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Phenylketonuria (PKU) is a rare metabolic condition characterised by an inability to metabolise phenylalanine (Phe), found in many foods. When pregnant with PKU, women must adhere to a strict low-Phe diet. If they do not, foetal abnormalities or pregnancy loss can occur. Pregnancies are therefore closely clinically monitored and dominated by dietary management, leaving little "space" for women's emotional experience. This article explores the emotional impact of PKU during pregnancy and how this effects pre-natal bonding. Based on interviews with six women with PKU, conducted whilst they were pregnant, this article explores their unusual and previously undocumented experience. Image-making during interviews allowed women to uncover aspects of their experience that might otherwise have remained hidden. Interpretative phenomenological analysis of the transcripts and images generated five themes summarising the women's experiences. Some themes reiterated findings from previous studies, for example, the huge cognitive burden associated with PKU pregnancies and the importance of both expert and informal support to successful pregnancy management. However, new understanding also emerged, including rich description of the emotional load of these pregnancies and strategies that women use to manage this. Anxiety about baby safety was central to their experiences, and the effect of this on pre-natal bonding was explored. This article calls for increased formal and informal support for women with the emotional aspects of their PKU pregnancies, for example, the creation of "attachment-aware" services that support women with their anxiety, promoting strong pre-natal attachment and subsequently protecting maternal and infant mental health throughout pregnancy and beyond. [ABSTRACT FROM AUTHOR]

Body dysmorphic disorder (BDD) is a mental health condition characterised by distress associated with perceived defects in one's physical appearance. Such defects are likely to be very slight or invisible to external observers, making it difficult for people with BDD to convey what they see. Participants created artwork representing how they cope with BDD, then completed a follow-up interview to discuss their artwork. Framework for the Analysis of Drawings was used together with Interpretative Phenomenological Analysis. Three overarching themes were generated from the analysis, centred around BDD's fusion with one's lifeworld, perceptual detachment, and fragmented selves. We suggest incorporating artwork creation in BDD research and clinical settings may elucidate understanding of "hidden" experiences. Clinicians may find it helpful to reflect on how the distinctive BDD "way of seeing" can infuse not just specific perceptions of the body, but also the person's wider relationship to the world. [ABSTRACT FROM AUTHOR]

Objectives: Mental imagery is important in the development and maintenance of psychological disorders and well‐being but has been neglected in people with intellectual disabilities. A detailed idiographic analysis of the lived experience of mental imagery in this population is presented. Design: This qualitative study uses interpretative phenomenological analysis (IPA). It involved inclusive research methods with people with intellectual disabilities and other stakeholders (including family members, advocates, support workers and intellectual disability service managers). Methods: Ten individual semi‐structured interviews were conducted with people with mild–moderate intellectual disabilities. Participants were opportunistically sampled through organisations providing community services to people with intellectual disabilities in the UK. Two men and eight women (mean age 43 years) participated. Interviews were audio‐recorded and analysed using IPA. Results: People with intellectual disabilities are able to experience a range of rich and detailed mental images across all sensory modalities. Participants reported changes in affect based on mental imagery, and an ability to experience both spontaneous and deliberate mental images. The emotional saliency of the object of mental imagery appeared to influence participants' ability to engage with imagery. A number of adaptations make mental imagery more accessible and easier to report. The ability of people with intellectual disabilities to experience vivid mental imagery has important clinical implications for the use of a range of mental imagery interventions with this population. Conclusions: The need to consider mental imagery interventions for this population, and how these can be adapted to ensure accessibility is a priority for people with intellectual disabilities and psychological disorders. [ABSTRACT FROM AUTHOR]

Few children with mental health problems access evidence-based interventions. Primary schools may be an ideal setting to improve access to treatment through screening and intervention programmes, but some families' circumstances and experiences may increase barriers to benefiting from this approach. Interviews were carried out with parents of children living in potentially challenging circumstances, including foster and military-connected families. We aimed to explore parent perceptions of a school-based screening/intervention programme and potential barriers to uptake. Parents described that due to their past experiences, that they might not trust or engage with a school-based screening/intervention. Nonetheless, parents considered that the delivery of a sensitive school screening/intervention programme might provide an opportunity for schools to strengthen their relationship with families. These findings highlight the need for future school-based screening/intervention programmes for child mental health to consider the needs of families of children from varied circumstances, and ensure steps are taken to promote trust. [ABSTRACT FROM AUTHOR]

