Young People's Narrative Accounts of Participation in the Design and Delivery of NHS Mental Health Services

Abstract

Rationale and Aims: Youth participation in the design and delivery of mental health services has continued to gain momentum both nationally and internationally over recent years. However, research in this area has largely focussed on discrete participatory projects and service outcomes, rather than the experiences of young people involved. This research looks at the ways in which young people story the experiences and meaning of participation in the design and delivery of mental health services within the NHS.

Methods: A qualitative approach was used in order to explore the accounts of six young people with experience of participating in mental health service design and delivery. Face-to-face semi-structured interviews were held with young people, each lasting approximately 60 minutes. Interviews were audio-recorded, transcribed, and analysed using narrative analysis. Narrative analysis was used to explore the content, performance, context and discursive elements of the accounts individually and collectively. Consideration was given to the social and political contexts that arguably shaped these accounts. A participatory research design was used at supervisory level and across different stages of the research. This allowed collaboration on areas such as identifying and prioritising interview questions, co-designing information material, input on analysing and interpreting data, and disseminating the findings.

Analysis: Transcripts were read multiple times as a way to develop individual summaries and construct an analysis across all of the accounts. Reflective notes were made noticing content, identity performance and context (Wells, 2011). Particular attention was paid to preferred identities around what kind of stories were told (Riessman, 2008) and the way in which narrators employed or challenged dominant societal discourses (Wells, 2011).

Findings: The findings demonstrate the ways in which the young people taking part construct rich, multi-layered narratives with the potential to enhance understanding of their experience of service participation in mental health service delivery. Four main storylines were observed across accounts. These were stories of 1. Moving into social spaces and holding out a helping hand; 2. Having to become the ‘right fit’ for participation; 3. Repositioning from patient to person; 4. Strengthening alternative identity stories through relationships. Strategies of resisting dominant narratives around ‘patient’ subjectivity and societal views of what it means to be a young person are highlighted, with survivor discourse key for constructing an alternative subjectivity.

Implications: The findings are discussed with reference to existing literature along with their potential bearing for clinical practice, strengths and limitations of the methodology are considered, and directions for future research, policy, and service delivery specified.