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Discourses around prevention and population health have been gathering momentum in UK mental health policy for over a decade. This trend has been influenced by an economic rationale, prominent reports into the social determinants of health and mental health, and pressure from national and international organisations to take a population based approach to address them. And yet despite this, there are indications that the political focus on mental health prevention has not resulted in clear preventative action. The current study aimed to address the social problem of prevention through a critical appraisal of the discursive features of recent mental health policy. The intention was to facilitate clinical psychologists' engagement with the political context of their work. A 5 stage framework for Critical Discourse Analysis (Fairclough, 2001) was utilised to explore the underlying conceptual frameworks of relevant policies, and the impact these had on the way preventative action was operationalised. This was undertaken from a critical realist epistemological position. On the basis of a historical analysis into prevention and population health discourses, two representative policies were selected for more detailed discursive analysis. These were Advancing our Health: Prevention in the 2020s (Department of Health and Social Care, 2019) and the NHS Mental Health Implementation Plan 2019/20 - 2023/24 (NHS England, 2019a). The analysis indicated that potential discursive obstacles to preventative action could be found in; how the target of prevention was conceptualised, conflicting notions of responsibility for prevention, and the malleability of the concept of prevention itself. This was discussed in reference to the network of policy structures and practices that also present a barrier to prevention. Implications for clinical psychologists in terms of individual, community and policy level actions were considered.

Trans issues are at the forefront of today's society. It is estimated that approximately one percent of the UK population is gender variant, and the number of people accessing treatment is growing each year. However, linguistic research into trans identities and communities is still deficient. Models of language and gender studies still assume a binary gender structure and do not take into consideration the increasing amount of gender variance in society. Additionally, a lack of an established transgender studies discipline and limited numbers of trans researchers makes research into trans populations more difficult. The aim of this study is to examine how transgender people in North East England construct their identity with a backdrop of discriminatory discourses perpetuated by British news media and wider society. Sociolinguistic research into trans populations is an emerging area of study, as language and gender research has traditionally been constrained by cisnormative assumptions. Even with Butler's (1990) seminal work on gender and discourse, this kind of research has still been done within the binary gender system. Taking an inductive approach to data collection and analysis, I conducted semi-structured in-depth interviews with trans participants in the North East, and used a mixture of Membership Categorisation Analysis and Narrative Analysis for data analysis. The findings from the research illustrate how difficult it is for gender variant people to find a name or label for themselves within the binary system, and that emerging terminology is often inadequate for trans identities. Additionally, there is a pressure for gender variant people to adhere to narratives appearing in media outlets which perpetuate one way of 'being trans'. The difficulty in finding a name for oneself promotes a feeling of being the other. Also, the perpetuation of a singular trans narrative creates pressure and fear in people who may not adhere to it. In conclusion, this fear which arises for trans individuals is often pre-emptive as being othered through language and exposed to external ideas of gender variance creates an extra burden on participants. It is this that leads them to equate their positive experiences with luck.

Stroke is a major public health problem and stroke patients suffer much mortality and morbidity due to chest infections, especially in the acute period. Chest infections are associated with respiratory muscle weakness and poor cough. We studied ischaemic hemispheric stroke patients within two weeks of their first-ever stroke to investigate their respiratory physiology, volitional and non-volitional respiratory muscle strength and voluntary and reflex cough function. -- Patients were weak on voluntary but not involuntary tests of expiratory muscle function. They were also impaired on tests of both voluntary and reflex cough. The data we collected suggests that impairment may be due in part to ineffective coordination of the complex cough manoeuvre, following cerebral ischaemia. -- To further investigate the underlying reasons for impaired cough flow we studied functional residual capacity (FRC) in a group of stroke patients with mild impairments. In the semi-recumbent position patients’ FRC was significantly lowered, compared with healthy controls even in these acute patients little residual disability. The low FRC was strongly associated with low cough inspired volume and low cough inspired volume was associated with poor cough flow. -- Transcranial magnetic stimulation was used to investigate the corticomotor projection to the abdominal muscles. We also designed a cough training protocol to be tried initially in the lab, to see if there is an effect of cough training on corticomotor excitability. This was a feasibility study in two patients; we make recommendations to increase the training duration to ten minutes and suggest how TMS could be used to assess the effect of training on corticomotor excitability. If an effect is shown in the lab across a number of patients, the training regimen could then be tried over longer periods in a clinical trial.