AbstractIf you are someone affected by severe mental illness your personal identity may be invalidated as an inpatient on a psychiatric ward (Goffman, 1961; Rosenhan, 1973). This can also happen, however, and frequently does, in community psychiatric contexts such as outpatient settings and day services where one would expect a more personal approach to support. My dissertation presents a combination of four qualitative research studies, alongside theoretical analysis, to support this thesis and offer some alternative reflections on how we might reconceptualise community psychiatric services.
The first paper draws on my personal experience as both a voluntary and paid support worker for voluntary sector organisations to provide examples of how the contract culture has evolved in local authorities, and how the loyalties of the dayservice providers have tended to shift from the actual service users to the funders instead. The fourth study returns to this issue and is based upon a case study analysis of a social inclusion day-service. It was found that the service users were being asked to fit their lives and identities into rigid services and intervention frameworks that were contractually driven, rather than led by their own needs.
Loss of identity and agency was found to occur in the more formal outpatient facilities. Study 2 presents a discourse analysis study of how the loss and the return of agency in therapeutic relationships are signalled by linguistic structures adopted in the narratives of psychiatric outreach service users. Study 3 incorporates thematic analysis to investigate the positive and negative experiences of compliantly ‘engaged’ community mental health team outpatients. These apparently compliant outpatients nevertheless often felt invalidated as human beings. They mainly attributed this sense of de-personalisation to brief contact with frequently changing psychiatrists, the rigid intervention frameworks, and practitioners showing a lack of courtesy and personal concern.
Study 5 presents further evidence of the failings of contemporary community intervention frameworks by contrasting the lives of two individuals affected with severe mental illness. Their narratives reveal the richness of their lives and aspirations and the systemic failure of community psychiatric services to address their personal needs. The final general discussion summarises the weaknesses in contemporary intervention frameworks and draws on the work and thoughts of the early pragmatists (most notably George Herbert Mead and John Dewey) to propose a pragmatic way forward. Community practitioners need to move away from forcing service users’ lives into fixed frameworks, and instead should acknowledge and accommodate the shifting personal complexities of being a human living with a mental illness.
|Date of Award||May 2011|
|Supervisor||Alan Costall (Supervisor), Clare Wilson (Supervisor) & Joerg Zinken (Supervisor)|