How do people with long‐term mental health problems negotiate relationships with network members at times of crisis?

Walker, Sandra; Kennedy, Anne; Vassilev, Ivaylo; Rogers, Anne

doi:10.1111/hex.12620

Cited by 24 publications

(20 citation statements)

References 28 publications

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“…Novel strategies identified in the current study included the active restriction of personal support networks and of non-kin ties in particular especially during periods of acute illness. These findings echo more recent evidence which suggests that network constriction may in fact be an adaptive response which promotes recovery [29,30]. Participants also identified strategies which reflected the flexibility of friendships including diversification or 'thinning' of friendships (e.g.…”

Section: Discussionsupporting

confidence: 75%

“…Identified network members included friends, family members, health professionals, pets, hobbies, places, activities and objects. This was supplemented by additional questions drawn from the literature which were designed to explore the role and function of different network members in relation to the managing of mental health in everyday settings [29,32,35,[37][38][39]. See also the Appendix.…”

Section: Data Collectionmentioning

confidence: 99%

“…Networks of diminished quantity and quality have the potential to exacerbate existing social disadvantage reducing the opportunities and capacity to develop new or sustain existing social connections which might otherwise be used to manage mental health symptoms [5]. However, recent evidence suggests that self-imposed isolation or network restriction particularly during times of crisis can be viewed as an active strategy for managing mental health through the provision of time and space for healing and as a way of regaining strength [29]. Similarly, longitudinal studies demonstrate that people experiencing the first onset of serious mental illness actively reconstruct the ways in which they engage with social networks (reduced contact or termination of social contacts) to avoid having to tell people about their illness, to reduce interpersonal conflict and lessen burden to themselves and others [30].…”

Section: Introductionmentioning

confidence: 99%

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Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

et al. 2020

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Background: Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems. Methods: A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model. Results:The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks. Conclusions: Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.

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Section: Discussionsupporting

confidence: 75%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

et al. 2020

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“…SDM in mental health raises further challenges reflecting a context of practice in which patients are aware of the threat or actual containment and coercion [17,18] which necessarily has a bearing on trust, ways of engaging and disclosure to professionals which is likely to impact on the quality of care planning relationships [19]. Additionally, user perspectives on interventions designed to more appropriately meet need have emphasised that they should be readily available and sensitive to community and domestic settings [20], and the context of everyday life which often lies out with the support provided by mental health professionals [21,22].…”

Section: Introductionmentioning

confidence: 99%

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Brooks

Lovell

Bee

et al. 2018

Soc Psychiatry Psychiatr Epidemiol

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Purpose Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user-and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels. Methods A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. Results The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. Conclusions Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

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“…The assessment of intervention implementation suggested that severity of disease may impact the level of engagement with the intervention, including the ability to participate in social/community activities. It is possible that study participants with severe disease interpreted the severity of their COPD symptoms as a crisis; withdrawal from social networks and reduced network engagement can occur in a time of crisis, as a form of self-preservation, and avoidance of difficult relational work [29]. Hence, there may be a need for an adapted version of the GENIE intervention where the emphasis for people with a higher need for clinical support is not on expanding networks, but rather on reflection on current level of engagement and on the retention of existing social ties.…”

Section: Discussionmentioning

confidence: 99%

Findings from an exploration of a social network intervention to promote diet quality and health behaviours in older adults with COPD: a feasibility study

Bloom

Welch

Vassilev

et al. 2020

Pilot Feasibility Stud

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Background: Diet quality in older people with chronic obstructive pulmonary disease (COPD) is associated with better health and lung function. Social factors, such as social support, social networks and participation in activities, have been linked with diet quality in older age. A social network tool-GENIE (Generating Engagement in Network Involvement)-was implemented in a COPD community care context. The study aimed to assess the feasibility of the GENIE intervention to promote diet quality and other health behaviours in COPD. Methods: Twenty-two community-dwelling older adults with COPD were recruited from a local COPD service. Participants were offered usual care or the GENIE intervention. Process evaluation methods were used to assess intervention implementation, context and mechanisms of impact; these included observations of patient interactions with the intervention, documented in observational field notes and in films of a patient group discussion. Diet quality was assessed by food frequency questionnaire; 'prudent' diet scores were used to describe diet quality at baseline and at 3-month follow-up. Change in diet quality was expressed per month, from baseline to follow-up. Results: Feasibility data showed that the GENIE intervention could be implemented in this sample of community-living older people. The intervention was acceptable to clinicians and older people with COPD, especially for those with less severe disease, when facilitated appropriately and considering the levels of literacy of participants. There was no significant change in diet quality in the intervention group over the follow-up period (median change in prudent diet score per month (interquartile range (IQR), 0.03 (− 0.24-0.07)), whereas an overall fall in diet quality was observed in the control group (− 0.15 (− 0.24-0.03)). Conclusion: The process evaluation findings suggest that this intervention is feasible and acceptable to both patients and clinicians. Although the sample size achieved in this study was small, findings suggest that the intervention may have a protective effect against declines in diet quality, and other health behaviours, in an older COPD population. Findings from this feasibility study indicate that further evaluation of the GENIE intervention is warranted in a larger study, with a longer follow-up.

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How do people with long‐term mental health problems negotiate relationships with network members at times of crisis?

Cited by 24 publications

References 28 publications

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Findings from an exploration of a social network intervention to promote diet quality and health behaviours in older adults with COPD: a feasibility study

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