Experiences of mental health support workers in mental healthcare practice: Three visual arts narratives

Mental health support workers (MHSWs) make positive contributions to mental recovery practice yet their roles and needs are often unclear. This research explored the occupational lived experiences of three MHSWs working in Irish healthcare services. The study examined perceptions regarding work. A narrative design was used incorporating participatory art-based inquiry as a collaborative means engaging participants. innovative methodology enabled exploration evocative expression participants’ stories. Participants revealed feelings vulnerability anxiety personal supporting others; finding not commonly previous research. MHSW skills knowledge were evident; however, this expertise focus valued strengths challenges engagement service provision discussed. Interdisciplinary team integration is terms contrasting philosophies, practitioner professional demands imperatives. teams need engage with principles, acknowledging vulnerabilities all practitioners establishing adequate supervision support. Greater clarity education required concerning roles/scope for enable productive interdisciplinary partnerships. have undergone significant transition recent years (Tondora et al., 2014). International enactment deinstitutionalization philosophy (Ellison 2018), democratizing impacts user movements (Davidson 2016) global staff shortages services (Oates 2021) resulted increasing diversity workforce. Accordingly, composition contemporary teams, particularly community practice, has widened include peer non-peer (MHSWs). These developments impacted beneficial challenging ways. paper presents arts narratives care without registration who work Key aspects role providing companionship non-clinical users well promoting through practical help supported into activity. proliferated years, UK, USA Australia (Jasper 2019). introduced Ireland order augment existing workforce (McCrae 2008). introduction (and international) made priority more recently advance recovery-oriented (Hunt & Byrne, 2019; Watts Higgins, 2017). Although various job titles been used, term “support worker” increasingly describe group (Duffield Specifications, qualifications competencies vary across jurisdictions; there usually requirement skill people problems. may be gained self-experience or knowledge/skills acquired educational (Tudor 2018). Peer experience problems advanced use own others distress, empathic relationships focussed interventions (Clossey identified internationally an essential valuable component delivery system change. (Gillard 2017; Hunt 2019) studies claiming that promote recovery, empowerment, self-efficacy social inclusion among (Verbeek 2018; Wilberforce worker presented distinct from each other, life experiences, motivations perspectives those occupying these can quite similar. Allock Hollingsworth (2009) found 40% UK had declared themselves either current former users. Therefore, generally likely even though they identify necessarily distress base (Huxley 2009). which gaining momentum internationally, central defined “personalized journey managed by individual acquire self-perception, will, despite difficulties illness” (Doğan 2020, p92). In perspective, does mean resolution suffering symptoms full functional return but rather developing resilience living issue (Perlman concept contrast traditional notion clinical espoused many practitioners. Clinical follows belief primarily caused neurochemical process involves elimination restoration pre-illness state medical/practitioner intervention (Egeland 2021; Slade Unlike espouse recovery. Given endeavour reclaiming meaning, purpose agency everyday life, Borg (2007) proposes perform “everyday helpers.” contribution identified; new also present both wider team. Operating somewhere “between friend employee” (Manthorpe 2010, p319), challenge habitual “professional” nature helping delineation roles. lack agreed scope formalized support/development structures further source confusion frustration other members already multi-layered multidisciplinary (Cleary frequently regarded “adjuncts” “assistants” supplementing under direction registered (for example nurses workers) (Wilberforce face additional struggles related capacities limitations. emotionally demanding professionally confusing world compound compromise worker's (Zerubavel Wright, 2012). While undertaken positions contexts, much takes organizational/operational standpoint; (Byrne Gillard For example, Kilpatrick al. (2017) Ehrlich (2020) argue roles/contributions underexplored inconclusive specific carried out area. Furthermore, represented via collective thematic analysis/synthesis (Vandewalle 2016; Walker Bryant, 2013) depth specificity. There less being (Debyser 2018) although some first person emerging visible (Irwin, Sinclair, Our contributes illumination experience. Using design, participative arts-based inquiry, facilitated share explore agents, evaluations dynamic environment. Sharing enables understanding insight achieved methods (Barone Eisner, 2012; Cohn Magliano, 