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Gender identity assessments (GIAs) have been criticized by practitioners and trans and gender non-conforming (TGNC) individuals alike. With the practice of exploring individuals’ gender identity for treatment pathway purposes being potentially invasive and inappropriate, the current study aims to explore explicit standards.

The current study used the Delphi methodology to survey practitioners familiar with GIA. Over three rounds, 14 international participants rated their agreement about six areas relating to the assessment: purpose; content; approach; forensic application; psychometric instruments; and wider issues. Statements that reached an 80% cut-off among participants were viewed as a sufficient level of agreement, while the remaining items were fed back for repeated ratings. Furthermore, participants had the opportunity to suggest additional items that the group could rate.

Overall, a consensus across 23 items was achieved. The findings indicate a practice emphasizing collaboration between clinician and client to facilitate an informed decision. Furthermore, participants advocated for a non-pathologizing version of the GIA. This is a departure from diagnoses like gender dysphoria toward an approach which encapsulates also positive aspects of the trans experience, for example, resilience and future plans.

Limitations include sampling biases due to participants’ high specialization and challenges in recruiting TGNC individuals. Furthermore, findings appear restricted to adult services.

To the best of the author’s knowledge, this pilot is a first step to making current practice transparent and comparable, with the hopes to improve trans care. Furthermore, it is contextualized with the previously suggested application of the power threat meaning framework to GIA.

The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID).

Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID.

For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services.

Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution.

This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities.

Service users’ voice is at the forefront of movements within psychiatry that look to create more humanising care. Although genuine co-production of knowledge is limited by the power differential intrinsically functional to the health care setting, the arts have the potential to create collaborative environments and equalise relationships. The purpose of this case study is to describe and discuss the design and pilot evaluation of creative writing workshops in a forensic mental health ward as an innovative method for humanising care.

A creative writing intervention focussing on everyday experiences was implemented in a forensic mental health ward and involved four residents and four mental health professionals working together. Interviews were conducted with the four mental health professionals as part of a service evaluation. Transcripts were analysed using thematic analysis.

Two themes emerged from the analysis of interviews with mental health professionals: “a new way of learning about each other” and “imagining beyond the staff-resident relationship”. The authors discuss the intervention’s benefits in terms of its potential to foster mutuality and empathy beyond the illness narrative.

Creative writing can be used to engage patients and mental health professionals to jointly share everyday experiences and identities beyond illness.

The creative writing workshops present an innovative approach concerning the use of creative arts for humanising care through mutuality.

In this chapter, an overview of the trauma-informed approach is described. The background and context to trauma, its impact on the person, and organisational responses are considered. More specifically, I distinguish between trauma specific and non-specific organisations by defining the characteristic of each. This chapter sets the tone for the remainder of the book by introducing a conceptual model for both specific and non-specific trauma organisations. In order to do this, I outline the differential components that are deemed necessary for organisations to be trauma-responsive; in doing so, I introduce the Trauma Ecology Model to the literature, outlining its various components.

The label “Personality Disorder” continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by critical practitioners and academics are tempered by acknowledgement of certain positive social consequences of obtaining a diagnosis. This study aims to engage service users and staff in a process of inquiry to better understand the complexities of views on the terminology of Personality Disorder.

This study set out to qualitatively explore the views of a range of people with lived, occupational and dual lived experience/occupational expertise, relating to the diagnostic label of Personality Disorder, via participatory and critical group debate. The World Café approach is an innovative methodology for participatory inquiry into subjective views suited to exploring the contested subject matter.

This study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words “personality” and “disorder” are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered.

The findings have the potential to contribute to the ongoing critical debate regarding the value of the Personality Disorder construct in the provision of care and support. Specific emphasis upon the relational framing of care provision offers a means to ameliorate some of the negative impacts of terminology. Perspectives are influenced in the way the label is understood, hence, attention is required to enhance these processes in clinical practice. There is much more study required to overcome stigmatisation, prejudice, and lack of knowledge and understanding. Further research identifying means for challenging stigma and the factors contributing to positive clinical interactions are required.

This study brings together a wide range of views and experiences of mental health professionals, individuals lived experiences and those who align to both lived and occupational expertise. A safe space was provided via the uniquely co-produced World Café research event to bring together discussion and debates from mixed perspectives makes this a novel study. The focus being on perspectives towards contested language, labelling and social impact adds to scholarship in this field.

Readmission to hospital can be distressing, costly for the National Health Service (NHS) and legally it should be a last resort as it entails restriction of liberty. This study aims to develop an understanding of factors leading to readmission for a cohort of service users under the care of a community forensic mental health team (CFMHT) in England to consider how support could be improved to reduce incidence of future readmissions.

Thematic analysis was used to examine case recording relating to 13 service users who were readmitted to hospital within a specified time period. The same service users were invited to complete questionnaires regarding their views of what contributed to the readmission to cross-reference with themes identified.

The analysis of case notes produced eight sub-themes. These were sorted into three overarching themes, illustrating the challenges that service users face upon discharge from hospital, the sense they make of these challenges and the impact upon relational patterns, in particular with the CFMHT. Researchers highlight that the multiple challenges can increase service users’ sense of being under threat which can lead to distrust of professionals.

Practical suggestions arising from the study were fed back to the subject team and are listed at the end of the paper.

Findings from this study parallel those previously reported. This study contributes an inter-relational aspect of the factors and the central role of meaning-making in the path of recovery and building a life in the community.

