Exploring Mental Health Practitioners’ Beliefs About Hope and Experiences of Fostering Service Users’ Hope Within Community and Secure Settings

Hope has been linked to psychological well-being, resilience and
recovery from mental health difficulties. Many recovery-oriented policies
have included calls for mental healthcare staff to develop hope-inspiring
relationships with their clients. However, guidance and research regarding
the clinical application of these recommendations are lacking. This is
particularly the case within forensic mental health services, which have been
slower to adopt the recovery model. This thesis aimed to develop an
understanding of staff perspectives about hope and their experiences of
fostering hope with service users, in forensic mental health settings. An initial
scoping exercise found that no such studies have been conducted in secure
settings. Therefore, Paper One reports a review of qualitative literature
exploring staff beliefs of hope, practices to foster hope and the challenges
faced by practitioners across a broad range of mental health settings. The
therapeutic relationship, helping the client to maintain social connections,
uncovering values and goals and working to develop different perspectives
emerged as important hope-inspiring practices. Clinicians identified the
importance of maintaining their own sense of hope and also the challenges
to remaining hopeful. Many of the studies lacked an integration of the
themes and categories that emerged from analysis. Paper Two reports an
empirical study that utilised a Grounded Theory methodology to develop a
model of nurses’ experience of inspiring hope in their clients within one
medium secure hospital. The grounded theory that was developed from the
data described what it meant for the nurses to hold on to hope for their
clients. Two categories (being the intervention and doing reasonable hope)
captured the practices through which nurses worked to foster hope. These
practices were influenced by the nurses’ beliefs about hope and the context
of the secure unit. The model also captured the emotional impact of working
to inspire hope and the way in which nurses managed their emotional
response. The clinical implications of the findings, particularly to staff
recruitment, training and support, are discussed. Paper three outlines the
author’s own reflections on the research process.