The importance of helpful help in mental health crises : Experiences, stories, and contexts – A qualitative exploration
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The main aim of this thesis was to explore experiences of helpful help in mental health crises within the context of crisis resolution teams (CRTs). Helpful help has been explored from three different perspectives: 1) service users, 2) carers, and 3) CRT clinicians. These perspectives are represented through three different sub-studies in this thesis. The study included a strategic sample of participants recruited from eight different health trusts, geographically covering large parts of Norway. Individual interviews with 14 service users and 12 carers as well as eight focus group interviews with a total of 50 clinicians were conducted. All interviews were conducted locally. The thesis has an explorative and troubling approach to truth and how knowledge can be created. My initial assumptions and understandings of truth and knowledge and how these are entwined with contexts, participants, and the researcher have been subject to continuous questioning, troubling, and development. These processes are understood as important parts of the knowledge that emanates from this project and are made transparent and reflected upon throughout the thesis as significant parts of its overall framework. A competence group consisting of people with diverse experiences as service-users, carers, and/or clinicians has contributed to the processes of exploring, troubling, and creating knowledge. The first article of this thesis explores service users’ experiences of helpful help in a mental health crisis. A hermeneutic phenomenological approach was used to analyze data into common themes across the dataset. The article suggests that experiences of mental health crises and helpful help are closely entwined. Mental health crises are experienced as devastating and multilayered events affecting the practical sides of life, sense of having worth, and sense of safety. Important issues relating to help that were emphasized by the participants were practical support and help with daily structure, establishing a foundation of safety, and strengthening the sense of self. The article discusses how these different issues of help are connected, suggesting that practical help plays an important role in supporting self-worth and the sense of safety. However, practical and structural issues were rarely addressed by CRTs. The article suggests the need for a broadened and social contextual-oriented perspective on mental health crises as important in developing practices that are perceived as more helpful. The second article explores carers’ experiences of helpful help. Data were analyzed using a narrative approach, focusing on emplotment. The configuration of data elements into coherent stories, using a personal plot as an organizing structure, revealed that seemingly thematically similar experiences have a highly personal imprint. Though experiences of burden and loss were common, these experiences were embedded within the personal history and context of the carer. The article discusses how understanding a carer’s individual experiences and needs in a contextual, storied manner can reveal information that is crucial to the collaboration of help that is perceived as helpful within a home-based approach to mental health crises. The third article explores discourses through which CRT clinicians understand and talk about helpful help. Data were analyzed using a discursive psychological approach. Two broad discourses were identified: helpful help as something “made,” with CRT workers as creators of collaborative and innovative practices, and helpful help as something “given,” with the CRT workers as representatives of a predefined specialist mental health service culture. The article discusses how the contradictions between these discourses reflect the diverse rationale for the development of CRTs and the possible tensions and pressures under which CRT work is conducted. In this overall context, the article also critically examines the tensions between the discourse of constructing new practices and existing practices constituted by the more traditional discourse in the specialist mental health services. Based on an overall discussion and reflection combining the three sub-studies, this thesis speaks to the necessity of introducing more person-in-context-oriented approaches in the understandings and practices of helpful help in mental health crises. There appears to be a gap between service users’ and carers’ desire for more contextually and practically oriented help and how help is talked about and acted out from the professional side. This thesis calls for further research on possible causes for this divide.
Has partsArticle 3 : Klevan, T., Karlsson, B., Ness, O., Grant, A., & Ruud, T. (2016). Between a rock and a softer place—A discourse analysis of helping cultures in crisis resolution teams. Qualitative Social Work. doi: 10.1177/1473325016668962
Article 2 : Klevan, T., Davidson, L., Ruud, T., & Karlsson, B. (2016). “We are different people”—A narrative analysis of carers’ experiences with mental health crisis and support from crisis resolution teams. Social Work in Mental Health. http://www.tandfonline.com/doi/full/10.1080/15332985.2015.1133471
Article 1 : Klevan, T., Karlsson, B., & Ruud, T. (in press, accepted 25.02.16). “At the extremities of life”—Service user experiences of helpful help in mental health crises. American Journal of Psychiatric Rehabilitation.