Joanna Maher - thesis submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology (DClinPsych)

Chapter 1 Critical Review of the Literature (CRL) Providing care for individuals with a diagnosis of Borderline Personality Disorder (BPD) forms a large part of mental health service provision. The care needs of this population are often complex and can raise a number of unique challenges for healthcare staff. Using insights from the social-cognitive model of stigma, this review first explores the challenges that may be experienced by this client group within a healthcare context. From this foundation, this review seeks to consider the specific components of training interventions for staff which seek to improve knowledge, attitude and/or behaviour toward this client group. To this end, searches were undertaken on EMBASE, PubMed, PsycINFO, CINAHL and Medline and, after screening, 18 eligible papers were identified. These included quantitative, qualitative and mixed method papers. Quantitative data highlights the variety of practical and interactive delivery methods employed by facilitators to convey theoretically driven training content. Qualitative data revealed that participants (healthcare staff) found benefit from an interactive, practical training programme, alongside the provision of a novel yet accessible framework through which to better understand BPD. The benefit of peer-support, personal testimony from an individual with lived experience and support post-training was also highlighted. Key limitations of existing literature are explored and recommendations for future research are suggested. Chapter 2 Service Improvement Project (SIP) Purpose Mental health crisis care within the UK has been highlighted as a healthcare challenge that demands urgent attention. Launched in 2018, Oxford Safe Haven (OSH) is an out-of-hours crisis service seeking to provide a non-medical space for adults in mental health crisis. This study seeks to explore the impact of OSH from two perspectives; the experience of the service-user and whether there is a change in use of other emergency services for those attending OSH. Study approach This study employs a mixed-method approach. Semi-structured interviews with eight service-users were conducted to explore individual’s experience of the service. Thematic analysis was used to identify key themes. Service-user feedback forms were also considered. Alongside this, A&E attendance rates 12 months before and after first OSH attendance were analysed to assess whether pattern of OSH use impacts use of A&E. Findings Overall response from service users was positive and service-users indicated that OSH provides rich and varied care. Contrary to prediction however, there did not appear to be a change in A&E use for individuals using OSH. This presents a complex picture. Findings suggest that there are distinct groups of individuals who have differing care needs and engage with crisis services in different ways. Value Whilst conducted at OSH, this study provides novel insights into service-user experience and engagement with this service delivery model. This study presents recommendations for service development from both a commissioner and practitioner perspective. Further research is needed to understand the perspective of different groups of individuals engaging with crisis care services. Chapter 3 Main Research Project (MRP) Transition to motherhood can be a time of intense stress for women, and mental health problems, including anxiety, are common during this time. This study seeks to understand the relationship between post-natal stress, level of social support and the development of post-natal anxiety in the first months of motherhood. Online questionnaire data collected between 6-10 weeks and 14-18 weeks post-partum for 80 new mothers was included in the study analysis. Contrary to prediction, moderated regression analysis indicated that level of social support did not moderate the relationship between stress and anxiety during this period. Overall, this sample reported low levels of anxiety which is in contrast to other similar studies. In seeking to understand these findings, the impact of online recruitment and data collection are considered, alongside factors such as the presence of other mediating or moderating factors. Future research with this population should carefully consider participant recruitment methods in order to connect with a sample of women that reflects the wider population.