Narratives of people's everyday occupational lives following long term psychiatric hospitalisation
This narrative study examines the stories of the everyday occupational lives of eight people with a serious mental illness who had been subject to the policies of psychiatric institutionalisation and deinstitutionalisation in New Zealand. The participants, who ranged in age from 35 to 66 years at the time of the interview, had spent at least five years living in psychiatric hospitals. Seven were now living either on their own, with spouses, or sharing a flat. One person was living in a mental health group home in which non-clinical staff were available to provide minimal supervision. A semi-structured interview format facilitated responses to the question: What, from the participants’ perspectives, had influenced their everyday occupational lives in the community since leaving hospital?
A review of the literature highlighted the need for people to have a balance and variety of occupations in their lives. There does not appear to have been any research undertaken into the longer term effects of the institutionalisation and deinstitutionalisation polices on people’s everyday lives. In this study, a narrative methodology was selected to enable some of this group of people to tell their stories of living in the community since their deinstitutionalisation in the 1980s and early 1990s. The interviews were audiotaped and all participants were given the opportunity to comment on their own transcripts. A thematic analysis was undertaken, and the major influences which emerged were the effects which illness, lengthy hospitalisation and psychiatric medications had had on the participants’ everyday lives. The consequences of these influences were that the participants continued to pursue a limited range of roles and occupations. In particular, five of the participants did not appear to participate in the roles of family member, friend, or paid worker, despite these roles being highly valued by them. In addition, an exploration of the narrative typologies revealed that a number of the participants framed their stories in a restitution narrative. Their past experience, shaped by the health system, has given them the understanding that it is the role of health workers to restore them to positive health and well-being.
There is a need to undertake research into how and where people in New Zealand find friends, to enable this knowledge to inform the support which is provided to people with a mental illness who have been socially isolated. Recommendations have also been made for further research into people who have been subject to deinstitutionalisation policies. It is argued that some people will require long term support from health workers, perhaps for the rest of their lives.