2020). Thus, aimed gain in-depth contribute context training programme devised practitioners, educationalists Dublin, Ireland. value evidenced (Higgins designed development learning on development, promotion challenges, based approaches, treatment/support strategies self-care. As part evaluation training, researchers conducted initial complete course cohort fourteen women MHSWs. Ryan (2012) highlight journeys run parallel elicit while undertaking programme. See Casey Webb, (2019) details findings However, participants chose concentrated exclusively Analysis particular experiences. separate dissemination merited given relevance practice. focusses participant conveyed Narrative phenomenological assumption humans sense events configuring relating stories about (Casey, Proudfoot Corbally;2016; Riessman, Through story sharing, narrator audience drawn closer event/experience process, meaning making occurs (Plummer, facilitate tell range analytic processes involve collaboration (Squire verbal written narrative; writers limits language “tellability” (Llewellyn-Beardsley p305; 2020) complex beyond spoken/textual thus difficult narrate verbally. Llewellyn-Beardsley (2020 p305) recommend text “need extended, future develop typologies non-verbal narratives.” our capture diverse nuanced MHSWs, considered suitable methodological fit purpose. Arts-based uses visual, dramatic poetic art practices exploring representing human (Leavy, McNiff, It situated within paradigm creation draws history produced tells it extends goes (Cohn creating piece, tentative, ambivalent previously unvoiced meanings grappled articulated ways visual mode chosen pre-programme VARK style assessment (Fleming http://www.vark-learn.com/english/page.asp?p=questionnaire) high percentage student learned most effectively kinaesthetic modes. preferred styles, persuasive evidence, appropriate Visual images created meaningful intent express Magliano (2020, p215) propose “visual reflect fundamental meaning-making, complexity what presumed.” class (14 female students) invited consented participate involved preparatory information/discussion session information proposed assured participation non-participation would no connection study. Implications small sample population possibly identifying artwork discussed limitations guaranteed anonymity. Professional psychological available if during duration research; none service. All provided informed consent engagement, recording accompanying discussion sharing comments subsequent publications reports. adhered ethical guidelines Helsinki Declaration principles (World Medical Association, Ethical approval obtained University's ethics committee. whose female, worked Two disclosed prior participative, 14 played active analysis artwork, following (PVRM) set Mitchell (2011). PVRM asked create image articulation, asking construct piece conveying (Mitchell 2011). followed wherein cohort, describing constructing attempting convey audience/participants responded presented/described peers, commenting how resonated them experiences/issues conveyed. art-making ensuing two researchers. recorded transcribed, photographed (with consent) room presentation/discussion session. outlined, (2011) individually collectively interpret completed including them, colour spatial organization piece. then engaged secondary content analysis, encompassing interpretation again using framework advocated (2011), discussed/interpreted patterns themes explanations. detailed description see Webb (2019). preserve anonymity far possible, pseudonyms used. Table 1 demographics. “Mine picture hands … holding baby heart your when you palms always open em, yes so Liz volunteered do me I needed well, she that’s my …” (Maura) Maura's (Figure 1) explanation expectations receiving help. Her conception “holding” foetal symbolizes emotional profound trust helper. help; expectation “that open,” is, at hand. clear initially whether Maura her relation referring continues likening needs/receives process; therefore, appear “volunteered me,” drawing draw/place child heart. recognizes assistance actualizes performs understandings/expectations acknowledges needs. perception arise and/or requiring level availability others. “My boat …. actually put relapsing….and we fall overboard kind nearly drown…. obstacle (pointing black stick shape) drown……and weather gets very bad, rains, thunders lightenings …and……. will continue (jovially), go back beginning start ….and take along …I’m sure (laughing)” (Liz) Liz's decision enact, narrative, scenario relapsing underlying possibility. overwhelm Maura. coming recue, suggests, “we drown…and lightenings…” She represents herself fragile, frightened looking feathers, pink one seemingly carrying yellow one. Both weighted down sea “obstacle.” believes overcome ordeal “the continue.” regards form rescue, specify exactly what/how along. traumatic force unfolding event (relapse/drowning) instance matched any corresponding energetic confident response Liz. “Alright…this white pipe cleaner figure behind wall) …I 20 …and I’m told every day ‘they’re going nowhere’ ‘don’t bother yourself’. …So….me