Acting as a Mental Health Expert by Experience and Its Impact on Social Identity

This study was conducted to examine the construction of social identity among mental health experts by experience working in Finnish municipal mental healthcare services. The construction of social identity is approached as an ongoing lifelong process that is significantly affected by lived experiences with mental health problems and recovery from them. The research data consist of focus group discussions, and the analysis is based on a thematic design that is initially material-driven. As a result, four categories are formed to describe the effect of acting as an expert by experience on social identity and the importance of the issue. Experts by experience have to consider profound questions about their identity and future in their new life situation. The individual meanings of acting as an expert by experience are considered particularly important. The support provided by group members builds confidence in one's chances of success and thereby supports the development of social identity. Social identities of experts by experience are partially built in encounters with professionals representing the mental health care system. This creates opportunities for new roles for those who act as experts by experience.

'What people diagnosed with bipolar disorder experience as distressing': A meta-synthesis of qualitative research

BACKGROUND

Bipolar disorder (BD) is considered to have a significantly negative impact on functioning and prognosis is considered poor. Current treatments are modestly effective and predominantly focus on reducing extreme mood fluctuations and symptoms, yet less is known about what patients themselves describe as distressing. Therefore we aimed to assess this through a systematic review.

METHODS

A comprehensive literature search was conducted in four major bibliographic databases in August 2017, updated in July 2018. Qualitative studies exploring BD were included if they contained themes related to distress. First person accounts from people with BD discussing what they experience as distressing were extracted and synthesised using thematic synthesis. Author interpretations were also extracted to support the synthesis.

RESULTS

Twenty-four studies were included. Five main analytical themes were developed: 1) diagnosis, 2) loss, 3) uncertainty, 4) threat and 5) relationships. Two further crosscutting themes were identified as 1) stigma and 2) fear of relapse. Implications for interventions to focus on these causes of distress also emerged.

LIMITATIONS

The included studies did not adequately examine the authors' potential own biases and influences within their interpretations of the data. One author predominantly undertook data extraction and coding for the current review, although research team discussions led to an agreed consensus on themes.

CONCLUSIONS

This was the first qualitative study to specifically explore distress in BD. The meta-synthesis highlights important areas that people with BD experience as distressing. Adaptations to current interventions, to focus on what people find distressing could seek to improve treatment outcomes.

[Subjectivity and autonomy: meanings and narratives with respect to discontinuing psychiatric drugs]

The objective of this work was to reconstruct the meanings and narratives surrounding the process of discontinuing psychiatric drugs, taking into account the strategies used to abandon these drugs and the processes of construction of identity. In 2015, in-depth semi-structured interviews were conducted individually with five people from Santiago, Chile who had experiences of psychiatric diagnosis, who received treatment with psychiatric drugs during eight o more years, and who discontinued the use of psychiatric drugs for at least one year. The results show the existence of institutional barriers which limit the right to abandon treatment; therefore, people do so autonomously through intimate and personal processes utilizing self-help and social support strategies. At the same time, discontinuing psychiatric drugs implies the construction of a "former user" identity, concentrating knowledge in the figure of expert by experience in the mental health field.