Emma Izon - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: sexuality
concealment
identity
Jewish
LGBTQ+
severe mental illness
family
healthcare professionals
hallucinations
older adults
psychological intervention 
psychosocial
qualitative
psychosis
minoritised groups
siblings

Systematic Review of the Literature: The Psychosocial Stressors of Siblings of People with Experiences of Psychosis (SOPEP): A Systematic Narrative Review across Cultures.
Background: This study aimed to synthesise the psychosocial stressors of siblings of people with experiences of psychosis (SOPEP). Understanding the specific needs of siblings across diverse cultures would help mental health services to provide culturally specific psychosocial family and sibling-centred support. This may result in improved relationships between families, better psychosocial wellbeing for siblings, and better outcomes for patients. Methods: Following PRISMA guidelines, a systematic review was conducted to explore the psychosocial stressors of SOPEP. Six databases were utilised to identify literature of qualitative methodology. Results: Twenty-two studies were included that investigated the Psychosocial Stressors of SOPEP. SOPEP’s experiences were influenced by various stages: individual factors, social factors, physical and macro-level environments. Six key components contributed to SOPEP’s psychosocial stressors and facilitated or hindered their intentions, behaviours, and experiences of caregiving. These were the SOPEP’s beliefs about psychosis, caregiving beliefs, family and cultural values, personality traits, pragmatic challenges, and access to resources. Conclusions: Globally, SOPEP and families may benefit from their involvement in family interventions and individual support that facilitates caregiving and acknowledges their responsibilities, resources, psychosocial needs and emotional experiences.

Service Improvement Project: Understanding Barriers to Receiving Psychological Intervention for Older Persons in the Community, who Experience Distressing Hallucinations.
The NHS 10-year plan aims to address inequalities in service provision, provide appropriate mental health support to all ages, and upskill healthcare professionals working in mental health community services. This research involved three phases: Phase 1– a clinical audit, Phase 2– a survey exploring the perceptions of mental health professionals in the service, and Phase 3– the Plan-Do-Study-Act improvement strategy. Between 2015-2021, only 6% of older persons with experiences of hallucinations were referred to psychological services, of whom only 1.3% received psychological interventions. Healthcare professionals within the community mental health team felt a combined psychological and pharmaceutical approach was most helpful for patients but were less confident referring patients to psychological services and discussing these benefits. Recommendations for services include utilising assessment tools to assess hallucinations in older persons, collaborating with third sector organisations and access to further training for healthcare professionals.

The Theoretical Driven (Main) Research Project: Investigating Sexual Orientation Concealment and Psychological Health in an Ethno-religious LGBTQ+ Jewish Group and Non-religious LGBTQ+ Group.
Background: An individual’s relationship with sexuality and religion may be complex, particularly when these principles conflict. According to Minority Stress Theory, people from minority groups (e.g., religion, sexuality) can experience excess stress, which may contribute towards psychological distress. LGBTQ+ people living in more stigmatising environments may therefore seek to conceal their sexual orientation and this can negatively impact their mental health. Aim This study looked to investigate sexual identity concealment in an ethno-religious Jewish LGBTQ+ population. Methods: The experiences of concealment of Jewish LGBTQ+ were compared with a non-religious LGBTQ+ group. Information about participants’ concealment behaviour and their psychological health was collected, alongside participants’ Jewish identity. Results: Concealment was higher in the non-religious LGBTQ+ group compared to the Jewish LGBTQ+ group, although overall mental health was significantly poorer in the Jewish group. The study did not find concealment to predict mental health. Within the Jewish group, LGBTQ+ individuals who identified as more culturally and religiously Jewish concealed more. Discussion: Other processes may better predict mental health for this population. Minority Stress Theory suggest this may be due to proximal stressors, such as expectations of rejection or internalised homophobia. Meanwhile, the importance of Jewish cultural and family values over religious practice may explain participants’ openness about their sexual orientation. There is a need for qualitative research to explore the impact on and purpose of concealment for Jewish LGBTQ+. There is also a need for more quantitative research to better understand the experiences that contribute towards mental health difficulties for LGBTQ+ Jews and how services can meet this need.