Victoria Bird

Title	Supporting the recovery of black individuals who use adult community mental health services
First supervisor	Mike Slade
Second supervisor	Tom Craig
Abstract	Background There is currently a gap within the literature regarding the perceptions of recovery and the effectiveness of recovery-focused services for black individuals. Aims and Objectives The project aims to address the above gap in the existing literature by developing and testing a framework of recovery support for black individuals who use adult community mental health services. The project is being conducted as part of the REFOCUS programme and is structured around the MRC Framework for designing and evaluating complex interventions. Methods The study is using an experimental mixed methods design composed of three phases: Phase 1: Data from three sub-studies is being used to develop a framework of recovery support. Sub-study 1: A systematic review and narrative synthesis of existing models of recovery for black individuals. Sub-study 2: 13 semi-structured interviews which focused on the meaning of recovery. Sub-study 3: 5 focus groups assessing the barriers and facilitators of recovery from mental health problems. Phase 2: The preliminary framework developed in Phase 1 has been used to inform a component of a complex intervention to support recovery: the REFOCUS intervention. Phase 3: The effectiveness of the REFOCUS intervention for black individuals will be assessed in a cluster RCT. The RCT evaluation includes both a quantitative pre-planned subgroup analysis and a qualitative process evaluation both including individuals from black communities. Data from the RCT evaluation will be used to further refine and develop the model of recovery support for black individuals who use community mental health services.
Status:	January 2010 ongoing
Contact:	Email Victoria Bird

Elaine Brohan
Title	Disclosure of a mental health problem in the employment context: Measurement of stigma and discrimination and development of a decision aid tool
First supervisor	Graham Thornicroft
Second supervisor	Mike Slade
	Abstract Introduction This thesis expands knowledge about an important barrier to finding and keeping work for individuals with a mental health problem: the perception of and response to stigma and discrimination. Disclosure decisions are identified as a key point in which stigma and discrimination become personally relevant to the individual. Methods A mixed methods approach was used. After a systematic review, in-depth interviews were conducted with mental health service users. These themes identified were further explored using data collected in three employment contexts: 1) employed; 2) volunteering; and 3) unemployed. These themes and the systematic review were then used to develop a decision aid tool (DAT) to assist mental health service users in reaching disclosure decisions. The initial feasibility and acceptability of this DAT were assessed. In a complementary strand of work a narrative review on measures of mental illness stigma was conducted. A new measure of experienced discrimination (DISCv12) was then developed and psychometrically tested, as the review identified no suitable measure. Results Four super-ordinate themes were drawn from the analysis of the in-depth interviews (n=15): 1) public understanding of mental health problems; 2) the employment context; 3) personal impact of labelling; and 4) disclosure needs. These super-ordinate themes and their constituent sub-themes were reflective of the additional interviews (n=30). The finalised DAT demonstrated feasibility and acceptability (n=15). Mean decisional conflict regarding disclosure reduced from 52.0 to 35.5 after completing the DAT. The final DISCv12 demonstrated good psychometric properties (n=86) including inter-rater reliability (weighted kappa range: 0.62-0.95), internal consistency (α=0.78) and test-retest reliability (n=46) (weighted kappa range: 0.56-0.89). Conclusions This thesis advances knowledge by developing an empirically based model of disclosure beliefs and behaviours related to stigma and discrimination, by developing and piloting a decision aid tool relating to disclosure decisions, and by providing a new measurement tool to investigate experienced discrimination.
Status:	Passed
Contact:	Elaine Brohan
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