Tidlig intervensjon og recoveryprosesser ved førsteepisode psykose : En kvalitativ utforsking av ulike perspektiver

Abstract

The purpose of this thesis is to shed light upon different perspectives on early intervention for psychosis and related recovery processes for persons who have been in contact with early intervention services. The goal is to provide new knowledge that can contribute to making mental health services more precise in meeting the needs of persons with first-episode psychosis. The thesis consists of three sub-studies that, through a pragmatic qualitative approach, attempt to contribute to this objective. The first sub-study examines different discourses conveyed through information campaigns designed to promote help-seeking behavior related to early intervention services. The second sub-study is a systematic literature review focusing on how people experience contact with such services and their subsequent recovery processes. Findings from the included studies were integrated into a meta-synthesis. The final sub-study explores the way in which young adults experience meeting an early detection team for psychosis and related mental health services in such a context. The first sub-study is designed as a narrative discourse analysis. The study seeks to answer the following research questions: Which meaning content exists in multi-faceted information campaigns, and which roles and actors do such information campaigns build? Data material from one early intervention service was analyzed, and the findings are presented as three overarching themes: (1) knowledge is key, (2) (almost) an illness among illnesses, (3) we all have a responsibility. Four subthemes were included in the final theme: a) to respond quickly (all), b) to step in (all), c) to provide an answer (the mental health professionals), and d) to tag along (patients). The themes are discussed in relation to tensions between different discourses related to the following main questions: How to combine professional expert knowledge with collaborative practices that underline shared decision making and active roles for service-users? How to combine a focus on symptoms and illness and at the same time express the importance of the patient’s resources? How can we ask people to take social responsibility for help-seeking when professionals are placed in expert positions that may not be optimal for creating a dialogue with potential patients or their networks? The second sub-study is a meta-synthesis of findings from 17 included qualitative articles. The research questions in this study are: How do people experience being in contact with an early intervention service for psychosis? And how do they engage with these services in their own processes of recovery? The goal was to establish a new and comprehensive interpretation of the findings from the various studies. The findings were analyzed through: (a) comparing summaries of the studies, and (b) synthesizing the findings from the studies. We found five overarching themes, which can be viewed as a process, and which describe the service users’ experiences: (1) something is wrong, (2) do for myself, (3) it’s about people, (4) a price to pay, and (5) ongoing vulnerability. These are discussed in light of relevant research literature and linked to conceptualizations of illness and recovery in a medical and a social model. The final sub-study consists of in-depth interviews with ten young adults who had been in contact with an early detection team for psychosis and who had received treatment within mental health services. We asked the following research questions: How do young adults with first-episode psychosis experience social relationships within and outside of mental health services – as helpful or as obstacles to their early recovery processes? And how can such relationships complement each other? Through a thematic analysis we identified two themes concerning relationships with professionals: 1) being seen as a unique person with preferences, and 2) getting help when you are lost. We also identified three additional themes related to family and friends: 3) supportive family networks, 4) they cannot understand everything, and 5) different kinds of friendships. We found great variations in access to social support. The findings were discussed in light of relevant research and literature, with a particular focus on social aspects of recovery. The thesis discusses findings from the three sub-studies in relation to discourses for psychosis related to illness and normality, tensions within mental health services, primarily between a medical model and a recovery model, as well as the importance of relationships viewed from a social recovery perspective.