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This article traces how students are represented in undergraduate prospectuses from 1998 to 2021 by employing a corpus-assisted approach to critical discourse analysis of a 1.9 million word corpus of prospectuses from a single Russell Group university in England. Recent decades have witnessed an increase in tuition fees and competition to attract students; hence, it is important to understand to what extent, if any, the representation of students has changed in the prospectuses. Our findings add to the literature by showing for the first time that the representation of students in prospectuses has shifted in ways consistent with the impact of market-driven policy on the sector. Initially, students were positioned primarily as learners, partners to the university, and members of a community. Latterly, students are positioned primarily as consumers and future professionals. These findings are significant because they capture the extent to which a market-driven agenda has been normalised by institutions, and demonstrate how this process of normalisation occurs. Even before they reach campus, young people are conditioned and defined by the market, with the prospectus presenting university as an opportunity to enhance earning power rather than to benefit from life-changing education. [ABSTRACT FROM AUTHOR]

Background: Instances of self‐harm by young people are rising and are an increasing challenge for healthcare and mental health services. Young people's negative experiences of accessing help and support when they self‐harm are a contributing factor to them not seeking help in future episodes. Method: Semistructured interviews were conducted with 10 young people aged 17–20 years old who had received therapy relating to self‐harm from a National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) service in the East of England. The data were analysed using reflective thematic analysis. Findings and Discussion: This study provides a new understanding of how a greater sense of feeling in control over their lives is a common goal for therapy for young people who self‐harm. This investigation also shows that gaining understanding or reclaiming a sense of being in control results in the young person experiencing the therapy in a positive light and assessing it as successful. The results also show that an increased sense of being in control is sometimes overlooked and a missing aspect of therapy with young people who self‐harm. [ABSTRACT FROM AUTHOR]

Objectives: Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability. Design: Qualitative interview study. Methods: Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non‐affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi‐structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability. Results: Interviews (Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self‐efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy. Conclusions: Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone). [ABSTRACT FROM AUTHOR]

Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression. Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. Results: A total of 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. A total of 199 (36.6%) participants knew about the MCA. A total 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney, respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services. Conclusion: In BD, the demand for advance plans about welfare with loss of capacity was high, but utilisation of the MCA was low with barriers at service user, clinician and organisation levels. [ABSTRACT FROM AUTHOR]

Background: Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar.Methods: A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team.Results: In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT's long-term availability.Conclusions: Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions.Trial Registration: Study registration: ISCTRN 16267685. [ABSTRACT FROM AUTHOR]

The role of staff involved with undergraduate admissions and recruitment has changed since the turn towards marketisation in higher education. This article focuses on the system in England following both a sharp rise in student fees and an associated tendency for the public university agenda and related social priorities, such as widening participation, to come up against more private and commercial priorities, such as business engagement, league table performance and internationalisation. Drawing on evidence from detailed interviews with admissions personnel, both academic and non-academic, across three disciplines within one higher prestige university, we revisit the notion of selectivity and the practice of selection. Tensions are revealed between two opposing approaches: a more traditional model of university admissions, as based on local knowledge and sensitivity towards underrepresented groups, and a purportedly merit-driven model, as driven by perceived market position. We explore the intricate and often unexpected ways in which staff reconcile their professed beliefs with their professional practices, and the complex identity work needed to renegotiate personal values in light of shifting institutional needs. Findings are offered as a microcosm for broader trends in the higher education sector. [ABSTRACT FROM AUTHOR]

In 2012, the English Higher Education system witnessed one of the biggest hikes in the cost of university participation seen in the sector, with the annual fee for most undergraduate degree programme raised to a new limit of £9,000. Accompanying this rise in 'headline' fees was a series of changes to the repayment mechanism that allowed the move to be framed in progressive terms by policymakers and other advocates. A small dip in applications followed, but the UK's widening participation agenda seemed not to be bruised by the hike, with the proportion of students from less advantaged backgrounds applying to higher education institutions (including higher prestige universities) remaining constant. This paper examines the messages that were communicated alongside the 2012 fees rise, its aim being to help shed light on how public discourses about participation in the higher fees era are framed. It is argued that the greater overall expense for most students in terms of lifetime repayments was partially obscured in favour of a narrative that emphasised the short-term benefits for middle-earning graduates and long-term concessions for lower-earning graduates. Using the contemporary English model as a case study, the wider implications for quality and, more particularly, equity of a less regulated, more market-driven higher education system are explored. Attention is also paid to the impact on selection procedures and on broader questions about the extent to which university is (and is perceived as) a public or private good. [ABSTRACT FROM AUTHOR]

