Impact of Mental Health Services on Resilience in Youth with First Episode Psychosis: A Qualitative Study

Original Article

Abstract

The purpose of this qualitative study is to understand how mental health and related services support and hinder resilience in young people diagnosed with first-episode psychosis. Seventeen youth between the ages of 18–24 were recruited and 31 in-depth interviews were conducted. Findings illustrated that informational and meaning making, instrumental, and emotional supports were experienced positively (i.e., resilience-enhancing); whereas services with ghettoizing, engulfing, regulating, and out of tune practices were experienced negatively (i.e., resilience-hindering). These results demonstrate how various types of service-related practices influence resilience in youth and can inform future planning of services for psychosis.

Keywords

Mental health services Resilience Well-being Service engagement Youth mental health 

Notes

Acknowledgments

The first author was partially supported by a Doctoral Scholarship Award from the Canadian Institutes of Health Research while conducting this research. The third author is supported by the Canada Research Chair Program. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

References

  1. Amminger, G., Harris, M., Conus, P., Lambert, M., Elkins, K. S., Yuen, H. P., & McGorry, P. D. (2006). Treated incidence of first-episode psychosis in the catchment area of EPPIC between 1997 and 2000. Acta Psychiatrica Scandinavica, 114(5), 337–345.CrossRefPubMedGoogle Scholar
  2. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480.CrossRefPubMedGoogle Scholar
  3. Arnett, J. J. (2014). Emerging adulthood: The winding road from the late teens through the twenties. New York: Oxford University Press.CrossRefGoogle Scholar
  4. Barnett, E., & Casper, M. (2001). A definition of “social environment”. American Journal of Public Health, 91(3), 465.PubMedPubMedCentralGoogle Scholar
  5. Bottrell, D. (2009). Understanding ‘marginal’perspectives towards a social theory of resilience. Qualitative Social Work, 8(3), 321–339.CrossRefGoogle Scholar
  6. Bottrell, D., & Armstrong, D. (2012). The social ecology of resilience (pp. 247–264)., Local resources and distal decisions: The political ecology of resilience New York: Springer.CrossRefGoogle Scholar
  7. Boydell, K. M., Stasiulis, E., Volpe, T., & Gladstone, B. (2010). A descriptive review of qualitative studies in first episode psychosis. Early Intervention in Psychiatry, 4(1), 7–24.CrossRefPubMedGoogle Scholar
  8. Boyden, J., & Mann, G. (2005). Children’s risk, resilience, and coping in extreme situations. In M. Ungar (Ed.), Handbook for working with children and youth: Pathways to resilience across cultures and contexts (pp. 3–26). Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar
  9. Bruner, J. (1987). Actual minds, possible worlds. Cambridge, MA: Harvard University Press.Google Scholar
  10. Bruner, J. (1991). The narrative construction of reality. Critical Inquiry, 18(1), 1–21. http://www.jstor.org/.
  11. Canadian Institutes of Health Research. (2006). Institute of human development, child and youth health, strategic plan 2006–2010. Montreal.Google Scholar
  12. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage.Google Scholar
  13. Chase, S. E. (2005). Narrative inquiry: Multiple lenses, approaches, voices. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed., pp. 651–679). Thousand Oaks, CA: Sage.Google Scholar
  14. Clandinin, D. J., & Connelly, F. M. (2000). Narrative inquiry. International encyclopedia of education, 1–23.Google Scholar
  15. Creswell, J. W. (2007). Qualitative inquiry and research method: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  16. Darbyshire, P., Muir-Cochrane, E., Fereday, J., Jureidini, J., & Drummond, A. (2006). Engagement with health and social care services: Perceptions of homeless young people with mental health problems. Health and Social Care in the Community, 14(6), 553–562.CrossRefPubMedGoogle Scholar
