A narrative analysis of service users’ stories of recovery 1.0
Research type
Research Study
Full title
A narrative analysis of service users’ stories of recovery within a Scottish Forensic Mental Health Service
IRAS ID
319039
Contact name
Judhika Ravindran
Contact email
Sponsor organisation
NHS Lanarkshire - Primary Care Division
Duration of Study in the UK
0 years, 8 months, 26 days
Research summary
Summary of Research
This study aims to capture the recovery stories of service users currently involved within forensic mental health services either as inpatients or those living in the community. This is because most studies exploring forensic service users’ recovery experiences are presently statistics, focused on remediation of mental health symptoms as a marker of recovery (Bengston, Lund & Langstrom 2019; Warner, Glazier, & Lane 2021). Few studies currently capture the rich detail which contributes to how services support recovery. Thus it is important that service users are asked about their personal recovery experience, in a way that that encourages them to feel heard and empowered. This may encourage the participant to express their opinions about their experiences more authentically, focusing on aspects of their journey that brings the most significance to them without being effected by the expectations or structure of the interview. The narrative approach enables interpretation of service user stories allowing for wider consideration of contextual, cultural, social, and historical factors that may have influenced how the individual has interpreted their experience (Squire, Andrews and Tamboukou, 2008). This approach can provide further insight and vital information surrounding how the forensic mental health system responded to their needs and supported them during a challenging time in their life.
Within England qualitative research has been published to capture the experiences of forensic service users. However there is less research produced within this context within Scotland. The Mental Health Strategy (2017-2027) and the Scottish Recovery Network (SRN) advocate for the adoption of the recovery principles (Jacobson and Greenley, 2001). Thus it is clear that NHS Scotland, and therefore Scotland’s forensic mental health services should support the recovery principles in line with government guidance and NHS Core values. Therefore it is hoped that this study will be an effective contribution to professional understanding service user experience through a recovery focused approach which may in turn help inform policy and practice.Summary of Results
Title: A narrative analysis of recovery stories within a Scottish forensic mental health service.Background: There is a depth of understanding around the recovery approach however there is a lack of research, that reflects how forensic mental health (FMH) services interpret and apply the recovery approach. Furthermore, at present, there is a gap in the research regarding the experiences and stories of FMH Service Users (SUs). The Scottish Government’s Mental Health Strategy (2017-2027) strongly supports that the recovery approach should be a holistic approach, by which all mental health services approach care. However, principles of autonomy and choice can be challenging to apply within a forensic setting. That is because of the added responsibility FMH services have in providing security and protecting the public. Therefore, it is worth recognising how the recovery approach is applied within these settings, from the view of SUs in Scotland.
Aims and Questions:
1.
What does recovery mean to forensic SUs?
2.
What can we learn about the individual recovery journeys from SUs commencing the transition to the community and for those who have been discharged into the community?
3.
How might this insight inform how Forensic Mental Health Services within Scotland, implement the recovery approach and how would this support the recovery of forensic SUs?Methods:
This qualitative study used a narrative analysis approach, which recognises each participant’s experience as a core story, that has been told and shared with the researcher. Participants who were either transitioning to living in the community or had been discharged took place. Interviews included open questions and remained unstructured, with minimal input from the researcher.Emden’s (1998) narrative analysis guidance was used to conduct the analysis, and Kirkpatrick’s (2008) framework was adopted to break down the subplots.
Main Findings:
Personal Stories:
SUs emphasized freedom by way of discharge and acceptance of their mental health disorder, as signalling recovery.Community Narratives:
Participants highlighted the importance of signs of respect and equality, such as autonomy in daily tasks. Most participants viewed the connections with the clinical staff as highly important to recovery. Some of the discharged participants continued to disagree with their psychiatric diagnostic label despite adhering to treatment.Dominant Cultural Narratives:
Participants seldom spoke about the stigma they had faced, except for one participant. Participants highlighted the importance of the high quality of care delivered. Changes in approach to care over the past two decades were recognised. Furthermore, there was recognition of a lack of standardisation between hospitals within the same security level.Conclusions:
The findings confirm the challenges FMH services have in applying the recovery approach, including the need for services to adopt standardised service delivery within the same level of security. Participants recognised and welcomed the change in approach. This study brings light to the importance of connection with staff and using the SU’s definition of recovery as a suitable yardstick, to work towards.REFERENCES
Emden, C. (1998). Conducting a narrative analysis. Collegian, 5(3), 34–39. https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fdoi.org%252F10.1016%252Fs1322-7696&data=05%7C02%7Capprovals%40hra.nhs.uk%7C970ad51d3e3d4ed6870308dd3bc9bf6b%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638732459881447418%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=J3BN6XUaKyJH5oIJeAxFbmSWosgYTprmQaIHmqJnNY4%3D&reserved=0(08)60299-1/NBTI/VOW6AQ/AQ/a39ee433-81e5-4c1d-b2fb-c0030b226c06/1/20vHhS3h7r
Kirkpatrick, H. (2008). A Narrative Framework for Understanding Experiences of People With Severe Mental Illnesses. Archives of Psychiatric Nursing, 22(2), 61–68. https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fdoi.org%252F10.1016%252Fj.apnu.2007.12.002%2FNBTI%2FVOW6AQ%2FAQ%2Fa39ee433-81e5-4c1d-b2fb-c0030b226c06%2F2%2FsojXB_I9y6&data=05%7C02%7Capprovals%40hra.nhs.uk%7C970ad51d3e3d4ed6870308dd3bc9bf6b%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638732459881468743%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=GCzdhPmjHycjMfE5Zv4cpMtN8LGaFoW5ygxd7K8xeLo%3D&reserved=0
Scottish Government. (2017-2027). Mental Health and Well Being Strategy: 2017-2027. Edinburgh. Scottish Government.REC name
West of Scotland REC 5
REC reference
23/WS/0042
Date of REC Opinion
2 May 2023
REC opinion
Further Information Favourable Opinion