Objective: Living Library events involve people being trained as living 'Books', who then discuss aspects of their personal experiences in direct conversation with attendees, referred to as 'Readers'. This study sought to generate a realist programme theory and a theory-informed implementation guide for a Library of Lived Experience for Mental Health (LoLEM)., Design: Integrated realist synthesis and experience-based co-design., Setting: Ten online workshops with participants based in the North of England., Participants: Thirty-one participants with a combination of personal experience of using mental health services, caring for someone with mental health difficulties and/or working in mental health support roles., Results: Database searches identified 30 published and grey literature evidence sources which were integrated with data from 10 online co-design workshops conducted over 12 months. The analysis generated a programme theory comprising five context-mechanism-outcome (CMO) configurations. Findings highlight how establishing psychological safety is foundational to productive Living Library events (CMO 1). For Readers, direct conversations humanise others' experiences (CMO 2) and provide the opportunity to flexibly explore new ways of living (CMO 3). Through participation in a Living Library, Books may experience personal empowerment (CMO 4), while the process of self-authoring and co-editing their story (CMO 5) can contribute to personal development. This programme theory informed the co-design of an implementation guide highlighting the importance of tailoring event design and participant support to the contexts in which LoLEM events are held., Conclusions: The LoLEM has appeal across stakeholder groups and can be applied flexibly in a range of mental health-related settings. Implementation and evaluation are required to better understand the positive and negative impacts on Books and Readers., Trial Registration Number: PROSPERO CRD42022312789., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis., Methods: The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders., Discussion: This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious., Trial Registration: ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.

Background: Bipolar disorder (BD) is a chronic and recurrent affective disorder. Recovery is defined as the process by which people can live fulfilling lives despite experiencing symptoms., Aims: To explore how an opportunistically recruited group of service users with BD experience recovery and self-management to understand more about how a service users' recovery may be supported., Method: Twelve service users with BD took part in a series of focus groups. Service users' responses to questions about their personal experiences of self-management and recovery were analysed. Focus groups were transcribed verbatim and thematic analysis ([ Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101]) was employed to identify common themes in the data., Results: Four key themes were identified: (1) Recovery is not about being symptom free; (2) Recovery requires taking responsibility for your own wellness; (3) Self-management: building on existing techniques; (4) Overcoming barriers to recovery: negativity, stigma and taboo., Conclusion: Service users with BD have provided further support for the concept of recovery and have suggested a number of ways recovery can be supported. A self-management approach informed by the recovery literature has been proposed as a way to support service users' recovery.

Objectives: This paper aims to study dysfunctional self-schematic processes, abnormal coping styles, over-responsiveness to reward stimuli (indicative of an over-sensitive behavioural activation system) and stability of self-esteem in relation to subclinical hypomania., Design: Three cross-sectional studies were conducted on selected students on the basis of their scores on the Hypomanic Personality Scale (HPS) (study 1) and on elevated HPS and Dysfunctional Attitude Scale scores (studies 2 and 3)., Methods: In studies 1 and 2, participants completed questionnaires and kept a self-esteem diary for 6 days. In study 3, the experience sampling method was used to assess momentary self-esteem, emotion and use of different coping styles over a 6-day period., Results: Study 1 demonstrated that hypomanic traits are associated with high fluctuations in self-esteem. In study 2, high scores on both the HPS and the Dysfunctional Attitude Scale, but not the HPS alone, were associated with bipolar spectrum symptoms. These participants showed more evidence of alcohol and substance abuse, greater self-esteem fluctuation and dysfunctional coping styles (rumination and risk-taking) compared with controls. Changes in self-esteem were related to the use of these strategies., Conclusions: Vulnerability to bipolar disorder is associated with a combination of depression-related and reward-related processes., (Copyright © 2011 John Wiley & Sons, Ltd.)

Specific forms of ruminative cognitive styles and self-appraisals have been implicated in the development of bipolar symptomatology. This study investigated the associations between measures of positive and negative forms of appraisals and rumination with vulnerability to hypomania, and also investigated the conceptual overlap between these measures in terms of the responses to emotional experiences captured. Hypomania vulnerability was predicted by measures of positive cognitive styles, whilst current depressive symptoms were explained by scores on measures of negative cognitive styles in an analogue sample of 353 participants. A principal components analysis conducted upon the rumination and appraisal measures yielded three components representing positive and negative cognitive styles, and a normalizing of symptoms component. The implications of these results are discussed., (© 2011 Wiley Periodicals, Inc.)