Background: The Feeling Safe Programme is a cognitive therapy developed to improve outcomes for individuals with persecutory delusions. It is theoretically driven, modular and personalised, with differences in therapeutic style and content compared with first‐generation cognitive behavioural therapy for psychosis. Objectives: We set out to understand the participant experience of the Feeling Safe Programme. Design: A qualitative study employing interpretative phenomenological analysis. Methods: Using a peer research approach, semi‐structured face‐to‐face interviews were conducted with six people who had received the Feeling Safe Programme as part of the outcome clinical trial. Results: Participants spoke of feeling 'unsafe' in their daily lives before the intervention. Openness to the intervention, facilitated by identification with the programme name, and willingness to take an active role were considered important participant attributes for successful outcomes. The therapist was viewed as a professional friend who cared about the individual, which enabled trust to form and the opportunity to consider new knowledge and alternative perspectives. Doing difficult tasks gradually and repeatedly to become comfortable with them was important for change to occur. The intervention helped people to do ordinary things that others take for granted and was perceived to produce lasting changes. Conclusions: The Feeling Safe Programme was subjectively experienced very positively by interview participants, which is consistent with the results of the clinical trial. The successful interaction of the participant and therapist enabled trust to form, which meant that repeated practice of difficult tasks could lead to re‐engagement with valued everyday activities. [ABSTRACT FROM AUTHOR]

Schools may be well-placed to identify signs of mental health (MH) problems in children; however, there has been little research into how school-based screening and intervention initiatives should be delivered. One-to-one in-depth interviews were carried out with 15 practitioners that support children's MH within primary school settings. Data were analysed with template analysis. We explored practitioners' perceptions of a school-based screening/intervention programme for childhood MH problems and views about potential barriers to uptake. Three themes were identified. First, practitioners described feeling overwhelmed by the volume of children requiring support and the limited capacity of their service. Second, practitioners identified potential barriers to engagement in a school screening/intervention programme, including familial concerns about stigma. Finally, practitioners were optimistic that a screening/intervention programme could have positive effects for children who might otherwise not be identified as potentially benefitting from support. This study highlights that a primary school-based screening/intervention programme designed in partnership with stakeholders would be well received by practitioners supporting MH within school settings. [ABSTRACT FROM AUTHOR]

Objectives: Most existing research on the family context of psychosis focuses on the 'burden' of caring for people experiencing psychosis. This research is the first to ask young people experiencing early psychosis to 'map' and describe their experiences and understandings of their family relationships, and how they have related to their psychosis and recovery. Design: The research took an inductive, multimodal hermeneutic–phenomenological approach (Boden, Larkin & Iyer, 2019, Qual. Res. Psychology, 16, 218‐236; Boden & Larkin, 2020, A handbook of visual methods in psychology, 358‐375). Method: Ten young adults (18–23), under the care of early intervention in psychosis services in the UK, participated in an innovative relational mapping interview (Boden, Larkin & Iyer, 2018), which invited participants to draw a subjective 'map' of their important relationships. This visual methodology enables subtle, complex, ambivalent, and ambiguous aspects of the participants' experiences to be explored. Results: Findings explore the participants' accounts of how they love, protect, and care for their families; how they wrestle with family ties as they mature; and their feelings about talking about their mental health with loved ones, which was typically very difficult. Conclusions: This paper advances understanding of recovery in psychosis through consideration of the importance of reciprocity, and the identification and nurturance of relational strengths. The capacity of a young person to withdraw or hold back when trying to protect others is understood as an example of relational agency. The possibility for extending strengths‐based approaches and family work within the context of early intervention in psychosis services is discussed. Practitioner points: Young adults experiencing early psychosis may benefit from support to identify their relational strengths and the opportunities they have for reciprocity within their family structures, where appropriate.Relational motivations may be important for a range of behaviours, including social withdrawal and non‐communication. Services may benefit from exploring the young person's relational context and subjective meaning‐making in regard to these actions.Young adults experiencing early psychosis may benefit from opportunities to make sense of their family dynamics and how this impacts on their recovery.Attachment‐based and relationally oriented interventions that increase trust and openness, and reduce feelings of burdensomeness are likely to support family functioning as well as individual recovery. [ABSTRACT FROM AUTHOR]

