were interviewed alongside their care partner.Practical implications The findings cast doubt on the viability of extra care facilities, designed for couples living with dementia, if extra care continues to be conceptualised and marketed as a preventative lifestyle choice. The findings indicate the value of consulting with people with dementia, and their care partners, when designing new forms of housing with care specifically for people living with dementia.Social implications The findings of this consultation exemplify the wish of couples living with dementia to remain together, in what they perceive to be “home”, for as long as possible. Couples living with dementia are therefore unlikely to wish to move into an extra care facility as a lifestyle choice option, early into their journey with dementia. This raises questions about the suitability of extra care, as a form of housing with care, for couples living with dementia.Originality/value This paper contributes to the body of literature, exploring the feasibility of new and innovative alternative care and housing options, for people with dementia. This paper is one of the first to explore extra care as a housing and social care option for couples with dementia. [ABSTRACT FROM AUTHOR]

Purpose: Employing brief, low-intensity, face-to-face parenting programs can result in improvements in parenting and child behavior; however, their usefulness is often limited by low participation rates. Online technologies are increasingly presented as a panacea for promoting program reach in a cost-effective way. The extant literature, however, provides limited guidance on issues around the implementation of online parenting programs. Grow is a universal, health-promoting parenting program that targets families with 5–10 year olds and was developed for face-to-face delivery and then adapted for a web-based format. The purpose of this paper is to present implementation results from feasibility proof of concept studies of Grow Face-to-Face and Grow Online and explores issues regarding mode of delivery and parent participation. Design/methodology/approach: Data were gathered from participants using attendance records, end-of-module/session surveys and semi-structured, in-depth interviews, and were examined using descriptive statistics and inductive thematic analysis. Findings: Findings suggest that, compared to the online implementation, recruitment was more difficult for the face-to-face implementation. Conversely, retention in the online program was poorer than in the face-to-face program. Participants from both programs self-reported high levels of engagement and satisfaction. Parents who completed Grow Online expressed a desire for more interpersonal interactions, which suggests a possible need for hybrid programs that combine online technologies with traditional face-to-face modes of delivery. Originality/value: These findings challenge the idea that the internet can fully address barriers to parenting program participation by showing that while parents may sign up more readily for an online program, they may struggle to complete all modules. This is problematic as program dosage can influence parent and child outcomes. [ABSTRACT FROM AUTHOR]

Purpose Facilitation of genuine occupational engagement rather than a more superficial level of participation that has minimal therapeutic benefit is a challenge within secure mental health settings. The purpose of this paper is to develop, pilot and evaluate therapeutic tools based on a framework of occupational engagement.Design/methodology/approach The study used action research with occupational therapists from two secure residential units. Focus group discussions gathered participants’ views of how the occupational engagement framework could be used to inform a therapeutic tool. Following the development and piloting of the subsequent tools, focus groups were again used to review their usefulness in practice. Discussions were audio recorded and thematically analysed.Findings Three tools were designed and piloted. Evaluation revealed a number of benefits and different ways in which the tools could be used in practice.Research limitations/implications This research has indicated that the occupational engagement framework has potential for increasing understanding of the relationship between the value and consequences of participating in occupations. The limited timescale of the research restricted the opportunity to fully explore the tools’ potential effectiveness as outcome measures.Practical implications The clinical tools developed within this research have provided some information to the clinical teams which has contributed to their understanding of how service users experience participating in occupations.Originality/value The occupational engagement framework and resulting tools have the potential to enhance understanding of occupational engagement within secure settings. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine Family Development Centre (FDC) staff’s[1] perspectives on their roles and capacity to promote early childhood language learning through good parenting.Design/methodology/approach This research employed in-depth interviews with 30 FDC coordinators and volunteer staff, supported by limited field observations.Findings Identifying risk, surveillance of at-risk families, building community solidarity and activities to support parenting and children, emerged as key components of FDC work. Volunteers softened their surveillance role by emphasising their social support function and personal links to local communities. Most activities aimed to strengthen family bonding and relationships, with fewer specifically addressing early childhood language deficits. Volunteers found the latter challenging, and generally sought to work in cooperation with education, public health and child care staff where projects involved language development.Practical implications Most volunteers said they lacked the capacities to promote early language development effectively and required additional training in such areas as partnerships and collaboration, family and parenting support, and project management. The authors argue that the importance given to partnerships reflects volunteers’ recognition that they need to draw on outside expertise to address children’s language problems. Given resource constraints, volunteers will remain central to family support work for the immediate future. Even with training lay volunteers will not become language experts, and future policy should centre on building a framework of professional support for the community teams.Originality/value This study fills a gap in knowledge about FDC volunteer roles and suggests a need for training that focuses on teamwork rather than specialist language expertise. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to draw on systemic and psychodynamic theories to subject published serious case reviews (SCRs) involving self-neglect to a deeper level of scrutiny, in order to understand how complex contexts impact on self-neglect work. It also updates the dataset of self-neglect SCRs and accompanying thematic analysis. Design/methodology/approach – Psychodynamic and systemic ideas are applied to the content of published SCRs in order to understand how different contexts – societal, legal, organisational, professional and personal – impact on and are influenced by work with adults who self-neglect. Further published reviews are added to the core dataset, with thematic analysis updated using four domains. Findings – Thematic analysis within and recommendations from SCRs have focused on the micro context, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis also commonly extends to how organisations have worked together and how Local Safeguarding Adults Board (LSABs) have supported and scrutinised their collaboration. This level of analysis enables an understanding of local geography. However, there are wider systems that impact on and influence this work, especially law and the societal context. If review findings and recommendations are to fully answer the question why, systemic analysis should be extended to appreciate the influence of national geography. Research limitations/implications – There is still no national database of reviews commissioned by LSABs so the dataset reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in LSAB annual reports. This makes learning for service improvement challenging. Practical implications – Answering the question why is a significant challenge for safeguarding adults reviews (SARs). Different approaches have been recommended, some rooted in systems theory. The theoretical formulations here extend the lens of systemic analysis on the different contexts that influence how practitioners work with adults who self-neglect and simultaneously are shaped by that work. This adds to the practice, management and organisational evidence base for working with adults who self-neglect but also shines the analytic lens on legal and policy mandates. Originality/value – The paper extends the use of systemic theory for understanding and learning from practice with adults who self-neglect and additionally offers psychodynamic formulations to appreciate what happens within and between practitioners and their organisations. The paper therefore contributes new perspectives to the methodology for conducting SARs. It also extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. [ABSTRACT FROM AUTHOR]

Purpose – The critical potential of hospital discharge policies and practices to ameliorate the health and social care needs of homeless people has become the focus of considerable interest in England. Central to this rise in policy formation and practice development is an acute understanding of the multiple exclusions homeless people face in navigating public health and social care systems. In ways small and large this nascent landscape is serving to redefine and reshape hospital arrangements for homeless people, and opening-up new ways to deliver care across clinical, social and therapeutic boundaries. The purpose of this paper is to seek to add empirical vigour and theoretical rigour to this unfolding policy and practice terrain. Design/methodology/approach – This paper draws on findings from a case study concerned with exploring and explaining how statutory and voluntary sector organisations use specialist hospital discharge policies and practices to coordinate pathways of care for homeless people. Findings – This paper illustrates how people affected by homelessness and ill-health are routinely denied access to statutory housing support, social work assessments and district nursing provision through acts of institutional gatekeeping and professional abrogation. Originality/value – This paper makes an important contribution to understandings of the connections between hospital discharge arrangements for homeless people and statutory housing, social work and district nursing provision. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to present a qualitative analysis of the facilitators of recovery in in-patient psychiatric rehabilitation from the service users' perspective. Design/methodology/approach -- Interviews with 31 in-patients were coded and analysed thematically at an interpretive level using an inductive approach. Findings -- The dominant themes identified were hope, agency, relationships and opportunity. Totally, 20 subthemes were identified. Agency was more important to men than women and agency, hope and relationships were all more important to detained patients. Research limitations/implications -- Interview data were collected in writing rather than taped. The results may not be transferrable to patient populations with significantly different demographic or service factors. Practical implications -- Services need to target interventions at the areas identified by service users as important in their recovery. The findings suggest both environmental and relational aspects of care that may optimise recovery. Services also need to be able to measure the quality of the care they provide. A brief, culturally valid and psychometrically assessed instrument for measuring the recovery orientation of services is required. Originality/value -- As far as the authors are aware no qualitative work to date has examined the recovery experiences of psychiatric rehabilitation in-patient service users in order to understand what services require to do to enable recovery from their perspective. The conceptual framework identified in this paper can be used to develop a service user self-report measure of the recovery orientation of services. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a qualitative analysis of the role of self-harm self-help groups from the perspective of group members.Design/methodology/approach A qualitative case study approach guided the research, which involved working with two self-harm self-help groups and all regularly attending members.Findings A thematic approach to the analysis of the findings indicates that self-harm self-help groups can provide a safe, non-judgemental space where those who self-harm can meet, listen and talk to others who share similar experiences for reciprocal peer support. Offering a different approach to that experienced in statutory services, the groups reduced members’ isolation and offered opportunities for learning and findings ways to lessen and better manage their self-harm.Research limitations/implications This was a small-scale qualitative study, hence it is not possible to generalise the findings to all self-harm self-help groups.Practical implications The value of peers supporting one another, as a means of aiding recovery and improving well-being, has gained credence in recent years, but remains limited for those who self-harm. The findings from this research highlight the value of self-help groups in providing opportunities for peer support and the facilitative role practitioners can play in the development of self-harm self-help groups.Originality/value Self-harm self-help groups remain an underexplored area, despite such groups being identified as a valuable source of support by its members. This research provides empirical evidence, at an individual and group level, into the unique role of self-harm self-help groups. [ABSTRACT FROM AUTHOR]

Purpose Problems related to sexual functioning have been reported in patients with anxiety disorders in general and panic disorder in particular. The past literature has shown the association of sexual conflicts of panic disorder patients with sadomasochism, and revealed the themes of: guilt, self-punishment, role of unconscious conflicts about sexuality, anger and separation. The purpose of this paper is to explore sexual conflicts in patients with panic disorder and their beliefs regarding guilt around sexual fantasies and dreams.Design/methodology/approach Interpretative paradigm and case study method was employed. For collecting data, semi-structured interviews were recorded, transcribed and subjected to within and cross-case analyses. Clarifying researcher’s bias and rich thick description were used for verification of data.Findings Cross-case analyses revealed themes of negative emotions, positive emotions and ambivalence. Negative emotions (i.e. guilt and anger) were experienced as threatening and harmful and caused distress to participants. Positive emotions, such as, satisfaction, pleasure and happiness were revealed in response to questions related to sexual fantasies, thoughts dreams, emotional attachment and sexual relations. Ambivalence was shown in response to questions related with reactions toward sexual fantasies, masturbatory practices, sexual relations and/or emotional attachment.Research limitations/implications The participants of this study consisted of two self-selected individuals who had diagnosis of panic disorder with agoraphobia. The main limitation of the study is a small sample size comprising of men only. This research can provide grounds for more Asian studies in future especially by including females.Practical implications The findings point toward addressing sexual conflict in therapeutic intervention of panic disorder.Social implications The findings have implications in society in expanding the awareness and knowledge about sexual conflicts in clinical population and general population suffering from anxiety symptoms.Originality/value This research study adds understanding of psychological issues in Pakistan’s socio-cultural context. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the support experiences of older people who have been abused in Ireland. Design/methodology/approach – Recruited through dedicated elder abuse services, nine older people who had experienced elder abuse participated in in-depth, semi-structured interviews. The data were analysed using thematic content analysis. Findings – The study highlighted the help-seeking pathways of abused older people and revealed that few older people sought help for themselves and most were unaware of the services available to support and protect older people. Data analysis identified the range and type of help received from family, friends, voluntary and statutory services, as well as the perceived barriers to accessing help and support. Research limitations/implications – The research did not include abused older people who lacked mental capacity or who had experienced self-neglect, criminal victimisation by strangers or who had not received statutory support services. This field may benefit from future research that seeks to examine the support experiences of these groups. Practical implications – Family, staff and professionals who care for older people need to be cognisant of the signs of elder abuse, and bring them to the attention of older people should they have concerns, as older people may not always recognise that they are being abused. Originality/value – The paper contributes to our understanding of the support needs of older people in Ireland and the perceived barriers to accessing help and support. [ABSTRACT FROM AUTHOR]

Purpose Many homeless people have significant levels of early adverse experiences and consequent mental health difficulties. The purpose of this paper is to examine the experiences of residents and staff living and working in a psychologically informed environment (PIE), a new model of hostel for homeless people which aims to update and make more flexible the principles of the therapeutic community, thereby meeting the psychological and emotional needs of residents.Design/methodology/approach Semi-structured interviews were carried out with nine residents, ten staff and five psychotherapists at two PIE hostels in London. The data were analysed using thematic analysis with a phenomenological epistemological approach.Findings Analysis generated 18 themes for residents and staff combined, organised into five domains: what makes a home, resident needs, managing relationships, reflective practice and theory vs practice of PIEs. The study suggests that PIEs broadly meet their aim in providing a different type of environment from standard hostels. Efforts to build relationships with residents are particularly prioritised. This work can be challenging for staff and reflective practice groups provide a supportive forum. There are limits to the extent to which the theoretical PIE can be put into practice in the current political and economic climate.Originality/value This is one of the first qualitative studies of PIEs. It provides perspectives on their theoretical background as well as how they operate and are experienced in practice. It may be informative to services intending to establish a PIE and to commissioners in assessing appropriate resources. [ABSTRACT FROM AUTHOR]

Purpose – The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice. Design/methodology/approach – Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts. Findings – Three main themes were identified: participants identified their normative task as the promotion of “moving on” (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults. Originality/value – Staff working in a inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report on a small telehealth pilot in local authority sheltered housing in NE England. This explored the training and capacity building needed to develop a workforce/older person, telehealth partnership and service that is integrated within existing health, social care and housing services. Design/methodology/approach – A qualitative case study approach on the implementation and deployment of a pilot telehealth service, supporting sheltered housing tenants with Chronic obstructive pulmonary disease (n=4). Findings – Telehealth training and capacity building, needs to develop from within the workforce/older person partnership, if a usable and acceptable telehealth service is to be developed and integrated within existing health, care and housing services. To be adaptable to changing circumstances and individual need, flexible monitoring is also required. Practical implications – Service users and workforces, need to work together to provide flexible telehealth monitoring, that in the longer term, may improve service user, quality of life. Originality/value – The pilot explored a workforce/older person partnership to consider how to add and implement telehealth services, into existing health and housing services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the lived experiences of women without children experiencing housing instability and homelessness in Calgary, Canada; and narratives of what triggered their journeys were constructed according to the tenets of hermeneutic phenomenology, and suggest a framework for assisting these women. Design/methodology/approach – The design for this study is qualitative, approached through hermeneutic phenomenology rooted in Gadamerian philosophical hermeneutics (Gadamer, 2004). Hermeneutic phenomenology, as a research method has provided insight into understanding phenomena and human experiences that are important to human science professionals. Findings – The experience of homelessness for women without children started while they still lived at home, but after they lost all sense of “being at home” as a