Managing common mental disorders and PTSD in the community.

This thesis initially focuses on primary mental health provision within the community across common mental health disorders. It analyses a data set of Improved Access to Psychological Therapies (IAPT) service users from the North East Essex IAPT service Health in Mind. The analysis initially focuses on identifying predictors for referrals, non-attendance (did not attend/DNA) and levels of engagement. Following on from this examination of the data further analysis is undertaken on success assessment for the service users in the data set. An alternative assessment criterion is proposed and explored. Next, in response to increased pressure on NHS resources and services and to explore why certain client groups have high levels of non-engagement, the thesis then explores the specific mental health disorder of Post-Traumatic Stress Disorder (PTSD) in a client group of British Military Veterans. A series of three pilot studies (angling, falconry/archery and equine intervention) are carried out to explore the validity of a proposed new intervention to reduce PTSD symptomology, Peer Outdoor Exposure Therapy (POET). To extrapolate the learning achieved through the pilot studies a Random Control Trial (RCT) was executed looking at the efficacy of POET when utilising the most effective of the pilot study formats, angling. To enhance the knowledge obtained through the RCT a thematic analysis of four in depth interviews with participants from the study, thirty three months after their attendance, was utilised to help formulate a psychological model of the effect of POET.