Purpose: Section 136 (S136) of the Mental Health Act (1983, 2007) provides legislative powers for police officers to detain those suspected of being 'mentally disordered' for a mental health assessment. Despite its increasing use, there is currently little qualitative research exploring detainee's experiences. Methodology: Participants recruited from NHS places of safety participated in a semi-structured interview. The novel application of Critical Incident Technique (CIT) within this study enabled the specific identification of critical incidents which mental health service users thought had either helped with, or worsened the S136 detention experience. A wish list of absent factors was also gathered. Findings: Six categories of helpful critical incidents, seven categories of unhelpful critical incidents and five categories of wish-list items were identified. The importance of authentic relationships underpinned many categories, as well as challenging stigma, considering previous detentions; and receiving practical support. Originality/value: The outlined study is the first of its kind to utilise CIT methodology to specifically identify critical incidents related to the process of S136 detention. These findings provide specific ways to improve the experience of detention informed directly by those who have been directly subjected to S136. Take time to invest in meaningful relationships with those who are detained; asking about the individual's life experience and their perception of its relationship to their current presenting difficulties. Identify the service user's values -what's important to them, and what gives meaning to their life – and discuss this in relation to what their worries, concerns or wishes may be for treatment. Discuss previous experiences of involuntary admission- this can support all parties involved to consider the impact of detention upon the individual, and services. Use problem-free discussions to normalise and help de-stigmatise mental health difficulties and support rapport building. Provide practical support, such as food, drink and routinely allow those who are detained to gather personal belongings such as a change of clothes or a book. Ensure advocacy services are always available and accessible for those who are detained under S136. Where possible, avoid the use of restrictive or stigmatising practices in front of the public where possible (e.g. use of handcuffs, police vehicles as transport) to minimise risk of increasing mental health stigma. [ABSTRACT FROM AUTHOR]

Some aspects of experience can be challenging for research participants to verbalise. Interpretative phenomenological analysis (IPA) researchers need to get experience-near to meet their phenomenological commitments, capturing the "texture" and quality of existence, and placing participants in relation to events, objects, others, and the world. Incorporating drawing into IPA designs provides a vehicle through which participants can better explore and communicate their lifeworlds. IPA researchers also require rich accounts to fulfil their interpretative commitments. Drawing taps into multiple sensory registers simultaneously, providing polysemous data, which in turn lends itself to hermeneutic analysis. This article outlines a multimodal method, the relational mapping interview, which was developed to understand the relational context of various forms of distress and disruption. We illustrate how the approach results in richly nuanced visual and verbal accounts of relational experience. Drawing on an "expanded hermeneutic phenomenology," we suggest how visual data can be analysed within an IPA framework to offer significant experiential insights. [ABSTRACT FROM AUTHOR]

Background: Lifetime risk of suicide in first‐episode psychosis far exceeds the general population, with the risk of suicide persisting long after first presentation. There is strong evidence to suggest that women more frequently attempt suicide, while men are at a greater risk of completing suicide. First‐hand experiential evidence is needed in order to better understand men's motives for, and struggles with, suicidality in early psychosis. Methods: Semi‐structured interviews were conducted with 7 participants. The interviews explored each respondent's account of their suicide attempt within the broader context of their life, in relation to their past, present and future. In line with the exploratory, inductive nature of the study, an Interpretative Phenomenological Analysis was used to explore the meaning of suicide attempts in these accounts. Results: Three super‐ordinate themes emerged: Self‐as‐vulnerable (intra‐ and inter‐personal relationships), appraisal of cumulative life events as unbearable and meaning of recovery marked by shared sense of hope and imagery for the future. Conclusions: Young men in the early stages of their treatment are seeking to find meaning for frightening, intrusive experiences with origins which often precede psychosis. These experiences permeate personal identity, relationships and recovery. Suicide was perceived as an escape from this conundrum, and was pursued angrily and impulsively. By contrast, the attainment of hope was marked by sharing one's burden and finding a sense of belonging. Specialized assertive outreach programmes may be beneficial in improving the social inclusion of young men who may be particularly marginalized. [ABSTRACT FROM AUTHOR]