consequence of identifiable negative home experiences, such as abuse. The effects or impacts of stable childhood or adult home experiences and the implications of such in contributing to the feelings of homelessness were pervasive in the stories told by these women. Practical implications – Access to housing does not mean getting out of the feeling of homelessness, because the trauma that triggers the experience for the clients often last for a life time. Long-term engagement with the client will be synonymous to increasing the possibility that they can be stabilized permanently. Resources dedicated to these clients must be tailored to each client’s needs, with strong agency collaboration with the mainstream systems. Social implications – Community health nurses and other support workers for individuals experiencing homelessness need to build bridges with inter-professional groups to close the gap created by societal attitudes toward women and domestic abuse survivors through advocacy and education, especially in countries where women are still treated as second class citizens. Originality/value – Although there has been a considerable amount of research conducted on the determinants of homelessness and housing instabilities in women or their pathways into homelessness, the plight of women without children and their experiences while homeless have received little attention in literature. This study explored the lived experiences of women without children experiencing homelessness and narratives of what triggered their journeys were constructed according to the tenets of hermeneutic phenomenology, and suggest a framework for assisting these women. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore how staff attend to their well-being when working in an inpatient mental health setting with older adults with dementia and complex mental health needs; how staff understand the link between their well-being and the well-being of patients. Design/methodology/approach – A semi-structured group interview was held with 11 members of two multidisciplinary teams. The discussion was audio-recorded and analysed using thematic analysis. Findings – Staff reported managing their well-being by both connecting with and avoiding the difficult emotions of the work. The team avoided the gravity of the work through humour, a task-focus, an absence of thinking and the displacement of workplace frustrations onto an outgroup. Connecting with emotions was done in tolerable ways: in contained reflective spaces, in the presence of supportive others, through genuine connections with patients as people and when the organisation demonstrated care for the staff. Practical implications – Avoidant strategies appeared to represent short-term ways of maintaining staff well-being, while connecting with the gravity of the work appeared to represent what we hope is a more sustainable approach to managing well-being. A crucial premise for staff well-being is teams embedded within organisations that care for their employees. Originality/value – Poor staff well-being can have serious consequences for an organisation, particularly in the existentially challenging environment of dementia care. This study offers a unique opportunity to explore staff well-being in a UK inpatient mental health setting with older adults with dementia and complex mental health needs. [ABSTRACT FROM AUTHOR]

Purpose – Mental health difficulties are often stigmatised because of situated ways of talking that become taken-for-granted “truths”. Against this backdrop, identities of those affected are constructed. The purpose of this paper is to explore identities of former inpatients at an Irish Child and Adolescent Mental Health Service. Design/methodology/approach – Ten young people (aged 18-22) participated in discussions and their discourse was analysed using a critical discursive perspective. Findings – Three key identities emerged: a hidden identity, a misunderstood identity and the struggle for a re-claimed identity. Research limitations/implications – Findings indicate the power of discourse in creating stigma and the need for mental health professionals to draw on empowering discourses to help service-users construct positive identities. The importance of involving service-users in research is also implicated. Originality/value – This research involves service-users who are increasingly, although not traditionally, involved in research. Use of qualitative methodology allows their voices to be heard and gives meaning to their experiences. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to add to the understanding of homelessness by exploring and analysing the homeless pathway of a young expectant mother as she negotiates her way through temporary accommodation and comes to terms with her circumstances and new identity as a person without a home. Design/methodology/approach – A phenomenological interviewing approach was used in order to gain insights into the subject's lived daily world from her perspective. Themes were then identified that encapsulated the essential qualities of the interview. Findings – The stress and negative emotions of being homeless appear to be accentuated significantly due to pregnancy, taking the potential for the positive feelings associated with pregnancy away from the participant. Structural factors such as the homelessness legislation and affordable housing supply had a strong influence over her homeless pathway, resulting in feelings of a loss of control over her destiny and choices and subsequent feelings of low self-worth, which she had to try to come to terms with. However, the pregnancy was also used as a positive coping strategy, as was family support. Originality/value – Minimal research has been undertaken on the experiences of homeless women who are pregnant. The results point to the need to understand the deeply negative impacts that homelessness can have on individuals, particularly expectant mothers. The value of examining homelessness as a pathway is also shown. