The inter-relationships between stigma, severe mental health problems, substance use and suicidal thoughts and acts.

Suicidal thoughts and acts are a severe global health concern, and are significantly elevated in people with severe mental health problems, such as, mental health problems on the schizophrenia spectrum. The use of alcohol and drugs by those with such problems further elevates the frequency and intensity of suicidal thoughts, behaviours and attempts. Stigma from others (external) and the self (internal) is often associated with both severe mental health problems and substance use. Research is needed which examines the interplay between internal and external stigma, mental health problems and substance use, and the ways in which this interplay affects suicidal thoughts, plans and acts. The over-arching objective of this PhD proposal is to investigate the interactions between severe mental health problems, internal and external stigma, and substance use which feed into the psychological mechanisms underlying suicidal thoughts, plans and attempts using convergent qualitative, quantitative, and mixed methods, designs and analyses. Four empirical studies are proposed.
The first and second study will use qualitative methods and analyses, namely grounded theory, to investigate experiences of internal and external stigma, mental health problems, substance use and suicidality. The first study will recruit adults living in the community with mental health problems, specifically schizophrenia. The second study will recruit mental health professionals from NHS mental health services and mental health charities. The third study will use experience sampling to track in the moment thoughts, feelings and behaviours relating to stigma, substance use, mental health problems and suicidality throughout the day for seven days. This data will be analysed using multi-level modelling. The fourth study will use a daily diary to collect free responses relating to stigma, mental health problems and suicidality from both people with mental health problems and from mental health professionals. The data will be analysed using mixed methods in which qualitative and quantitative responses converge. The methods used across the studies are diverse, e.g., qualitative, quantitative, and mixed methods and, therefore, provide excellent post-graduate training and preparation for post-doctoral fellowship applications. The project also involves training in advanced clinical psychology skills, namely, administering structured clinical interviews (e.g., the PANSS; Positive and Negative Syndrome Scale for Schizophrenia).
Patient and Public Involvement is central to this PhD proposal and a service-user reference group will be set up at the outset which will feed into all stages of the work from refining the research questions to disseminating the findings.