Objectives: To explore the perspective of adults with intellectual disabilities from minority ethnic groups, on their relationship with social care services. Methods: Thirty-two adults took part in semi-structured interviews. Transcripts were analyzed within a Pluralist framework, adopting the structure of Template Analysis and then drawing on phenomenological, narrative, and discursive approaches. Results: Our participants were generally positive about the services which they received, which they evaluated primarily in terms of their continuing good relationship(s) with specific workers. Our respondents were sophisticated users of cultural resources and identities; the concept of ‘cultural affordance’ may be useful alternative to ‘cultural competence’. We discuss three distinctive narratives about independence (Stability; Progress; Resistance). Each highlights the importance of maintaining connectedness to others, and the crucial role played by ownership of decision-making. Conclusions: We have developed a set of resources which service providers (and researchers) can use with people with intellectual disabilities, in order to support mutual understanding, service planning and delivery. [ABSTRACT FROM AUTHOR]

Abstract: Substance use amongst people with schizophrenia is well‐established: up to 50% report using illicit substances. The occurrence of both conditions can also induce people to disengage from mental health services. The research question sought to understand, from the perspective of both service users and clinicians, cannabis use within the experience of people with schizophrenia. The transcripts of the seven participants and the two focus groups were analysed using interpretative phenomenological analysis. Service Users and Clinicians were recruited from Assertive outreach community‐based teams. seven male service users who described their ethnic identity as ‘black’, diagnosed with schizophrenia and a history of treatment disengagement and 12 clinicians who worked with this client group. The two component study involved semi‐structured interviews with the Service Users and two focus groups with the Clinicians. Service Users perceived cannabis use as a means by which they could ‘reestablish their identity’ that had been damaged and the social consequences of diagnosis. Clinicians similarly perceived drugs, cannabis in particular, as a significant part of the service users’ life. This study provides greater depth to understanding cannabis use within the experience of people with a diagnosis of schizophrenia. [ABSTRACT FROM AUTHOR]

Abstract: Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as ‘black’. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in‐depth, semi‐structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) “People just keep hounding me”, (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants’ experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement. [ABSTRACT FROM AUTHOR]

Purpose: The study explored how service providers address the challenges of providing culturally competent care within disability services in the United Kingdom. Design/Method: Focus groups and interpretative phenomenological analysis were used to explore the experiences of 20 service providers from a range of professions, working with South Asian families. Results/Findings: Two superordinate themes emerged. The first concentrated on difficulties with language and communication and the challenges posed by the use of interpreters. The second included five subthemes that broadly described a five-stage process of dealing with barriers and engagement to service delivery, followed by reflections on the effort made to provide culturally competent care in the face of limited resources and training. Discussion/Conclusion: The study makes recommendations for cultural competency within health and social care services. [ABSTRACT FROM AUTHOR]