  17. Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: A report from the field. Schizophrenia Bulletin, 32, 443–450. doi:10.1093/schbul/sbj043.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Denzin, N. K., & Lincoln, Y. S. (2005). Introduction: The discipline and practice of qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed., pp. 1–32). Thousand Oaks, CA: Sage.Google Scholar
  19. Fisher, A., & Savin-Baden, M. (2001). The benefits to young people experiencing psychosis, and their families, of an early intervention programme: Evaluating a service from the consumers’ and the providers’ perspectives. British Journal of Occupational Therapy, 64, 58–65. Retrieved August 2, 2012 from http://www.cot.co.uk/british-journal-bjot/british-journal-occupational-therapy.
  20. Frankish, C. J., Hwang, S. W., & Quantz, D. (2005). Homelessness and health in Canada: Research lessons and priorities. Canadian Journal of Public Health, 96, S23–S29. http://journal.cpha.ca/index.php/cjph.
  21. Human Resources and Skills Development Canada, Policy Research Directorate (2009). Resilience among at-risk groups in Canada: Qualitative analysis. (Research Opportunities, Volume 4, Number 19). Gatineau, QC.Google Scholar
  22. Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548. doi:10.1037/0022-006X.73.3.539.CrossRefPubMedGoogle Scholar
  23. Kralik, D., van Loon, A., & Visentin, K. (2006). Resilience in the chronic illness experience. Educational Action Research, 14, 187–201. doi:10.1080/09650790600718035.CrossRefGoogle Scholar
  24. Lal, S. (2012). Resilience in youth recently diagnosed with psychosis: A qualitative inquiry (Doctoral dissertation). Retrieved from UBC Circle https://circle.ubc.ca/handle/2429/43435.
  25. Lal, S., & Malla, A. (2015). Service engagement in first-episode psychosis: Current issues and future directions. Canadian Journal of Psychiatry, 60, 341–345.PubMedPubMedCentralGoogle Scholar
  26. Lal, S., Suto, M., & Ungar, M. (2012). Examining the potential of combining the methods of grounded theory and narrative inquiry: A comparative analysis. The Qualitative Report, 17(41), 1–22. Retrieved from http://www.nova.edu/ssss/QR/QR17/lal.pdf.
  27. Lal, S., Ungar, M., Malla, A., Frankish, J., & Suto, M. (2014). Meanings of well-being from the perspectives of youth recently diagnosed with psychosis. Journal of Mental Health, 23(1), 25–30. doi:10.3109/09638237.2013.841866.CrossRefPubMedGoogle Scholar
  28. Larsen, J. A. (2007). Understanding a complex intervention: Person-centred ethnography in early psychosis. Journal of Mental Health, 16, 333–345. doi:10.1080/09638230701299186.CrossRefGoogle Scholar
  29. Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543–562. doi:10.1111/1467-8624.00164.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Lysaker, P., & Buck, K. (2006). Moving toward recovery within clients’ personal narratives: Directions for a recovery-focused therapy. Journal of Psychosocial Nursing and Mental Health Services, 44(1), 28–35.PubMedGoogle Scholar
  31. McCay, E., Beanlands, H., Leszcz, M., Goering, P., Seeman, M. V., Ryan, K., et al. (2006). A group intervention to promote healthy self-concepts and guide recovery in first episode schizophrenia: A pilot study. Psychiatric Rehabilitation Journal, 30, 105–111. doi:10.2975/30.2006.105.111.CrossRefPubMedGoogle Scholar
  32. O’Brien, A., Fahmy, R., & Singh, S. P. (2009). Disengagement from mental health services. Social Psychiatry and Psychiatric Epidemiology, 44(7), 558–568.CrossRefPubMedGoogle Scholar
  33. Or, S. E. B., Hasson-Ohayon, I., Feingold, D., Vahab, K., Amiaz, R., Weiser, M., & Lysaker, P. H. (2013). Meaning in life, insight and self-stigma among people with severe mental illness. Comprehensive Psychiatry, 54(2), 195–200.CrossRefPubMedGoogle Scholar
