A biographical narrative study exploring mental ill health through the life course

This thesis is about people with mental health problems who happen to be older, rather than older people with mental health problems. Health policy that has focused on older people as a category has maintained a narrow focus on recognising depression and dementia, with older people being excluded from mental health policy aimed at adults of working age. This has resulted in age discriminatory practices, but in addition, the unique needs of people who have lived long term with mental ill health into later life have been ignored. Older people have been often conceptualised as consumers of care rather than citizens with aspirations and research about long term experience of mental ill health and recovery commonly excludes older people. This study aimed to redress this marginalisation and lack of knowledge by exploring the experience of long term mental ill health to older age from a strengths perspective congruent with recovery principles. The study is based on a social constructionist epistemology and narrative inquiry methodology. The research questions were: 1) How does living with long term mental ill health affect achievement and 2) How does long term mental ill health affect life in the present? People who were aged over 50 and who had at least 20 years duration of mental ill health that started before the age of 45 were included. Seven people were recruited though posters placed in GP surgeries, leisure centres and libraries and contacts through mental health services. Four women and three men between the ages of 52 and 76 participated. The study develops the curriculum vitae as a research tool, a method unique in mental health research, in order to root the enquiry within participant relevancies and perspectives to ensure that this previously unheard voice is captured. This tool is congruent with a biographical method that informs the development of two personalised interviews and enables the implementation of this method within a recovery (strengths) frame of reference. The resulting individual narratives were interpreted with reference to the principles of over reading and life course theory. A collective text was also developed which discusses the key findings. The novel approach taken in this research study resulted in an original contribution to current knowledge which provides evidence that can be used to challenge beliefs about people who have lived a lifetime with mental ill health. The study revealed a lifelong process where participants returned to their early life in making sense of their experiences. Long term mental ill health appeared to create an environment whereby participants maximised their chances of success by avoiding stress which has a myriad of personally relevant causes. This appeared to be achieved by keeping silent, which, whilst self-protective, nevertheless potentially exacerbated their stress further and resulted in further stressful consequences. In later life the changed sociocultural and personal environment became part of an autobiographical reasoning that sustained self-theory. This created a situation whereby the participants felt better but also worse at the same time, where personal growth co-existed alongside stress burnout but was coupled with a renewed sense of hope in later life. The implications for health and social care are discussed in relation to policy, practice, research and education in the context of age equality, recovery and long term conditions. Recommendations include: to focus on extensive durations of mental ill health as a special characteristic, to review the of use stress assessments and trauma histories in practice and research, for practitioners to establish the hopes and aspirations of older people who come into contact with services and for researchers to examine the presence of hope in older people with long term mental health problems