This research examines the experiential impact of hospitalisation on the parents of young people with early psychosis. In-depth interviews were conducted with a small sample of parents, and the resulting transcripts were analysed using Interpretative Phenomenological Analysis. Five themes emerged from the data: Accepting and blaming, Feeling out of control, Hospitalisation as temporary containment, Feeling let down by services and Stigma. Aspects of the hospitalisation process were characterised by parents as generally negative, but a number of positive affirmations were also offered regarding the containing, supportive and crucial role of services. Parents’ perceptions of hospitalisation as a difficult, and sometimes distressing, experience are exacerbated by the complexity of being the carer of a young person. Negotiating services and boundaries within the context of this relationship contributes to feelings of exclusion and disregard by professionals and services. The implications of this study resonate with the current government mental health strategy with regard to how services can engage and include carers in the mental health system, and equip and enable them to support their relatives with early psychosis. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the role of culture in shaping the caregiving experiences of British South Asian families caring for a child with developmental disabilities in the UK. In particular it explores how the coexistence of two distinct cultures (British/South Asian) impacts upon these caregiving experiences. Design/methodology/approach – A qualitative design using in-depth interviews and interpretative phenomenological analysis was used with seven parents identifying as British South Asian who had been born in the UK or had moved to the UK as young people. Findings – Three master themes emerged: living with loss, uncertainty and overwhelming responsibility; learning about disability and facing stigma; and having to cope. Research limitations/implications – Using a relatively homogeneous sample of carers this study provides an insight into how exposure to two different cultures shapes the understanding and adaptations of British South Asian carers in the UK. Social implications – Issues in the acculturation of these parents emerge which demonstrate the tensions they face in relating to both South Asian and Western cultural influences. The study makes recommendations for how services can work with such families in order to help them make sense of their children’s disability, access culturally appropriate support and cope with the numerous demands of being a caregiver. Originality/value – This paper contributes to a growing literature on the experience of South Asian parents who care for children with intellectual disabilities. It has important messages for workers about how to support these individuals most effectively. [ABSTRACT FROM AUTHOR]

This study examines carer attributes associated with placement stability for teenagers growing up in long term foster care, focusing on unexpected placement success. We explored experiences and perceptions relating to family, belonging and commitment in a group of foster carers providing a stable placement for a young person who had not been expected to settle. These placements showed positive outcome, despite factors in the child’s history that might have predicted otherwise.Seven foster carers were interviewed following a semi-structured guide, which covered their ideas about their relationship with the child in question, about the foster family, and the child’s sense of belonging in foster and birth family. Analysis of carers’ accounts of placements which had succeeded ‘against the odds’ revealed four major themes, described under the headings My Child—emotional bonding, the carers’ enlarged view of family and their parental regard for the young person; Jam in the Sandwich—working within a ‘compromised space’ between Local Authority and birth family; Repair and Rebuild—the craft of fostering including managing the foster/birth family boundary; Sticking with It—resilience, tenacity and maintaining hopefulness.The carers’ accounts offer pointers towards the ingredients of successful placements and prompt reflection on how these may be supported and promoted. They also highlight tensions inherent in the foster carer task relating to carers’ parental functioning for young people in long-term foster care. [ABSTRACT FROM PUBLISHER]

ABSTRACT Older homeless people are likely to have additional support needs in relation to well-being and housing. This study focuses on the experiences of hostel living for older, long-term homeless men in the UK. Semi-structured interviews were carried out with 10 participants. Transcripts were analysed using Interpretative Phenomenological Analysis. There were three main themes identified, which capture the men's concerns and the means by which they coped with the hostel environment: 'contingent sense of well-being in the hostel', 'importance of connectedness to others' and 'balancing independence with reliance on others'. Running through all the themes was a sense that three fundamental processes were in play: threat to material safety, threat to self-identity and threat to autonomy. Psychosocial implications of this study, for those working with homeless people, might involve addressing inequities of power, maintaining continuity of self-identity and facilitating the development of a sense of connectedness. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose - This study aims to explore the cultural context of care-giving amongst South Asian communities caring for a child with intellectual disabilities in the United Kingdom. Design/methodology/approach - In the context of the United Kingdom's Children's Intellectual Disability Services, the study set out to develop a culturally sensitive account of Sikh and Muslim parents' experiences of caring for a child with intellectual disabilities. Focus groups were conducted with parents from Sikh and Muslim support groups who were all accessing intellectual disability services for their children. Transcripts were analyzed using interpretative phenomenological analysis, a qualitative technique. Findings - Three master themes emerged from the analysis which were: Making sense of the disability; Feeling let down by services and Looking to the future. These themes reinforce findings from previous research particularly in relation to difficulties when making sense of the disabilities and difficult interactions with services. Practical implications - The study makes recommendations for service delivery to ethnic minority groups including being aware of intra-group variations in the interpretations and responses of South Asian parents. Originality/value - Ultimately, the study makes recommendations for developing culturally sensitive support and interventions for ethnic minority groups which is important given the increase in multi-ethnic populations in the UK. [ABSTRACT FROM AUTHOR]