  34. Plaistow, J., Masson, K., Koch, D., Wilson, J., Stark, R. M., Jones, P. B., & Lennox, B. R. (2014). Young people’s views of UK mental health services. Early Intervention in Psychiatry, 8(1), 12–23.CrossRefPubMedGoogle Scholar
  35. Reich, J. W., Zautra, A. J., & Hall, J. S. (Eds.). (2010). Handbook of adult resilience. New York: Guilford Press.Google Scholar
  36. Riessman, C. K. (2008). Narrative methods for the human sciences. Thousand Oaks, CA: Sage.Google Scholar
  37. Roe, D., & Davidson, L. (2005). Self and narrative in schizophrenia: Time to author a new story. Medical Humanities, 31, 89–94. doi:10.1136/jmh.2005.000214.CrossRefPubMedGoogle Scholar
  38. Roe, D., Hasson-Ohayon, I., Mashiach-Eizenberg, M., Derhy, O., Lysaker, P. H., & Yanos, P. T. (2014). Narrative enhancement and cognitive therapy (NECT) effectiveness: A quasi-experimental study. Journal of Clinical Psychology, 70, 303–312. doi:10.1002/jclp.22050.CrossRefPubMedGoogle Scholar
  39. Tsemberis, S., Kent, D., & Respress, C. (2012). Housing stability and recovery among chronically homeless persons with co-occuring disorders in Washington, DC. American Journal of Public Health, 102(1), 13–16.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Ungar, M. (2003). Qualitative contributions to resilience research. Qualitative social Work, 2(1), 85–102.CrossRefGoogle Scholar
  41. Ungar, M. (2004). A constructionist discourse on resilience multiple contexts, multiple realities among at-risk children and youth. Youth & Society, 35(3), 341–365.CrossRefGoogle Scholar
  42. Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychiatry, 81(1), 1–17.CrossRefPubMedGoogle Scholar
  43. Ungar, M. (Ed.). (2012). The social ecology of resilience: A handbook of theory and practice. New York: Springer.Google Scholar
  44. Ungar, M., Liebenberg, L., Dudding, P., Armstrong, M., & van de Vijver, F. J. (2013). Patterns of service use, individual and contextual risk factors, and resilience among adolescents using multiple psychosocial services. Child Abuse and Neglect, 37(2), 150–159. doi:10.1016/j.chiabu.2012.05.007.CrossRefPubMedGoogle Scholar
  45. White, B., Driver, S., & Warren, A. (2008). Considering resilience in the rehabilitation of people with traumatic disabilities. Rehabilitation Psychology, 53, 9–17. doi:10.1037/0090-5550.53.1.9.CrossRefGoogle Scholar
  46. Windell, D., & Norman, M. G. (2013). A qualitative analysis of influences on recovery following a first episode of psychosis. International Journal of Social Psychiatry, 59, 493–500. doi:10.1177/0020764012443751.CrossRefPubMedGoogle Scholar
  47. Yanos, P. T., Lucksted, A., Drapalski, A. L., Roe, D., & Lysaker, P. (2015). Interventions targeting mental health self-stigma: A review and comparison. Psychiatric Rehabilitation Journal, 38, 171–178. doi:10.1037/prj0000100.CrossRefPubMedGoogle Scholar
  48. Yanos, P. T., Roe, D., Markus, K., & Lysaker, P. H. (2008). Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services, 59, 1437–1442. doi:10.1176/appi.ps.59.12.1437.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • S. Lal
    • 1
    • 2
    • 3
  • M. Ungar
    • 4
  • A. Malla
    • 3
    • 5
  • C. Leggo
    • 6
  • M. Suto
    • 7
  1. 1.School of RehabilitationUniversity of MontrealMontrealCanada
  2. 2.University of Montreal Hospital Research Centre (CRCHUM)MontrealCanada
  3. 3.Douglas Mental Health University InstituteMontrealCanada
  4. 4.School of Social WorkDalhousie UniversityHalifaxCanada
  5. 5.Department of PsychiatryMcGill UniversityMontrealCanada
  6. 6.Department of Language and Literacy Education, Faculty of EducationUniversity of British ColumbiaVancouverCanada
  7. 7.Department of Occupational Science and Occupational TherapyUniversity of British ColumbiaVancouverCanada

Personalised recommendations