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to analyse the reflective journals kept by 62 students researching and interviewing people with learning disabilities. The aim was to explore the content and discover any themes that were generated throughout the journals as a result of the pre-, during- and post-interview process. Design/methodology/approach - The method used to analyse the journals was Interpretative Phenomenological Analysis (Smith and Osborn, 2008). Findings - The results showed that there was a shift from negative to positive reflections as the frequency of contact with people with learning disabilities increased and that the majority of students reported a change in attitude towards this group of individuals after experiencing direct contact (two to three meetings over a period of two months). Research limitations/implications - Implications of the findings are for government policies, promoting social inclusion through education, to offer the opportunity for direct contact with people with learning disabilities, (in keeping with All port's, 1954 Contact Theory) at an earlier stage in education, fostering an environment for earlier attitude change and increased social inclusion. Social implications - Changing society's attitude through our education system may decrease marginalisation by the public as well as discriminatory and abusive behaviour found in some social and community care settings. Originality/value - This piece of research may add value to social, government and educational policies. Finding an evidence base to continue to build policies for decreasing marginalisation and promoting social inclusion for people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of the paper is to discuss how adult support and protection (ASP) work might support or further damage an adult's strengths, skills and sense of self. There is a particular focus on adults who require some support with decision-making. Design/methodology/approach – Forum theatre and other creative techniques were used to discuss ASP with 42 people who access support. A range of advice for practitioners was generated, a portion of which is reported here. The research design was participatory, with ten people who access support being members of the research team. Findings – ASP work can support or undermine an adult's strengths, skills and sense of self, depending on the way it is performed. Three inter-locking themes are presented to illustrate this finding. First, participants thought it might be intimidating to be "singled out", and wished to be understood in the context of their relationships. Second, ASP was thought likely to be experienced as a judgement on the person and their problem-solving skills. Third, people wanted to be "really listened to" and acknowledged as a person with preferences and strengths. Practical implications – It is important for practitioners to be mindful of the process of ASP work, as well as of its outcomes. Ways must be found to keep the person central, and to maintain and develop their strengths and sense of self. Originality/value – The perspectives of adults actually or potentially affected by ASP have been under-researched. This study adds substantially to the available evidence. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to report upon psychiatric trainees' experience of providing psychodynamic therapy for the first time and their experience of group supervision.Design/methodology/approach - A total of five trainees, undertaking training in psychodynamic therapies, were interviewed on multiple occasions over an 18-month period - before, during, and after undertaking their first case of psychodynamic therapy. A semi-structured, qualitative interview approach was used to explore providing psychodynamic psychotherapy and participating in psychodynamic supervision groups. Interviews were transcribed in full and data analysed following the conventions of thematic analysis.Findings - Trainees' anxieties about working psychodynamically and their concerns for developing new competencies are recognised. Personal and professional challenges associated with this therapeutic approach are identified and the importance of "looking after" trainees is stressed; the role of trainee supervision groups in this is advocated. The potential challenges of integrating psychodynamic thinking into general psychiatric practice are discussed and suggestions to address these difficulties are proposed.Research limitations/implications - The small sample size reflects the total number of trainees participating in training at the time of the study; for future work, a larger sample drawn from multiple training centres would be recommended.Originality/value - Training in psychotherapy is now mandatory for all trainee psychiatrists and this is something which many trainees find daunting; training in psychodynamic techniques is particularly challenging. A fuller awareness and understanding of trainees' experiences is important in nurturing clinicians who are competent in psychodynamic thinking, and who might consequently apply these skills clinically. [ABSTRACT FROM AUTHOR]