Adult mental health problems can impact on parents, and research highlights that their children are at higher risk of developing mental health problems. In extreme cases, mental health problems are associated with a risk of fatal child abuse. Despite this, there are few studies exploring clinical decision-making by adult mental health professionals. This study used qualitative methods to explore Community Mental Health Team (CMHT) workers' experiences of decision-making in the interface between mental health and child welfare. Workers were interviewed about their experiences of clinical decision-making regarding child welfare. Interviews and accounts were analysed using Interpretative Phenomenological Analysis. Influences on decision-making were explored and triangulated with the accounts of Named Nurses for Child Protection. The findings revealed that CMHT participants were aware of their responsibilities towards children, but a complex synthesis of factors impacted on their sense-making about risk and welfare. Three superordinate themes emerged: the tensions of working across systems; trying to balance the perceptions and feelings involved in sense-making; and the role that interpersonal dynamics play in the understanding and management of risk. This paper focuses in particular on perceptions and feelings. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the personal meaning of eating difficulties. Eight women with a variety of eating issues were interviewed. These conversations were then analysed using Interpretative Phenomenological Analysis to construct a framework for understanding the personal world of the interviewees. Three overarching themes identified in participants’ accounts of their experiences are reported here: the experience of the eating difficulties as functional; negative effects of having eating difficulties; ambivalence towards the eating difficulties. These themes add to our knowledge of the potential role of personal experiences in the aetiology and maintenance of eating difficulties. [ABSTRACT FROM PUBLISHER]

Multiple placement transitions have been associated with poorer psychosocial outcomes for children growing up in local authority care. However, although there is an expanding literature examining the risk and protective factors connected with placement breakdown, very few studies have explored the quality of the move experience for those most closely involved with it. Our study considered how young people, foster carers and social workers made sense of unplanned placements’ endings. Bringing together the lived experiences of these key stakeholders in the placement system added a novel dimension to existing research knowledge. What emerged from our analysis was evidence of a pervasive and shared emotional experience; all of the participants were affected by the breakdown irrespective of age, experience, or professional role. However, despite many commonalities, there was also a strong sense of fragmentation between the groups, which was characterised by discourses of mistrust and miscommunication. This meant that emotional reactions to the breakdown were often suppressed or dismissed, resentments built-up and attempts to find a solution were thwarted by silence or angry recrimination. These findings raise real challenges for practice and policy development. In particular, they stress the importance of shared and meaningful dialogue between all key stakeholders within the social care system, the need for more effective and timely support when placements are in crisis and opportunities for those most closely involved with the placement breakdown to process the emotional experience. [ABSTRACT FROM PUBLISHER]

Romantic relationships are of particular importance to young people, and play a key role in the transition from adolescence to adulthood. Psychosis typically develops during late adolescence or early adulthood, a crucial period for gaining romantic experience. The significance of these relationships for young people with psychosis has never been explored. Eight participants were interviewed about their experiences and perceptions of romantic relationships using a semi-structured interview. The research was conducted using Interpretative Phenomenological Analysis (IPA). Five overarching themes emerged, suggesting that participants experienced conflict regarding romantic relationships, as they considered such relationships incompatible with psychosis, whilst they also associated them with normality and recovery. Relationships were perceived to be "risky", and participants were concerned with strategies for reducing these risks. Respondents typically perceived themselves to have a relative lack of experience and resources, making it more difficult for them to engage in romantic relationships. As romantic relationships are associated with a range of personal and social benefits, young people who have experienced psychosis may benefit from services supporting them in negotiating stigma and facilitating their involvement in romantic relationships. [ABSTRACT FROM AUTHOR]