rehabilitation, say I’ve done lot growth awful offer…and find clients confide lot… it’s only gotta ‘Well, look… whoever’s office’ boundaries…alright? there’s there…and poor here (mockingly). am team… nursing allow all…and…knowing course… skills, education… just banging head against wall…and there's times want give up… know? paint here…this me… loads ideas…loads things like do…but…I don’t think let in…because they’re lovely agro animosity anything…it’s that…you’re you’re kept to…even chat…or whatever…do things…you’re frowned upon things…and change that…but anyway, climbing over wall…looking saying “will won’t they?” know lads (self-deprecatingly) can’t it…okay…there’s red feathers it, okay…but broken…it’s wall little bit… Alison's powerfully conveys issues encounters role. experience, motivation energy apparent, too desire enact ideas learning. appears forces blocked number pessimistic view possibility progression “they're nowhere” “don't yourself.” Further, “bother(ing) yourself” seems actively dissuaded; “you're things” Alison identifies barriers culture mitigate knowledge. “I team…the all.” exclusion evocatively portrayed construction tangible clay wall. choice medium figure, performing exclusion. subtle; “while they're people…. you're separate.” “you” point emphasizes separation implies possible codes internalized; “it's job.” positioning users; confiding ‘only “Well, look…. whoever's office.” frustrating situation portrays vibrancy bright colours materials, constrained apparently unsurmountable provide known novel insights Liz, jointly images, literally co-construct representation relapse few self-perceptions expectations. Here, evokes thought powerful accessible way. vulnerable, trusting helper, reflects wounded healer archetype; power ability emerges one's woundedness similar situations (Roots Roses, efficacy widely romanticized uncritically accepted. (Conchar Repper, makes difficulties. Altruistic self-sacrificing evident trying rescue troubled waters overwhelmed. over-invest exceed manage balance caring self-care (Moran 2013). tension between expectation/capacity study, strong implications practice; Zerubavel Wright stress importance differentiating impaired professional. asserts carry Maura; achieved. confidence translating experiential/didactic (Cronise 2016). interaction experiential contexts construction. demonstrates conviction ideas, offer. enacting practical, traditional, biomedical Similarly, Cleary (2018) feeling constantly pressure navigate differing philosophies “like walking tightrope” (p1266). Despite government-led reviews nursing, concluding proposing adopted, exact values, remains unclear (Kidd 2015; Osborn Stein, results continued maintenance than approaches paternalistic risk aversion Expressed uncertainty doubts initiatives rarely (Aston Coffey, 2012); negative sentiments captured nurses’ responses attempts “But wall……looking ‘will won't they?’…and lads…… evidence overwhelm, vicarious trauma burnout. Additionally, hopelessness initiatives. Burnout acknowledged hazards (Mc Laughlin, Mc Mahon nurses, inadequately addressed (Howard Eddy-Imishue, We concur recommendation Repper Carter factored planning arrangements climate openness Higgins effective recognition management countertransference overwhelm. additionally highlighted experienced contexts. extended managing dynamics ongoing supervision. Davis (2015) recommends necessary workers. raise contesting philosophies/practices relationships. At core health, identity therapeutic relationship purposes boundaries. structured accountable contrasts characteristics mutuality (Hurley strive build hope empowerment interventions. struggle competing discourses imperatives, commonalities medically dominated system. Nurses, upholding unique contribution, recognizing valuing alternative beliefs bring benefits Role overlap marginalization require where roles, boundaries expectations, autonomy acceptance respect Mancini, calls professionalization Service managers ensure rest avoid frustration. necessitates increased Effective inculcation develops exposure (Ehrlich key Vandewalle Happell Scholz suggest champions, educate Byrne mentoring networks developed integrating limited Finally, important note play coordinating collegiality colleagues, accountability well-being safety Balancing imperatives openness, adopting solution care. his methodology, depth. could argued size; sizes; aim increase reader (Riessman, claim generalizable; methodologies invariably resonate audiences. approach aided methods. requires greater preparation support; embodied communicate immediate ways; textual/verbal language. regard, hoped responds contributing supports expression. poorly understood. context. narratives, communicated anxieties issues; teamwork; ethos recognized integrated benefits, communication, highly relevant concerns provision. closely understand strengths, values/ethos group/role. rich particular. envisaged engender debate teams. authors declare conflict interest. authors’ University Research Ethics Committee. Organisation, 1964) governing subjects guided times, data author reasonable request.