Methodological Orientation

Having laid out the argument justifying the approach of directly addressing service user experience, it is necessary to detail the procedure of recruitment for the project. This, in itself, raised a number of issues. Although used as a singular term, ‘service user’ refers to a rather heterogeneous set of people. For instance, many people who have

experienced mental health problems as would be defined by psychiatric practice, do not actually see their experiences as problematic or in need of treatment. We saw examples of this in Romme & Escher’s work, and there is a growing number of ‘Hearing Voices’ groups whose philosophy of non-pathologising voice hearing is based on the

pioneering work that formed the set up of the Hearing Voices Network (Romme & Escher, 1993, 2000).

3.3.1 Which Service Users?

The definition of service users incorporated in this thesis is based upon the notion of being in contact with psychiatric services of some kind. That is, people who are being treated for having experienced and been diagnosed with mental health difficulties. Of course, this represents a diverse set of people itself. A further procedure was to include people currently living in community care, which meant that anyone hospitalised was not included in the sample used. The nature of approaching potential participants proved an issue requiring a particular strategy. As part of their incorporation and treatment by psychiatric services many people would come into contact with clinical psychologists. A perception of psychology as a part of treatment may well be formed through this, and as such I was aware of the need to not be viewed in alliance with, or part of, any kind of psychiatric or clinical service.

This strategy meant identifying alternate means through which to access service users. Care in the community means that service users only become visible when in contact with services, or other kinds of centres. Given the requirement to distance myself from psychiatric services I decided to approach people through other avenues that they access due to being service users. This meant identifying and approaching a number of non-psychiatric settings, which involved day centres, support groups, and charity run

places for people with mental health difficulties to attend. Given the non-clinical status, it is possible that people using such centres may not actively be using psychiatric services themselves, and as such present a problem as to their status as service users. This was flagged up as a potential issue, but did not present a problem as all the participants were in contact and being treated by services. The nature of this contact was varied, with some in more regular contact than others.

Seven groups in the East Midlands area of the United Kingdom were approached, with myself providing an introduction to the research to staff, whom felt it most appropriate to inform members as to a time when I would be present so they could come and talk to me about the research. On meeting, I introduced the project and members expressed whether they were willing to be involved.

3.3.2 Participant Information

In total 38 interviews were conducted, with 9 female and 29 male service users. All participants were over 18, and thus issues of adolescence and mental health were not involved. Given the variability in both nature of mental health difficulties experienced, and course and outcome of distress, there were decisions to be made regarding

assessing service users’ mental state at point of interview. This was something discussed between service user, centre staff, and myself. All service users, upon reading the Participant Information Sheet, and Informed Consent Form (which can be seen in Appendix Three and Four respectively), provided written consent, and were happy to proceed with interview. Only three service users approached were not prepared to take part in the study.

Clinical information was not gathered on participants prior to interviews taking place. This was because it would have involved approaching people through formal

psychiatric services, as detailed clinical information was developed and utilised as part of formal practice. Additionally, it was not considered of prime importance. A detailed clinical history could inform as to a psychiatric understanding of people’s past mental health difficulties, but it does not enable insight into how service users’ own

knowledge practices, or indeed how they manage their treatments and surrounding environment. Having said that, in the course of interviews almost invariably service users’ mental health difficulties arose as a topic, and as such insight was gained into the

user’s own understanding of their experiences. The predominant reported experiences involved factors associated with a diagnosis of schizophrenia, e.g. reports of voice hearing, ‘abnormal’ beliefs. In addition, a widespread complaint was depression, with a number of service users suffering from, often quite severe, depression. Other

difficulties were reported, such as experiences associated with diagnoses of Obsessive Compulsive Disorder. The common link between all participants was contact with service providers, along with continued treatment, primarily psychiatric medication treatment. All participants were recognised by services and themselves as ‘service users’. Variability existed in regard to the prevalence of mental distress at time of interview. Those who had received a diagnosis of schizophrenia were generally ‘in recovery’ of some sort, i.e. they were not actively experiencing an episode of distress at the time. The mental states of those whose experiences were depressive in nature were sufficient to require continued treatment. All participants received treatment due to the continued mental distress or to prevent any relapse.

3.3.3 Interview Technique

In-depth semi-structured interviews were used; the schedule can be seen in Appendix Two. This approach allowed the participants to elaborate and introduce new aspects of experience, whilst still covering a set number of key areas. The decision to utilise interviews was further guided by consideration of the nature of the space provided. Given the understanding of service users that I was not allied in any way to clinical services, allowed them to engage in the interview space as a confidential one, not forming part of their engagement with service provision. This enabled topics to be explored that may have not been so if interviews occurred as part of their service use. Possible evidence of this is covered in Chapter Six, in which users discuss aspects of medication practices that they claim would not be discussed with service providers. Issues such as this, or detailed discussion of their past life experiences may not have arisen if they were part of a wider focus group either. One issue was that an implicit assumption may have been formed that the interview was a kind of counselling session. Certainly, service users, at times, discussed some issues, such as physical and sexual abuse in earlier life. To this end, it was made clear prior to interview, that it was not a form of counselling, and that if any issues arose that users found distressing members of staff were available after interview if any users wanted to talk to them. Interviews were then transcribed using a technique based upon that designed by Jefferson (1985),

but to a less detailed degree (e.g. Potter & Wetherell, 1987). This can be seen in Appendix One.

3.3.4 The Role of the Researcher

It is worth considering my role as researcher in this project. As we saw in Chapter Two, many different approaches have emerged in the service user research area. The one utilised here was for myself to act as researcher, with service user experience directly focused upon. Therefore, there were not issues such as providing research training for service users, as can be the case when users act as researchers themselves (Clark, Davis, Fisher, Glynn, & Jefferies, 2006; Davis, 2005).

Given the theoretical approaches of considering knowledge production as

contextualised, dependent on the re-worked nature of social practices, it is necessary to consider the practices at work in the interview interaction itself. What the context of interview brings, is myself as social psychological researcher, and the impact of that role on the production of interview. This issue refer to the process of being reflexively aware of one’s role throughout the research.

Assessing my own role is an important, although not straightforward task, although I will address it in the following ways. Two strands of interest need to be highlighted. Firstly my impact on interview interaction in terms of service users’ perception of me and my profession. This has been covered in the earlier section relating to theorising the position and location of the interviews in this thesis. It was mentioned that users understood that the research did not constitute any form of counselling, nor was it allied to any form of clinical practice. Rather, what was of interest was users’ own knowledge of their experiences as service users, along with gaining insight into the ways they manage their lives on a day-to-day basis. Users understood that interviews provided a safe, confidential space in which they were free to elucidate on any aspect of their experiences, framed around a semi-structured set of questions.

These issues can be thematised through recognition that analysing pure experience is always going to be an unachievable goal. Thus, it is simply not possible to gain unmediated access to service user experience, as there is a whole series of mediating factors (as have been detailed in the previous two chapters). What I, as interviewer

bring to user experience in the interview context is yet another layer of complexity. This additional layer does not render the whole project redundant. But, of course, it needs to be taken into account. Whichever methodological approach undertaken, an extra layer of complexity will always be added. And, the challenge has to be to seek to analyse how all the different layers are interacting, which is the analytic goal of this thesis.