Annie Altschul Collection

Section 5(4) (nurse’s holding power) of the Mental Health Act 1983 empowers prescribed nurses to legally prevent an informal in-patient from leaving hospital for up to six hours. However, there is a paucity of research exploring the process of events before, during and after its implementation. The doctorate study addresses these deficits.
Themes:

Focusing on long term mental ill health into later life, 1) How does living with long term mental ill health affect achievement 2) How does long term mental ill health affect life in the present? Interpretation of 7 narratives (age 52-76) found many strengths and unique strategies for success.
Themes:Living with long term mental ill health; strengths perspectives; adult life; self protection; making sense; multiple prolonged stress; consequences of the consequences; better and worse at the same time; renewed sense of hope in later life

Sociological theories underpinned an investigation into the organisation and delivery of community mental health care in two contrasting case studies. Findings exemplify how roles are realised in specific, interactive, settings with work sensitive to local particularities and to the 'lines of impact' running between macro, meso and micro-levels.
Themes: Community mental health care; mental health systems; ethnographic methods; division of labour

Coercive measures are ethically, morally and professionally controversial. This mixed methods study explores patient, staff and environmental factors influencing variations in attitudes and experiences towards the use of coercive measures within a high security hospital.
Themes: Sociology; mental health; coercive measures; restrictive practices; restraint; seclusion; rapid tranquillisation; institutions; organisations; emotional work

Background: There is strong evidence that many individuals presenting to primary care mental health services through Improving Access to Psychological Therapies (IAPT) services have mild to moderate personality disorder traits and are less likely to benefit from routine IAPT treatment. Currently there are no specific treatments made routinely available to this patient group in IAPT services. Aim: To understand the service provision for people who present to primary care IAPT services with common mental health disorders and co-morbid traits of personality disorder. Methodology: The Medical Research Council (MRC) guidelines for developing and evaluating complex interventions with an emphasis on the theory and modelling phases were followed with three inter-related studies. These included a scoping study literature review and two qualitative studies exploring health professionals (IAPT Healthcare Professional) and service users (Patients) perspectives of working in, and using IAPT services. Analysis of the qualitative interviews was achieved using a thematic framework analysis approach. Results: The scoping study literature review identified a lack of evidence based treatments and understanding of this patient group and their treatment in primary care IAPT services. Qualitative interviews were conducted with 28 health professionals and identified skills deficits for working with this patient group. A treatment gap was described between the interface of primary care and secondary care services for this patient group. Adaptions to clinical practice are suggested however significant deviation from IAPT core business was not supported. Qualitative interviews were conducted with 22 patients and found that this patient group valued flexible approaches to care and individualised treatment plans. A lack of choice and collaborative decision making process was described. Step 3 interventions appear to be preferred due to increased treatment duration, skill and flexibility of therapist. Patients commonly reported a deterioration in their mental health before seeking referral to IAPT services, often reaching points of crisis. Conclusions: The scoping study literature review provided a rationale for further qualitative investigation of primary care IAPT treatments that led to studies 2 and 3. A synthesis of these results provides the necessary insight and depth of information required to provide recommendations for practice and identifies areas for future research. Four key recommendations have been proposed: (1) Education of the IAPT workforce (2) Clinical Interventions (3) Provision of Treatment at the Right Level and (4) National Recommendations.
Themes:Personality disorder; complex emotional needs; primary care; improving access to psychological therapies (IAPT); qualitative research

This thesis presents a narrative that connects discussion of a number of my papers submitted for consideration of the award of PhD by published work with reflections on methods and theory within a critical sociological context. This analysis of my publications is extended by a critical engagement with communicative action theory to consider its relevance for thinking about service user involvement activity in university settings.
Themes: Mental health; social movements; service user involvement; social constructionism; communicative action; democracy

This thesis examined the concurrent mental and physical healthcare received by patients diagnosed with a personality disorder on acute general hospital wards. An explanatory sequential design was used to integrate mixed data. Findings indicated that patients with a diagnosis of personality disorder were subject to adverse experiences in NHS hospitals.
Themes: Personality disorders; psychological distress; emotional distress; acute hospital; acute care; nursing; discrimination; parity of esteem

This interpretive phenomenological study focuses on women with anorexia and their care workers in both day care and in-patient specialist eating disorder services in the UK. The findings illustrate the complexity of the alliance and acknowledged the impact of anorexia and the anorexic identity on the relationship.
Themes: Anorexia; eating disorders; maternalism; relationship; SEED-AN; therapeutic landscape