This study aims to explore the lived experience of loneliness among a group of people diagnosed with the contested diagnosis of borderline personality disorder (BPD). In so doing, it contributes to works offering dimensional conceptualisations of personality disorders and contributes to loneliness study more broadly which has seen a rise in interest since the Covid-19 epidemic and the subsequent enforced isolation and the resultant new phenomenon of sudden loneliness.

Participants with diagnoses of BPD were recruited through a combination of calls through online fora and announcements at self-help groups. A total of 25 people made contact, with interviews eventually being carried out with 14 of these. They were invited to take part in unstructured, recorded one-to-one interviews. Thematic analysis was used in this study, which used a narrative phenomenological approach using an Arendtian lens.

Through attending to the interwoven themes in the narratives of trauma, loss and loneliness, it emerged that the enduring loneliness experienced was compounded by repeated instances of testimonial injustice.

This study supports the need for a further deepening of our understanding of the complexity of experience at the interface of loneliness and mental ill health.

This study critiques the reductive assumptions behind websites, simplistic tool kits and training within the mental health arena dictating “what works” for loneliness. The paper argues for health professionals to develop a more nuanced listening to reported loneliness and that part of what may compound this complex experience among people diagnosed with personality disorder is epistemic injustice, rife within a climate of neoliberalism.

Neoliberalism has been identified as a key driver of distinct shifts in mental health policy and the commodification of mental health. Its fixation with medicalisation and its drive to treat “mental illness” as a problem within the individual positions people as self-contained agents and downplays, or worse, ignores the social, cultural and economic dimensions that contribute to the person’s distress. Neoliberalism’s discourse of “responsibilization” for example, urges individuals that families, communities and workplaces rather than publicly funded services become the main resources to respond to in times of mental distress. This, however, assumes a concreteness to these institutions which may be illusory and leaves those in difficulty dependent on presumed immediate social circles. These circles, however, if they exist, may contain the very people who have failed individuals or subjected them to the testimonial injustices so often cited in the narratives of this research.

The Arendtian account of loneliness rests on the premise that the human being of contemporary society is afflicted with a sense of isolation and homelessness, further exacerbated in today’s neoliberal context. By drawing on this account, the enmeshed and complex nature of mental illness, loneliness and dislocation from society and the ways in which continued epistemic injustice negatively impact on mental well-being are laid bare. Phenomenology of loneliness goes some way to helping people without the devastating life experiences common to those diagnosed, rightly or not, with a personality disorder gain a sense of the experience, and this research argues for psychological practice to be more mindful of this literature and the value of closely heard first-person narratives.

This paper aims to consider stalking as an offending behaviour and the prevailing narratives associated with this offending behaviour given the increased attention of society and criminal justice. The stereotypes and labels associated with the offending behaviour often sensationalise aspects of those who engage in stalking. Frequently, individuals are portrayed as disturbed, psychopathic, mentally ill, violent and culturally deviant. Sometimes stalking behaviour is perversely downplayed as romantic perseverance. The impact of the stalker label extends outward from the act of marking legal and societal transgression, which impacts upon prospects for rehabilitation and desistance through the shaping of assumptions and maintenance of disempowering connotations.

This paper considers the impact of the stalking label as a therapeutic-, and perhaps rehabilitation-interfering problem for those who have stalked, drawing on recent research by Wheatley, Winder and Kuss (2020a).

It discusses the wide-ranging implications of labelling in this context and considers therapeutic approaches for intervention that may encourage rehabilitation engagement, mitigate shame and support desistance from a strengths-based perspective.

This paper draws on recent research exploring stalking case narratives of their own experiences of what drives stalking behaviour, existing labelling literature, and on specialist practitioners’ experiences of working with this group, to influence future thinking and research to address nuances highlighted.

Mental health services have changed significantly in the past few decades. Currently, our services are transforming from one that was biomedically led to one that encompasses a recovery orientation. Additionally, a new field of study as it related to mental health care is emerging that of trauma-informed care. In this chapter, we explore briefly what we mean by the terms trauma and trauma-informed care. This is followed by a critical examination of how co-production and servant leadership can work together to support individuals through their trauma towards recovery and well-being. From which, we suggest that peer support workers are suitable candidates to co-produce trauma-informed services as they embody the connecting principles of choice and empowerment needed for all three concepts to converge and work together to enhance recovery and well-being. While I focus on using co-production in the mental health space in this chapter, the principles and practices can equally apply to other health and social care services.

This study aimed to explore how forensic mental health service users make sense of their past adverse experiences. Secondly, it aimed to explore whether service users considered their adverse experiences to be related to their current stay in a forensic mental health setting.

Interpretative phenomenological analysis was used to analyse interviews with eight service users in low and medium secure care. Six of the participants were male and two were female.

Four super-ordinate themes emerged from the data: “Living amongst adversity”; “Managing adverse experiences”; “Making sense of going into secure care”; and “Coping with the past in the present”. All participants referred to multiple adverse experiences throughout their lives and used harmful coping strategies to manage these. Individual differences in how they related their past experiences to their detention in secure care were evident.

Author guidelines state that this section is optional. Implications for clinical practice are discussed at length in the discussion section.

This study offers an insight into the way in which forensic mental health service users make sense of their past traumas in relation to their current admission to secure services. To the best of the authors’ knowledge, no research has previously addressed this from the perspective of service users.